Dorsal GPi/GPe Stimulation Induced Dyskinesia in a Patient with Parkinson’s Disease

Clinical vignette: A 68-year-old man with Parkinson’s disease (PD) had bilateral GPi DBS placed for management of his motor fluctuations. He developed stimulation-induced dyskinesia (SID) with left dorsal GPi stimulation. Clinical dilemma: What do we know about SID in PD patients with GPi DBS? What are the potential strategies used to maximize the DBS therapeutic benefit and minimize the side effects of stimulation? Clinical solution: Avoiding the contact implicated in SID and programming more ventral contacts, using lower voltage, frequency and pulse width and programming in bipolar configuration all appear to help minimize the SID and provide appropriate symptomatic motor control. Gap in knowledge: Little is known about SID in patients with PD who had GPi DBS therapy. More studies using volume of tissue activated and diffusion tensor imaging MRI are needed to localize specific tracts in or around the GPi that may be implicated in SID

Real-World Experiences of Parkinson's Disease OFF Time and Role of Demographics

Purpose OFF periods are episodes when Parkinson’s disease (PD) medications work suboptimally, with symptoms returning and impacting quality of life. We aimed to characterize OFF periods using patient-reported frequency, severity, and duration, as well as determine these characteristics’ associations with demographics. Methods A retrospective cohort study using Fox Insight Data Exploration Network (Fox DEN) database was conducted. Eligible patients had PD and were > 18 years. The experience of OFF periods was characterized by frequency (number of episodes/day), duration (duration/episode), and severity (impact on activities). Significance level was Bonferroni-corrected for multivariate analyses. Results From a population of 6,757 persons with PD, 88% were non-Hispanic Whites (mean age: 66 ± 8.8 years); 52.7% were males versus 47.3% females; mean PD duration was 5.7 ± 5.2; and 51% experienced OFF periods. Subsequent analyses were limited to non-Hispanic Whites, as they constituted a large majority of the participants and were the subgroup that had the sample size to derive reliable inferences. The analyses showed that 67% experienced 1–2 episodes/day, 90% experienced > 15-minute episodes, and 55% reported slight–mild severity/episode. Lower age was associated with a higher frequency (incidence rate ratio [IRR]: 0.992; P < 0.001) and severity (odds ratio [OR]: 0.985; P = 0.001) of OFF episodes. Income of < $35,000 was associated with 15.1 Conclusions Lower age, income <$35,000, longer PD duration, female gender, and being unemployed are associated with a higher frequency and severity of OFF periods with no associations for duration/episode among non-Hispanic Whites with PD. In time-constrained clinic environments, clinicians should tailor OFF periods management counseling to vulnerable demographic groups to enhance care delivery.(J Patient Cent Res Rev. 2024;11:8-17.

Alliance stratégique et apprentissage : Collectif des entreprises d’insertion du Québec et Comité économie sociale inter-CDÉC

En économie sociale et solidaire, les relations de coopération interentreprises sont généralement abordées en termes de concertation ou de partenariat et non pas sous l’angle des alliances stratégiques. Pourtant la définition de l’alliance correspond bien aux valeurs de l’économie sociale et solidaire puisque les entreprises qui s’engagent dans une alliance, en vue de réaliser des objectifs communs, ne renoncent pas à leur autonomie. Dans cet article1, on cherche à identifier l’impact de la formation d’alliances stratégiques entre organisations de l’économie sociale et solidaire de même nature, à trois niveaux d’apprentissage : le fonctionnement interne, les interactions entre elles et leurs rapports avec les pouvoirs publics. La recherche empirique a porté sur l’étude de deux cas : le Collectif des entreprises d’insertion du Québec (CEIQ) et le Comité économie sociale inter-CDÉC (Corporations de développement économique communautaire).In solidarity and social economy, the cooperative relationships between enterprises generally are approached in terms of concertation or partnership rather than strategic alliances. Nevertheless the definition of the alliance fits well with the values of solidarity and social economy since the enterprises that engage themselves in an alliance to realize common objectives do not forfeit their autonomy. In this article, the authors try to identify the impact of the formation of strategic alliances between similar solidarity and social economy organizations at three levels of learning: their internal functioning, the interactions among them and their relationships with the authorities. The empirical research focused on the study of two cases : the Collectif des entreprises d’insertion du Québec (CEIQ) and the Comité économie sociale inter-CDÉC (Community economic development corporations)

Group therapeutic singing improves clinical motor scores in persons with Parkinson's disease

Background: Previous reports suggest that group therapeutic singing (GTS) may have a positive effect on motor symptoms in persons with Parkinson's disease (PD). Objective: To determine the effect of a single session of GTS on clinical motor symptoms. Methods: Clinical motor symptom assessment was completed immediately before and after 1 hour of GTS in 18 participants. Results: A significant decrease in average scores for gait and posture and tremor, but not speech and facial expression or bradykinesia was revealed. Conclusion: These results support the notion that GTS is a beneficial adjuvant therapy for persons with PD that warrants further research.This article is published as Stegemoller E, Forsyth E, Patel B, Elkouzi A. Group therapeutic singing improves clinical motor scores in persons with Parkinson's disease. BMJ Neurol Open. 2022 Aug 3;4(2):e000286. doi: 10.1136/bmjno-2022-000286. Posted with permission. Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permission