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Parkinsonism & Related Disorders Nov 2022Orthostatic tremor is a rare and debilitating movement disorder. Its first-line treatment is pharmacological. For pharmaco-refractory patients, surgical treatment... (Review)
Review
BACKGROUND
Orthostatic tremor is a rare and debilitating movement disorder. Its first-line treatment is pharmacological. For pharmaco-refractory patients, surgical treatment options such as deep brain stimulation (DBS) and spinal cord stimulation (SCS) have been investigated recently.
OBJECTIVES
We conducted a systematic review of all published outcome and safety data on DBS and SCS for orthostatic tremor patients.
METHODS
We searched Pubmed and Embase for studies describing orthostatic tremor patients treated with DBS or SCS. We collected all available outcome and safety data and our primary endpoint was the change in unsupported stance duration 1 year postoperatively (±6 months).
RESULTS
We included 15 studies, reporting on 32 orthostatic tremor patients who underwent DBS, 4 patients SCS and 2 both. The ventral intermediate nucleus and the zona incerta were targeted in 25/34 and 9/34 DBS cases, respectively. The median stance time at 1 year follow-up was 240 s compared to 30 s pre-operatively (p < 0.001). Stimulation-induced side effects occurred in the majority of patients, but were often transient. Bilateral stimulation appeared more effective than unilateral and stimulation settings were comparable to thalamic DBS for essential tremor. There were insufficient data available to draw meaningful conclusions on the long-term effects of DBS. Due to insufficient data, no conclusions could be drawn on the effects of SCS on orthostatic tremor.
CONCLUSION
DBS may be effective to increase stance time in orthostatic tremor patients in the first year, but further research is necessary to evaluate the long-term effects and the role of spinal cord stimulation.
Topics: Humans; Tremor; Deep Brain Stimulation; Spinal Cord Stimulation; Zona Incerta; Essential Tremor; Treatment Outcome
PubMed: 36243552
DOI: 10.1016/j.parkreldis.2022.10.001 -
Multiple Sclerosis and Related Disorders Nov 2021This systematic review and meta-analysis aims to evaluate efficacy of deep brain stimulation (DBS) in treating MS-related tremor. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
This systematic review and meta-analysis aims to evaluate efficacy of deep brain stimulation (DBS) in treating MS-related tremor.
METHODS
We systematically searched PubMed, Web of Science, Embase, Scopus, Google Scholar, and gray literature using a search strategy including the MeSH and text words as (((Brain Stimulations) OR (Deep Brain Stimulations) OR (Deep Brain Stimulations) OR (Deep Brain Brain Stimulation) OR (Deep Electrical Stimulation of the Brain)) AND (Multiple Sclerosis OR Sclerosis, Multiple) OR Sclerosis, Disseminated) OR Disseminated Sclerosis) OR MS (Multiple Sclerosis)) OR Multiple Sclerosis, Acute Fulminating).
RESULTS
The literature search revealed 1663 articles, 1027 of which remained after removing duplicates. Seventeen articles, published between 1999-2018, were included for the meta-analysis, including overall 168 patients. Follow-up time ranged between 6-62 months. The pooled frequency of tremor improvement among the enrolled patients was 73%, (95% CI:64-83%) (I=84.1%, p<0.001). The pooled standardized mean difference (SMD) (after -before) was -2.9, (95% CI:-4.8, -0.98) (I=89.8%, p<0.001).
CONCLUSION
The results of this systematic review and meta-analysis demonstrate MS-related tremor improvement after DBS.
Topics: Deep Brain Stimulation; Humans; Multiple Sclerosis; Tremor
PubMed: 34517191
DOI: 10.1016/j.msard.2021.103256 -
Journal of Neuroimmunology Dec 2023Huntington's disease (HD) is an autosomal dominant disease caused by an abnormally high number of CAG repeats at the huntingtin-encoding gene, HTT. This genetic... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Huntington's disease (HD) is an autosomal dominant disease caused by an abnormally high number of CAG repeats at the huntingtin-encoding gene, HTT. This genetic alteration results in the expression of a mutant form of the protein (mHTT) and the formation of intracellular aggregates, inducing an inflammatory state within the affected areas. This dysfunction of inflammatory response leads to elevated levels of related inflammatory markers in both CNS tissue samples and body fluids. This study aims to investigate peripheral/blood concentrations of inflammatory molecules in HD.
METHODS
A search was conducted in MEDLINE, Scopus, Web of Science, and Embase databases until March 30th, 2023. Random-effect meta-analysis was used for exploring concentrations of inflammatory molecules in HD. Subgroup and sensitivity analyses were used to assess heterogeneity among the included studies. The study protocol has been registered in PROSPERO with the ID number CRD42022296078.
RESULTS
Ten studies were included in the meta-analysis. Plasma levels of Interleukin 6 (IL-6) and IL-10 were higher in HD compared to controls. Other biomarkers, namely, complement component C-reactive protein (CRP), C3, interferon-γ (IFN-γ), IL-1, IL-2, IL-8, and tumor necrosis factor-α (TNF-α), did not show any significant differences between the two groups. In addition, the subgroup analysis results established no significant differences in levels of these biomarkers in body fluids among premanifest and manifest HD patients.
CONCLUSION
The results of this study provide evidence for the presence of higher plasma levels of IL-6 and IL-10 in HD patients in comparison with healthy controls.
Topics: Humans; Huntington Disease; Interleukin-6; Interleukin-10; Biomarkers; Tumor Necrosis Factor-alpha; Huntingtin Protein
PubMed: 37984118
DOI: 10.1016/j.jneuroim.2023.578243 -
The Journal of Clinical Psychiatry Nov 2012Tardive dyskinesia and dystonia (TDD) are severe side effects of dopamine-blocking agents, particularly antipsychotics. While deep brain stimulation (DBS) has proven... (Review)
Review
BACKGROUND
Tardive dyskinesia and dystonia (TDD) are severe side effects of dopamine-blocking agents, particularly antipsychotics. While deep brain stimulation (DBS) has proven effective in the treatment of TDD, little is known about the possible psychiatric complications of DBS in psychiatric patients.
OBJECTIVE
To assess the efficacy and safety, specifically the psychiatric side effects, of DBS in patients with medication-induced TDD.
DATA SOURCES
PubMed and EMBASE databases were searched systematically on May 25, 2011, for articles written in English, using the search terms deep brain stimulation AND tardive.
STUDY SELECTION
Of the 88 original articles retrieved, 17 studies involving 50 patients with TDD who underwent DBS were included in the review.
DATA EXTRACTION
Data on the severity of the movement disorders before and after DBS, as rated on the Burke-Fahn-Marsden Dystonia Rating Scale or similar scales, were extracted. Data on psychiatric symptoms before and after DBS were used to calculate the percent improvement per patient per rating scale. Overall improvement and confidence intervals were calculated using a 1-sample, 2-sided Student t test.
RESULTS
The mean improvement of TDD of the combined patients 3 to 76 months after implantation was 77.5% (95% CI, 71.4%-83.3%; P < .000) on the Burke-Fahn-Marsden Dystonia Rating Scale. Of the 50 patients, 1 experienced an exacerbation of depression, and 1 experienced an exacerbation of psychosis.
CONCLUSIONS
DBS seems to be effective and relatively safe for patients with treatment-resistant TDD; however, the results should be interpreted with caution, as most of the data are from case reports and small trials.
Topics: Antiemetics; Deep Brain Stimulation; Dyskinesia, Drug-Induced; Dystonic Disorders; Globus Pallidus; Humans; Neurologic Examination; Psychiatric Status Rating Scales; Psychotropic Drugs; Treatment Outcome
PubMed: 23218160
DOI: 10.4088/JCP.12r07643 -
Journal of Child and Adolescent... Oct 2007The aim of this study was to assess the 1-year risk of second-generation antipsychotics (SGAs) for tardive dyskinesia (TD) in children and adolescents with assumed... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
The aim of this study was to assess the 1-year risk of second-generation antipsychotics (SGAs) for tardive dyskinesia (TD) in children and adolescents with assumed minimal past exposure to first-generation antipsychotics.
METHOD
We performed a systematic review and exploratory meta-analysis of long-term studies with SGAs, lasting at least 11 months and reporting on new cases of TD in patients less than 18 years old.
RESULTS
In 10 studies, 783 youth (mean age: 9.74 years, 79.2% prepubertal, 81.6% male, 78.4% white) received risperidone (n = 737, mean dose: 1.58 mg/day), quetiapine (n = 27, mean dose: 378.7 mg/day), or olanzapine (n = 19, mean dose: 10.4 mg/day) for a weighted mean of 329.6 days. Diagnoses included disruptive behavior disorders (n = 688, 87.9%), bipolar disorder (n = 52, 6.6%), schizophrenia/schizoaffective disorder (n = 26, 3.3%) and autism spectrum disorders (n = 17, 2.2%). Eight studies were open-label trials, two were retrospective chart reviews, and none included a comparator. Overall, three new cases of TD emerged during long-term treatment with SGAs of up to 3 years, resulting in crude and annualized TD rates of 0.38% (95% confidence interval, CI, 0.079-1.11) and 0.42% (95% CI, 0.087-1.24). The crude and annualized TD rates for risperidone (n = 737) were 0.27% (95% CI, 0.033-0.97) and 0.30% (95% CI, 0.037-1.10), respectively. In the two cases with information, TD resolved within weeks after antipsychotic discontinuation.
CONCLUSIONS
Results across 10 studies suggest relatively low 1-year TD rates in pediatric patients treated with SGAs. However, the available data base is limited by the small sample size of studies with SGAs other than risperidone and by the use of relatively low doses, which may have obscured a potentially greater risk for TD in children and adolescents treated with higher total SGA doses and for longer durations. Large, long-term studies of various SGAs, using state-of-the art methodology, are needed before firm conclusions can be reached about the risk of TD in pediatric patients treated long-term with SGAs.
Topics: Adolescent; Antipsychotic Agents; Child; Data Interpretation, Statistical; Dyskinesia, Drug-Induced; Female; Humans; Male; Psychotic Disorders
PubMed: 17979584
DOI: 10.1089/cap.2006.0117 -
Movement Disorders : Official Journal... Feb 2022Pathogenic variants in 5 genes (GCH1, TH, PTS, SPR, and QDPR), involved in dopamine/tetrahydrobiopterin biosynthesis or recycling, have been linked to Dopa-responsive... (Review)
Review
BACKGROUND
Pathogenic variants in 5 genes (GCH1, TH, PTS, SPR, and QDPR), involved in dopamine/tetrahydrobiopterin biosynthesis or recycling, have been linked to Dopa-responsive dystonia (DRD). Diagnosis and treatment are often delayed due to high between- and within-group variability.
OBJECTIVES
Comprehensively analyzed individual genotype, phenotype, treatment response, and biochemistry information.
METHODS
734 DRD patients and 151 asymptomatic GCH1 mutation carriers were included using an MDSGene systematic literature review and an automated classification approach to distinguish between different forms of monogenic DRDs.
RESULTS
Whereas dystonia, L-Dopa responsiveness, early age at onset, and diurnal fluctuations were identified as red flags, parkinsonism without dystonia was rarely reported (11%) and combined with dystonia in only 18% of patients. While sex was equally distributed in autosomal recessive DRD, there was female predominance in autosomal dominant DYT/PARK-GCH1 patients accompanied by a lower median age at onset and more dystonia in females compared to males. Accordingly, the majority of asymptomatic heterozygous GCH1 mutation carriers (>8 years of age) were males. Multiple other subgroup-specific characteristics were identified, showing high accuracy in the automated classification approach: Seizures and microcephaly were mostly seen in DYT/PARK-PTS, autonomic symptoms appeared commonly in DYT/PARK-TH and DYT/PARK-PTS, and sleep disorders and oculogyric crises in DYT/PARK-SPR. Biochemically, homovanillic acid and 5-hydroxyindoleacetic acid in CSF were reduced in most DRDs, but neopterin and biopterin were increased only in DYT/PARK-PTS and DYT/PARK-SPR. Hyperphenylalaninemia was seen in DYT/PARK-PTS, DYT/PARK-QDPR, and rarely reported in autosomal recessive DYT/PARK-GCH1.
CONCLUSIONS
Our indicators will help to specify diagnosis and accelerate start of treatment. © 2021 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
Topics: Dystonia; Dystonic Disorders; Female; GTP Cyclohydrolase; Genotype; Humans; Male; Phenotype
PubMed: 34908184
DOI: 10.1002/mds.28874 -
Experimental Brain Research Feb 2022Tourette syndrome (TS) is a neurodevelopmental condition characterised by tics, which are stereotyped movements and/or vocalisations. Tics often cause difficulties in... (Review)
Review
Tourette syndrome (TS) is a neurodevelopmental condition characterised by tics, which are stereotyped movements and/or vocalisations. Tics often cause difficulties in daily life and many with TS express a desire to reduce and/or gain control over them. No singular effective treatment exists for TS, and while pharmacological and behavioural interventions can be effective, the results are variable, and issues relating to access, availability and side effects can be barriers to treatment. Consequently, over the past decade, there has been increasing interest into the potential benefits of non-invasive brain stimulation (NIBS) approaches. This systematic review highlights work exploring NIBS as a potential treatment for TS. On balance, the results tentatively suggest that multiple sessions of stimulation applied over the supplementary motor area (SMA) may help to reduce tics. However, a number of methodological and theoretical issues limit the strength of this conclusion, with the most problematic being the lack of large-scale sham-controlled studies. In this review, methodological and theoretical issues are discussed, unanswered questions highlighted and suggestions for future work put forward.
Topics: Humans; Motor Cortex; Tic Disorders; Tics; Tourette Syndrome; Transcranial Magnetic Stimulation
PubMed: 34643763
DOI: 10.1007/s00221-021-06229-y -
International Journal of Geriatric... Jul 2016The advent of second-generation antipsychotics (SGAs) in the 1990s brought optimism that neuroleptic-induced tardive dyskinesia (TD) may become relegated to history.... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
The advent of second-generation antipsychotics (SGAs) in the 1990s brought optimism that neuroleptic-induced tardive dyskinesia (TD) may become relegated to history. Whether or not this is the case remains inconclusive, and this review aims to compare the risk of TD in older adults treated with first-generation antipsychotics (FGAs) versus SGAs.
METHODS
Relevant papers were sourced via a range of electronic databases, with a date range from 1957 to January 2015. Included studies used both a validated rating scale and research diagnostic criteria to report on the prevalence or incidence of TD in older adults exposed to antipsychotic medications.
RESULTS
For FGAs, the prevalence estimate was 53% (95% confidence interval [CI] [39.0, 68.4]) for mild TD and 38% (95% CI [25.9, 50.3]) for probable TD. Incidence estimates for probable TD with FGAs were 23% (95% CI [15.3, 30.6]) at 1 year, 42% (95% CI [24.8, 58.4]) at 2 years and 57% (95% CI [45.3, 69.1]) at 3 years. For SGAs, the incidence estimates at 1 year were 7% (95% CI [4.4, 10.2]) for probable TD and 3% (95% CI [1.5, 4.2]) for persistent TD.
CONCLUSIONS
The risk of probable TD is more than three times lower in older adults receiving SGAs in comparison with FGAs after 1 year of treatment (23% vs 7%). The risk of persistent TD at 1 year with SGAs is particularly low. Evidence is lacking in regard to the longer-term risk of TD with SGAs, although the rates associated with the prolonged use of FGAs are high. Caution is therefore still required, particularly with the protracted use of both FGAs and SGAs.
Topics: Aged; Antipsychotic Agents; Humans; Incidence; Middle Aged; Prevalence; Risk; Tardive Dyskinesia
PubMed: 26679687
DOI: 10.1002/gps.4399 -
Parkinsonism & Related Disorders Aug 2011Tremor is a frequent disabling consequence of many neurological conditions. We performed a search of MEDLINE, CINAHL, EMBASE and the Cochrane Library to identify all... (Review)
Review
Tremor is a frequent disabling consequence of many neurological conditions. We performed a search of MEDLINE, CINAHL, EMBASE and the Cochrane Library to identify all primary research studies published up to November 2010 which investigated non-pharmacological and non-surgical treatments for tremor in humans. Neuromuscular physiotherapy, strength training and functional electrical stimulation show promise in their applicability and adaptability. Limb cooling may not be feasible for continuous management, but may be appropriate for specific tasks. Tremor-suppressing orthoses based on viscous materials, weighted splints and vibration therapies need further evaluation especially in the domiciliary setting and applied to improving personal activities of daily living. The evidence base for many rehabilitation interventions in tremor is poor. Future research should focus on high quality randomized controlled trials of non-pharmacological and non-surgical interventions which show promise.
Topics: Humans; Physical Therapy Modalities; Tremor
PubMed: 21632272
DOI: 10.1016/j.parkreldis.2010.12.016 -
The Journal of Neuropsychiatry and... 2023Apathy is a common behavioral symptom of Huntington disease (HD). This systematic review describes current evidence on the pathophysiology, assessment, and frequency of... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
Apathy is a common behavioral symptom of Huntington disease (HD). This systematic review describes current evidence on the pathophysiology, assessment, and frequency of apathy in HD.
METHODS
This systematic review was conducted in accordance with PRISMA guidelines. Using a comprehensive search strategy, the investigators searched the MEDLINE, Embase, and PsycINFO databases. All studies that evaluated apathy in HD patients with a valid scale and reported apathy frequency or scores were included. Apathy scores were analyzed by mean or standardized mean differences in accordance with Cochrane guidelines.
RESULTS
A total of 1,085 records were screened and 80 studies were ultimately included. The Problem Behaviors Assessment-Short was the most frequently used apathy assessment tool. Apathy frequency generally ranged from 10%-33% in premanifest HD to 24%-76% in manifest HD. A meta-analysis of 5,311 records of patients with premanifest HD showed significantly higher apathy scores, with a standardized mean difference of 0.41 (CI=0.29-0.52; p<0.001). A comparison of 1,247 patients showed significantly higher apathy scores in manifest than premanifest HD, with a mean difference of 1.87 (CI=1.48-2.26; p<0.001). There was evidence of involvement of various cortical and subcortical brain regions in HD patients with apathy.
CONCLUSIONS
Apathy was more frequent among individuals with premanifest HD compared with those in a control group and among individuals with manifest HD compared with those with premanifest HD. Considering the complexity and unique pattern of development in neurodegenerative disease, further studies are required to explore the pathophysiology of apathy in HD.
Topics: Humans; Huntington Disease; Apathy; Neurodegenerative Diseases; Brain; Behavioral Symptoms
PubMed: 36353818
DOI: 10.1176/appi.neuropsych.20220033