Impact of Quantitative Assessment of Parkinson's Disease-Associated Symptoms Using Wearable Technology on Treatment Decisions.

We read with interest the report by Santiago et al. [1], demonstrating that clinician decision making regarding the management of motor symptoms of Parkinson’s disease (PD) can be enhanced by home-based, continuous objective measurement. Within the UK National Health Service, we have also been using the Parkinson’s Kinetigraph (PKG) since 2015. Similar to the Santiago cohort, in routine care, physicians target PKG use in patients they believe continuous objective measurement will improve the value of clinical encounters. With support from Parkinson’s UK, we have carried out an evaluation of utility across seven centers from the Parkinson’s Excellence Network, comprising a mix of local services and regional specialist neuroscience centers led by consultant neurologists, geriatricians or Parkinson’s nurse specialists

Management of secondary poor response to botulinum toxin in cervical dystonia: a multicentre audit

Background: Botulinum toxin A (BoNT‐A) is an effective treatment for cervical dystonia. Nevertheless, up to 30‐40% patients discontinue treatment, often due to poor response. The British Neurotoxin Network (BNN) recently published guidelines on the management of poor response to BoNT‐A in cervical dystonia, but adherence to these has not yet been assessed. Objectives: To assess adherence to and usefulness of BNN guidelines in clinical practice. Methods: We undertook a retrospective medical notes audit of adherence to the BNN guidelines in three U.K. tertiary neurosciences centres. Results: Out of 76 patients identified with poor response, 42 (55%) had a suboptimal response and, following BNN recommendations, 25 of them (60%) responded to adjustments in BoNT dose, muscle selection or injection technique. Of the remaining 34 (45%) patients with no BoNT response, 20 (59%) were tested for immune resistance, 8 [40%] of whom showed resistance. 14 (18%) of all patients were switched to BoNT‐B, and 27 (36%) were referred for deep brain stimulation surgery. In those not immune to BoNT‐A, clinical improvement was seen in 5 (41%) after adjusting their dose and injection technique. Conclusion: Our audit shows that optimizing BoNT dose or injection strategy largely led to improvements in those with suboptimal response and in those reporting no response without resistance. It would be helpful to standardize investigations of potential resistance in those with no therapeutic response

The perception of affective touch in Parkinson's disease and its relation to small fibre neuropathy.

Affective touch sensation is conducted by a sub-class of C-fibres in hairy skin known as C-Tactile (CT) afferents. CT afferents respond maximally to gentle skin stroking at velocities between 1-10 cm/sec. Parkinson's disease (PD) is characterised by markedly reduced cutaneous C-fibres. It is not known if affective touch perception is influenced by C fibre density and if affective touch is impaired in PD compared to healthy controls. We predicted that perceived pleasantness to gentle stroking in PD would correlate with C afferent density and that affective touch perception would be impaired in PD compared to healthy controls. Twenty-four PD patients and 27 control subjects rated the pleasantness of brush stroking at an optimum CT stimulation velocity (3cm/sec) and two sub-optimal velocities (0.3cm/sec & 30cm/sec). PD patients underwent quantification of C-fibre density using skin biopsies and corneal confocal microscopy. All participants rated stroking velocity of 3cm/sec as the most pleasant with significantly lower ratings for 0.3cm/sec and 30cm/sec. There was a significant positive correlation between C-fibre density and pleasantness ratings at 3cm/sec and 30cm/sec but not 0.3cm/sec. Mean pleasantness ratings were consistently higher in PD patients compared to control subjects across all three velocities. This study shows that perceived pleasantness to gentle touch correlate significantly with C-fibre density in PD. The higher perceived pleasantness in PD patients compared to controls suggests central sensitisation to peripheral inputs, which may have been enhanced by dopamine therapy. This article is protected by copyright. All rights reserved

Frequency and outcomes of gastrostomy insertion in a longitudinal cohort study of atypical parkinsonism

\ua9 2024 The Authors. European Journal of Neurology published by John Wiley & Sons Ltd on behalf of European Academy of Neurology.Background: Multiple system atrophy (MSA), progressive supranuclear palsy (PSP) and corticobasal syndrome (CBS) show a high prevalence and rapid progression of dysphagia, which is associated with reduced survival. Despite this, the evidence base for gastrostomy is poor, and the optimal frequency and outcomes of this intervention are not known. We aimed to characterise the prevalence and outcomes of gastrostomy in patients with these three atypical parkinsonian disorders. Method: We analysed data from the natural history and longitudinal cohorts of the PROSPECT-M-UK study with up to 60 months of follow-up from baseline. Survival post-gastrostomy was analysed using Kaplan–Meier survival curves. Results: In a total of 339 patients (mean age at symptom onset 63.3 years, mean symptom duration at baseline 4.6 years), dysphagia was present in >50% across all disease groups at baseline and showed rapid progression during follow-up. Gastrostomy was recorded as recommended in 44 (13%) and performed in 21 (6.2%; MSA 7, PSP 11, CBS 3) of the total study population. Median survival post-gastrostomy was 24 months compared with 12 months where gastrostomy was recommended but not done (p = 0.008). However, this was not significant when correcting for age and duration of symptoms at the time of procedure or recommendation. Conclusions: Gastrostomy was performed relatively infrequently in this cohort despite the high prevalence of dysphagia. Survival post-gastrostomy was longer than previously reported, but further data on other outcomes and clinician and patient perspectives would help to guide use of this intervention in MSA, PSP and CBS

Genome-wide association study of pain in Parkinson's disease implicates TRPM8 as a risk factor

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