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Parkinson Disease: HELP
Articles by Ramone L. Rodriguez
Based on 33 articles published since 2010
(Why 33 articles?)
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Between 2010 and 2020, R. Rodriguez wrote the following 33 articles about Parkinson Disease.
 
+ Citations + Abstracts
Pages: 1 · 2
1 Clinical Trial Long-term safety and efficacy of levodopa-carbidopa intestinal gel in advanced Parkinson's disease. 2018

Fernandez, Hubert H / Boyd, James T / Fung, Victor S C / Lew, Mark F / Rodriguez, Ramon L / Slevin, John T / Standaert, David G / Zadikoff, Cindy / Vanagunas, Arvydas D / Chatamra, Krai / Eaton, Susan / Facheris, Maurizio F / Hall, Coleen / Robieson, Weining Z / Benesh, Janet / Espay, Alberto J. ·Center for Neurological Restoration, Cleveland Clinic, Cleveland, Ohio, USA. · University of Vermont Larner College of Medicine, Burlington, Vermont, USA. · Westmead Hospital and Sydney Medical School, Sydney, Australia. · Keck/University of Southern California School of Medicine, Los Angeles, California, USA. · University of Florida College of Medicine, Gainesville, Florida, USA, and Orlando Veterans Affairs Medical Center, Orlando, Florida, USA. · University of Kentucky Medical Center, Lexington, Kentucky, USA. · University of Alabama at Birmingham, Birmingham, Alabama, USA. · Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA. · AbbVie Inc., North Chicago, Illinois, USA. · University of Cincinnati Academic Health Center, Cincinnati, Ohio, USA. ·Mov Disord · Pubmed #29570853.

ABSTRACT: BACKGROUND: Levodopa-carbidopa intestinal gel (designated as carbidopa-levodopa enteral suspension in the United States) provides stable plasma levodopa concentrations and reduces motor fluctuations in advanced Parkinson's disease patients through continuous delivery of levodopa via percutaneous endoscopic gastrojejunostomy. We report long-term safety and efficacy outcomes from an open-label phase 3 treatment program. METHODS: PD patients (n = 262) who completed a 12-week double-blind study and its 52-week open-label extension or a separate 54-week open-label study were enrolled in this ongoing phase 3 open-label, multinational study (NCT00660673). Safety and efficacy assessments were collected every 6 months. RESULTS: Mean total duration of exposure to levodopa-carbidopa intestinal gel was 4.1 years (range, 1.2 to 6.9 years). The overall discontinuation rate was 34% (average annual discontinuation rate, 10%). Although most patients (94%) reported an adverse event, the rate of adverse events decreased over time; 53% experienced a serious adverse event. Of patients in this extension study, 54% required jejunal tube replacement during the study, and 37% required percutaneous endoscopic gastrostomy tube replacement. Most patients were on levodopa monotherapy. Patients maintained reductions in "off" time and increases in mean "on" time without dyskinesia from initial levodopa-carbidopa intestinal gel infusion to he study end point (P < 0.001; n = 81). Activities of daily living and quality-of-life assessments demonstrated significant improvements that persisted through the study. CONCLUSIONS: This long-term study demonstrates sustained and clinically meaningful benefits from levodopa-carbidopa intestinal gel in advanced PD patients. Although adverse event rates decreased over time, vigilance is required for device-related complications and adverse events. © 2018 The Authors. Movement Disorders published by Wiley Periodicals, Inc. on behalf of International Parkinson and Movement Disorder Society.

2 Clinical Trial A randomized clinical trial of high-dosage coenzyme Q10 in early Parkinson disease: no evidence of benefit. 2014

Anonymous1120789 / Beal, M Flint / Oakes, David / Shoulson, Ira / Henchcliffe, Claire / Galpern, Wendy R / Haas, Richard / Juncos, Jorge L / Nutt, John G / Voss, Tiffini Smith / Ravina, Bernard / Shults, Clifford M / Helles, Karen / Snively, Victoria / Lew, Mark F / Griebner, Brian / Watts, Arthur / Gao, Shan / Pourcher, Emmanuelle / Bond, Louisette / Kompoliti, Katie / Agarwal, Pinky / Sia, Cherissa / Jog, Mandar / Cole, Linda / Sultana, Munira / Kurlan, Roger / Richard, Irene / Deeley, Cheryl / Waters, Cheryl H / Figueroa, Angel / Arkun, Ani / Brodsky, Matthew / Ondo, William G / Hunter, Christine B / Jimenez-Shahed, Joohi / Palao, Alicia / Miyasaki, Janis M / So, Julie / Tetrud, James / Reys, Liza / Smith, Katharine / Singer, Carlos / Blenke, Anita / Russell, David S / Cotto, Candace / Friedman, Joseph H / Lannon, Margaret / Zhang, Lin / Drasby, Edward / Kumar, Rajeev / Subramanian, Thyagarajan / Ford, Donna Stuppy / Grimes, David A / Cote, Diane / Conway, Jennifer / Siderowf, Andrew D / Evatt, Marian Leslie / Sommerfeld, Barbara / Lieberman, Abraham N / Okun, Michael S / Rodriguez, Ramon L / Merritt, Stacy / Swartz, Camille Louise / Martin, W R Wayne / King, Pamela / Stover, Natividad / Guthrie, Stephanie / Watts, Ray L / Ahmed, Anwar / Fernandez, Hubert H / Winters, Adrienna / Mari, Zoltan / Dawson, Ted M / Dunlop, Becky / Feigin, Andrew S / Shannon, Barbara / Nirenberg, Melissa Jill / Ogg, Mattson / Ellias, Samuel A / Thomas, Cathi-Ann / Frei, Karen / Bodis-Wollner, Ivan / Glazman, Sofya / Mayer, Thomas / Hauser, Robert A / Pahwa, Rajesh / Langhammer, April / Ranawaya, Ranjit / Derwent, Lorelei / Sethi, Kapil D / Farrow, Buff / Prakash, Rajan / Litvan, Irene / Robinson, Annette / Sahay, Alok / Gartner, Maureen / Hinson, Vanessa K / Markind, Samuel / Pelikan, Melisa / Perlmutter, Joel S / Hartlein, Johanna / Molho, Eric / Evans, Sharon / Adler, Charles H / Duffy, Amy / Lind, Marlene / Elmer, Lawrence / Davis, Kathy / Spears, Julia / Wilson, Stephanie / Leehey, Maureen A / Hermanowicz, Neal / Niswonger, Shari / Shill, Holly A / Obradov, Sanja / Rajput, Alex / Cowper, Marilyn / Lessig, Stephanie / Song, David / Fontaine, Deborah / Zadikoff, Cindy / Williams, Karen / Blindauer, Karen A / Bergholte, Jo / Propsom, Clara Schindler / Stacy, Mark A / Field, Joanne / Mihaila, Dragos / Chilton, Mark / Uc, Ergun Y / Sieren, Jeri / Simon, David K / Kraics, Lauren / Silver, Althea / Boyd, James T / Hamill, Robert W / Ingvoldstad, Christopher / Young, Jennifer / Thomas, Karen / Kostyk, Sandra K / Wojcieszek, Joanne / Pfeiffer, Ronald F / Panisset, Michel / Beland, Monica / Reich, Stephen G / Cines, Michelle / Zappala, Nancy / Rivest, Jean / Zweig, Richard / Lumina, L Pepper / Hilliard, Colette Lynn / Grill, Stephen / Kellermann, Marye / Tuite, Paul / Rolandelli, Susan / Kang, Un Jung / Young, Joan / Rao, Jayaraman / Cook, Maureen M / Severt, Lawrence / Boyar, Karyn. ·Department of Neurology, Weill Cornell Medical College, New York Hospital, New York. · Department of Biostatistics, University of Rochester Medical Center, Rochester, New York. · Department of Neurology, Georgetown University, Washington, DC. · National Institutes of Health, Bethesda, Maryland. · Department of Neurosciences, University of California, San Diego, La Jolla. · Department of Neurology, Emory University School of Medicine, Wesley Woods Center, Atlanta, Georgia. · Department of Neurology, Oregon Health and Science University, Portland. · Merck, New Jersey. · Biogen Idec, Cambridge, Massachusetts. · Department of Neurosciences, University of California, San Diego, La Jolla10VA Medical Center, San Diego, California. · Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles. · Department of Biostatistics, University of Rochester Medical Center, Rochester, New York12Department of Neurology, University of Rochester, Rochester, New York. · Québec Memory and Motor Skills Disorders Research Center, Clinique Sainte-Anne, Québec, Canada. · Rush University Medical Center, Chicago, Illinois. · Booth Gardner Parkinson's Care Center, EvergreenHealth, Kirkland, Washington. · London Health Sciences Centre, London, Ontario, Canada. · Overlook Medical Center, Atlantic Neuroscience Institute, Summit, New Jersey. · Department of Neurology, University of Rochester, Rochester, New York. · Columbia University Medical Center, Neurological Institute, New York, New York. · Department of Neurology, University of Texas Health Science Center at Houston. · Department of Neurology, Baylor College of Medicine, Houston, Texas. · Morton and Gloria Shulman Movement Disorders Centre, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada. · The Parkinson's Institute and Clinical Center, Sunnyvale, California. · Department of Neurology, University of Miami School of Medicine, Miami, Florida. · Institute for Neurodegenerative Disorders, New Haven, Connecticut. · Department of Neurology, Butler Hospital, Providence, Rhode Island26Alpert Medical School, Brown University, Providence, Rhode Island. · Department of Neurology, Butler Hospital, Providence, Rhode Island27Port City Neurology, Inc, Scarborough, Maine. · Department of Neurology, University of California, Davis, School of Medicine and Sacramento VA Medical Center, Sacramento. · Port City Neurology, Inc, Scarborough, Maine. · Colorado Neurological Institute, Englewood. · Milton S. Hershey Medical Center, Department of Neurology, Pennsylvania State Hershey College of Medicine, Hershey. · Ottawa Hospital Civic Site, Ottawa, Ontario, Canada. · Avid Radiopharmaceuticals, Philadelphia, Pennsylvania. · Department of Neurology, Emory University School of Medicine, Wesley Woods Center, Atlanta, Georgia33Atlanta VA Medical Center, Atlanta, Georgia. · Muhammad Ali Parkinson Center, Barrow Neurological Institute, St Joseph's Hospital and Medical Center, Phoenix, Arizona. · Department of Neurology, University of Florida Center for Movement Disorders and Neurorestoration, Gainesville. · Glenrose Rehabilitation Hospital, University of Alberta, Edmonton, Alberta, Canada. · Department of Neurology, University of Alabama at Birmingham. · Center for Neurological Restoration, Department of Neurology, Cleveland Clinic, Cleveland, Ohio. · Department of Neurology, Johns Hopkins University, Baltimore, Maryland. · Feinstein Institute for Medical Research, Center for Neurosciences, Manhasset, New York. · Department of Neurology, New York University Langone Medical Center, New York. · Department of Neurology, Boston University School of Medicine, Boston, Massachusetts. · The Parkinson's and Movement Disorder Institute, Fountain Valley, California. · State University of New York, Downstate Medical Center, Brooklyn, New York. · Department of Neurology, University of South Florida, Tampa. · Department of Neurology, University of Kansas Medical Center, Kansas City. · Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada. · Department of Neurology, Georgia Health Science University, Augusta. · Department of Neurology, University of Louisville, Kentucky. · University of Cincinnati College of Medicine, Cincinnati, Ohio. · Department of Neurology, Medical University of South Carolina, Charleston. · Associated Neurologists, PC, Danbury, Connecticut. · Department of Neurology, Washington University in St Louis, Missouri. · Movement Disorders Center, Albany Medical Center, Albany, New York. · Parkinson's Disease and Movement Disorders Center, Department of Neurology, Mayo Clinic, Scottsdale, Arizona. · Center for Neurological Health, University of Toledo, Toledo, Ohio. · Department of Neurology, Medical University of Ohio at Toledo. · Department of Neurology, University of Colorado Health Science Center, Denver. · Department of Neurology, University of California, Irvine Medical Center, Irvine. · Banner Sun Health Research Institute, Sun City, Arizona. · Department of Neurology, University of Saskatchewan, Royal University Hospital, Saskatchewan, Canada. · Department of Neurology, University of California, San Diego, La Jolla. · Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois. · Department of Neurology, Medical College of Wisconsin, Milwaukee. · Department of Neurology, Duke University, Durham, North Carolina. · State University of New York Upstate Medical Center and Syracuse VA Medical Center, Syracuse. · Department of Neurology, University of Iowa, Iowa City. · Department of Neurology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts. · Department of Neurology, University of Vermont College of Medicine, Burlington. · Department of Neurology, Ohio State University, Columbus. · Department of Neurology, Indiana University School of Medicine, Indianapolis. · Department of Neurology, University of Tennessee Health Science Center, Memphis. · Department of Neurology, CHUM-Hôpital Notre-Dame, Montréal, Québec, Canada. · Department of Neurology, University of Maryland School of Science, Baltimore. · Department of Neurology, University of Sherbrooke, Québec, Canada. · Department of Neurology, Louisiana State University Health Science Center, Shreveport. · Lewis Hall Singletary Oncology Center, Thomasville, Georgia. · Parkinson and Movement Disorders Center of Maryland, Elkridge. · Department of Neurology, University of Minnesota, Minneapolis. · Department of Neurology, University of Chicago, Chicago, Illinois. · Department of Neurology, Ochsner Clinic Foundation, New Orleans, Louisiana. · Department of Neurology, Beth Israel Medical Center, New York, New York. ·JAMA Neurol · Pubmed #24664227.

ABSTRACT: IMPORTANCE: Coenzyme Q10 (CoQ10), an antioxidant that supports mitochondrial function, has been shown in preclinical Parkinson disease (PD) models to reduce the loss of dopamine neurons, and was safe and well tolerated in early-phase human studies. A previous phase II study suggested possible clinical benefit. OBJECTIVE: To examine whether CoQ10 could slow disease progression in early PD. DESIGN, SETTING, AND PARTICIPANTS: A phase III randomized, placebo-controlled, double-blind clinical trial at 67 North American sites consisting of participants 30 years of age or older who received a diagnosis of PD within 5 years and who had the following inclusion criteria: the presence of a rest tremor, bradykinesia, and rigidity; a modified Hoehn and Yahr stage of 2.5 or less; and no anticipated need for dopaminergic therapy within 3 months. Exclusion criteria included the use of any PD medication within 60 days, the use of any symptomatic PD medication for more than 90 days, atypical or drug-induced parkinsonism, a Unified Parkinson's Disease Rating Scale (UPDRS) rest tremor score of 3 or greater for any limb, a Mini-Mental State Examination score of 25 or less, a history of stroke, the use of certain supplements, and substantial recent exposure to CoQ10. Of 696 participants screened, 78 were found to be ineligible, and 18 declined participation. INTERVENTIONS: The remaining 600 participants were randomly assigned to receive placebo, 1200 mg/d of CoQ10, or 2400 mg/d of CoQ10; all participants received 1200 IU/d of vitamin E. MAIN OUTCOMES AND MEASURES: Participants were observed for 16 months or until a disability requiring dopaminergic treatment. The prospectively defined primary outcome measure was the change in total UPDRS score (Parts I-III) from baseline to final visit. The study was powered to detect a 3-point difference between an active treatment and placebo. RESULTS: The baseline characteristics of the participants were well balanced, the mean age was 62.5 years, 66% of participants were male, and the mean baseline total UPDRS score was 22.7. A total of 267 participants required treatment (94 received placebo, 87 received 1200 mg/d of CoQ10, and 86 received 2400 mg/d of CoQ10), and 65 participants (29 who received placebo, 19 who received 1200 mg/d of CoQ10, and 17 who received 2400 mg/d of CoQ10) withdrew prematurely. Treatments were well tolerated with no safety concerns. The study was terminated after a prespecified futility criterion was reached. At study termination, both active treatment groups showed slight adverse trends relative to placebo. Adjusted mean changes (worsening) in total UPDRS scores from baseline to final visit were 6.9 points (placebo), 7.5 points (1200 mg/d of CoQ10; P = .49 relative to placebo), and 8.0 points (2400 mg/d of CoQ10; P = .21 relative to placebo). CONCLUSIONS AND RELEVANCE: Coenzyme Q10 was safe and well tolerated in this population, but showed no evidence of clinical benefit. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00740714.

3 Clinical Trial Selection of deep brain stimulation candidates in private neurology practices: referral may be simpler than a computerized triage system. 2012

Oyama, Genko / Rodriguez, Ramon L / Jones, Jacob D / Swartz, Camille / Merritt, Stacy / Unger, Richard / Hubmann, Monica / Delgado, Alain / Simon, Ely / Doniger, Glen M / Bowers, Dawn / Foote, Kelly D / Fernandez, Hubert H / Okun, Michael S. ·Department of Neurology, University of Florida, Center for Movement Disorders and Neurorestoration, McKnight Brain Institute, Gainesville, FL 32610, USA. ·Neuromodulation · Pubmed #22376158.

ABSTRACT: OBJECTIVE: The objective of this study is to compare a computerized deep brain stimulation (DBS) screening module (Comparing Private Practice vs. Academic Centers in Selection of DBS Candidates [COMPRESS], NeuroTrax Corp., Bellaire, TX, USA) with traditional triage by a movement disorders specialized neurologist as the gold standard. METHODS: The COMPRESS consists of a combination of the Florida Surgical Questionnaire for Parkinson disease (FLASQ-PD), a cognitive assessment battery provided by MindStreams® (NeuroTrax Corp.), and the Geriatric Depression Scale and the Zung Anxiety Self-Assessment Scale. COMPRESS resulted in the classification of patients into three categories: "optimal candidate,""probable candidate," and "not a good candidate." Similar categorical ratings made by a referring private practice neurologist and by a trained movement disorders specialist were compared with the ratings generated by COMPRESS. RESULTS: A total of 19 subjects with Parkinson's disease were enrolled from five private neurological practices. The clinical impressions of the private practice neurologist vs. those of the movement disorders specialist were in agreement approximately half the time (10/19 cases). The movement disorders specialist and COMPRESS agreed on 15/19 cases. A further comparison between outcomes from the entire COMPRESS module and the FLASQ-PD questionnaire by itself resulted in high agreement (18/19 cases in agreement). CONCLUSIONS: The COMPRESS agreed with an in-person evaluation by a movement disorders neurologist approximately 80% of the time. The computerized COMPRESS did not provide any screening advantage over the short FLASQ-PD paper questionnaire. Larger studies will be needed to assess the utility and cost effectiveness of this computerized triage method for DBS.

4 Clinical Trial A closer look at unilateral versus bilateral deep brain stimulation: results of the National Institutes of Health COMPARE cohort. 2010

Taba, Houtan A / Wu, Samuel S / Foote, Kelly D / Hass, Chris J / Fernandez, Hubert H / Malaty, Irene A / Rodriguez, Ramon L / Dai, Yunfeng / Zeilman, Pamela R / Jacobson, Charles E / Okun, Michael S. ·Department of Neurology, University of Forlida Movement Disorders Center, College of Medicine, University of Florida, Gainesville, FL 32611, USA. ·J Neurosurg · Pubmed #20849215.

ABSTRACT: OBJECT: In this paper, the authors' aim was to examine reasons underpinning decisions to undergo, or alternatively forgo, a second-sided deep brain stimulation (DBS) implantation in patients with Parkinson disease (PD). METHODS: Fifty-two patients with Parkinson disease (PD) were randomized to receive DBS to the subthalamic nucleus or globus pallidus internus (GPi) as part of the COMPARE trial. Forty-four patients had complete data sets. All patients were offered a choice at 6 months after unilateral implantation whether to receive a contralateral DBS implant. All patients had advanced PD. The mean patient age was 59.8 years (range 43-76 years), and the mean duration of disease was 12.2 years (range 5-21 years). The mean baseline Unified Parkinson's Disease Rating Scale (UPDRS)-III motor score was 42.7. The main outcome measures used in this study were the UPDRS-III Motor Scale and the UPDRS-IV Dyskinesia Scale. RESULTS: Twenty-one (48%) of the 44 patients in the cohort did not undergo bilateral implantation and have been successfully treated for an average of 3.5 years; of these, 14 (67%) had a GPi target. The most common reason for adding a second side was inadequacy to address motor symptoms. Patient satisfaction with motor outcomes after unilateral DBS implantation was the most common reason for not undergoing bilateral implantation. Those who chose a second DBS procedure had significantly higher baseline UPDRS-III motor and ipsilateral UPDRS-III scores, and a significantly lower asymmetrical index. The logistic regression analysis revealed that the odds of proceeding to bilateral DBS was 5.2 times higher for STN than for GPi DBS. For every 1% increase in asymmetry, the odds of bilateral DBS decreased [corrected] by 0.96. CONCLUSIONS: Unilateral DBS is an effective treatment for a subset of patients with PD. Baseline asymmetry is an important factor in the effectiveness and decision-making process between unilateral and bilateral DBS. Patients with GPi DBS in this cohort were more likely to choose to remain with unilateral implantation.

5 Article Effect of Levodopa-carbidopa Intestinal Gel on Non-motor Symptoms in Patients with Advanced Parkinson's Disease. 2017

Standaert, David G / Rodriguez, Ramon L / Slevin, John T / Lobatz, Michael / Eaton, Susan / Chatamra, Krai / Facheris, Maurizio F / Hall, Coleen / Sail, Kavita / Jalundhwala, Yash J / Benesh, Janet. ·University of Alabama at BirminghamBirminghamAlabamaUSA. · University of Central FloridaOrlandoFLUSA. · University of Kentucky Medical CenterLexingtonKYUSA. · Neurology Center of Southern CaliforniaCAUSA. · AbbVie Inc.North ChicagoILUSA. ·Mov Disord Clin Pract · Pubmed #29242809.

ABSTRACT: Background: Levodopa-carbidopa intestinal gel (LCIG; carbidopa-levodopa enteral suspension in the United States), delivered via percutaneous gastrojejunostomy (PEG-J) and titrated in the inpatient setting, is an established treatment option for advanced Parkinson's disease (PD) patients with motor fluctuations. However, long-term prospective data on the efficacy of LCIG on non-motor symptoms and the safety of outpatient titration are limited. Methods: In this 60-week, open-label phase 3b study, LCIG titration was initiated in an outpatient setting following PEG-J placement in PD patients. The efficacy of LCIG on motor and non-motor symptoms, quality of life, and safety was assessed. Results: Thirty-nine patients were enrolled in the study and 28 patients completed the treatment. A majority of patients (54%) completed outpatient titration within the first week of LCIG infusion. LCIG led to significant reductions from baseline in Non-Motor Symptom Scale (NMSS) total score (least squares mean ± SE = -17.6 ± 3.6, Conclusions: LCIG treatment led to reductions in non-motor symptom burden and motor fluctuations in advanced PD patients. The safety profile was consistent with previous studies that used inpatient titration and outpatient titration did not appear to pose additional risk.

6 Article Occurrence of Dysphagia Following Botulinum Toxin Injection in Parkinsonism-related Cervical Dystonia: A Retrospective Study. 2016

Patterson, Addie / Almeida, Leonardo / Hess, Christopher W / Martinez-Ramirez, Daniel / Okun, Michael S / Rodriguez, Ramon L / Rundle-Gonzalez, Valerie / Wagle Shukla, Aparna / Malaty, Irene A. ·University of Florida, Gainesville, FL, USA. ·Tremor Other Hyperkinet Mov (N Y) · Pubmed #27830106.

ABSTRACT: BACKGROUND: The aim was to compare the occurrence of post-injection dysphagia in parkinsonism-related cervical dystonia (PRCD) versus cervical dystonia (CD) of other etiologies (non-PRCD). A secondary objective was to explore potential clinical differences between PRCD and non-PRCD and their respective responses to botulinum toxin (BoNT). METHODS: A cross-sectional chart review was carried out of patients treated for CD with Onabotulinumtoxin A at the University of Florida. We collected demographic information, dose of BoNT injected, patient-reported presence of dysphagia as a side effect, patient-perceived duration of benefit and efficacy according to the Clinical Global Impression Scale (CGIS). RESULTS: Of the 144 patients included, 24 patients were diagnosed with PRCD and 120 were diagnosed as non-PRCD. Data analysis showed no significant differences in number of weeks of benefit from BoNT (PRCD 9.1±3.7 versus non-PRCD 9.4±3.7 weeks, p = 0.830), BoNT dosage (PRCD 235.0±95.6 versus non-PRCD 263.7±101.3 units, p = 0.181), median CGIS score (median = 2 or "much improved" for both groups, p = 0.88), or the presence of dysphagia after BoNT (PRCD 17% versus non-PRCD 19 %, p = 0.753, n = 132). In a subgroup analysis of the non-PRCD group, patients who experienced dysphagia were older than those who did not (63.9±8.9 years versus 58.1±14.4 years, p = 0.02). DISCUSSION: Despite an increased baseline risk of dysphagia in patients with PRCD, BoNT appears to be equally safe and equally beneficial in PRCD and non-PRCD patients.

7 Article Integrated safety of levodopa-carbidopa intestinal gel from prospective clinical trials. 2016

Lang, Anthony E / Rodriguez, Ramon L / Boyd, James T / Chouinard, Sylvain / Zadikoff, Cindy / Espay, Alberto J / Slevin, John T / Fernandez, Hubert H / Lew, Mark F / Stein, David A / Odin, Per / Fung, Victor S C / Klostermann, Fabian / Fasano, Alfonso / Draganov, Peter V / Schmulewitz, Nathan / Robieson, Weining Z / Eaton, Susan / Chatamra, Krai / Benesh, Janet A / Dubow, Jordan. ·Morton and Gloria Shulman Movement Disorders Clinic and the Edmond J. Safra Program in Parkinson's Disease, Toronto Western Hospital and Division of Neurology, UHN, Division of Neurology, University of Toronto, Toronto, Ontario, Canada. · University of Florida College of Medicine, Gainesville, Florida, USA. · University of Vermont College of Medicine, Burlington, Vermont, USA. · University of Montreal, Montreal, Quebec, Canada. · Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA. · University of Cincinnati Academic Health Center, Cincinnati, Ohio, USA. · University of Kentucky Medical Center, Lexington, Kentucky, USA. · Center for Neurological Restoration, Cleveland Clinic, Cleveland, Ohio, USA. · Keck/University of Southern California School of Medicine, Los Angeles, California, USA. · Quintiles, San Diego, California, USA. · Klinikim-Bremerhaven, Germany and Skane University Hospital, Lund, Sweden. · Westmead Hospital and Sydney Medical School, Sydney, Australia. · Charité-University Medicine Berlin, Berlin, Germany. · AbbVie Inc, North Chicago, Illinois, USA. ·Mov Disord · Pubmed #26695437.

ABSTRACT: BACKGROUND: Continuous administration of levodopa-carbidopa intestinal gel (carbidopa-levodopa enteral suspension) through a percutaneous endoscopic gastrojejunostomy is a treatment option for advanced Parkinson disease (PD) patients with motor fluctuations resistant to standard oral medications. Safety data from 4 prospective studies were integrated to assess the safety of this therapy. METHODS: Safety data from 4 studies were summarized using 2 overlapping data sets, permitting the separation of procedure/device-associated (n = 395) from non-procedure/device adverse events (n = 412). RESULTS: At the data cutoff, median exposure to levodopa-carbidopa intestinal gel was 911 days (range, 1-1980 days) with 963 total patient-years of exposure. Procedure/device adverse events occurred in 300 patients (76%), and serious adverse events occurred in 68 (17%); most frequently reported procedure/device adverse events and serious adverse events were complications of device insertion (41% and 8%, respectively) and abdominal pain (36% and 4%, respectively). Non-procedure/device adverse events occurred in 92% (379), with most frequently reported being insomnia (23%) and falls (23%); 42% (171) had non-procedure/device serious adverse events, with most frequently reported being pneumonia (5%) and PD symptoms (2%). Adverse events led to discontinuation in 17% (72), most frequently because of complication of device insertion (2.4%). There were 34 treatment-emergent deaths (8.3%) in the overlapping data sets, 2 of which (0.5%) were considered "possibly related" to the treatment system. CONCLUSION: In the largest collection of levodopa-carbidopa intestinal gel safety data from prospective clinical studies, procedure/device events were frequently reported and occasionally life threatening. Most non-procedure/device events were typical for levodopa treatment and an elderly population. These factors combined with high treatment efficacy led to a relatively low discontinuation rate in advanced PD patients.

8 Article Rasagiline for the symptomatic treatment of fatigue in Parkinson's disease. 2015

Lim, Thien Thien / Kluger, Benzi M / Rodriguez, Ramon L / Malaty, Irene A / Palacio, Rafael / Ojo, Oluwadamilola O / Patel, Shnehal / Gujrati, Yogesh / Nutter, Benjamin / Swartz, Camille / Hennessy, Carol / Fernandez, Hubert H. ·Cleveland Clinic, Cleveland, Ohio, USA. · University of Florida, Gainesville, Florida, USA. · University of Colorado, Aurora, Coloradio, USA. ·Mov Disord · Pubmed #26769459.

ABSTRACT: BACKGROUND: Fatigue affects 40% to 50% of all PD patients and is a leading cause of disability, with no clearly established or efficacious established treatments. METHODS: In this double-blinded, placebo-controlled, pilot trial, we investigated whether rasagiline improved fatigue among PD patients. Subjects were randomized to 1 mg daily of rasagiline or placebo for 12 weeks. The primary endpoint was a change in the Modified Fatigue Impact Scale from baseline to week 12. RESULTS: Thirty PD subjects (16 men), with Modified Fatigue Impact Scale baseline score of 67 ± 15, were randomized (16 to rasagiline vs. 14 to placebo). Significant improvement was noted in the mean Modified Fatigue Impact Scale score of the rasagiline group (12 points) as compared to placebo (8.5 points) from baseline to week 12 (P = 0.003). CONCLUSION: In this pilot study, rasagiline at a dose of 1 mg per day improved fatigue. Larger randomized studies are needed to confirm this finding.

9 Article Global attentional neglect of segmented lines in Parkinson's disease. 2015

Falchook, Adam D / Salazar, Liliana / Neal, Dan / Kesayan, Tigran / Williamson, John B / Malaty, Irene A / McFarland, Nikolaus R / Okun, Michael S / Rodriguez, Ramon L / Wagle Shukla, Aparna / Heilman, Kenneth M. ·a Department of Neurology , University of Florida , Gainesville , FL , USA. ·Neurocase · Pubmed #25073971.

ABSTRACT: Global attention requires disengagement from focal elements of stimuli. Since people with Parkinson's disease (PD) may reveal impaired disengagement, this study attempted to learn if people with PD may be impaired at allocating global attention. Healthy adults and people with PD attempted to bisect lines of uniform thickness and lines composed of two segments of unequal thickness and length. When the longer line segment was to the right of the shorter segment, the group with PD demonstrated an increased deviation toward the longer segment, supporting the postulate that people with PD have an impaired ability to disengage focal attention and engage global spatial attention.

10 Article Testosterone level and the effect of levodopa and agonists in early Parkinson disease: results from the INSPECT cohort. 2014

Okun, Michael S / Wu, Samuel S / Jennings, Dana / Marek, Kenneth / Rodriguez, Ramon L / Fernandez, Hubert H. ·Departments of Neurology, Neurosurgery and Psychiatry, McKnight Brain Institute, University of Florida, 100 S Newell Dr Rm-L3-101, Gainesville, 32611 FL USA. ·J Clin Mov Disord · Pubmed #26788334.

ABSTRACT: BACKGROUND: To determine if testosterone levels are influenced by dopaminergic therapy in Parkinson disease (PD) patients. Testosterone level has been reported to be low in patients with PD and other neurodegenerative diseases. In this study, we sought to determine whether dopaminergic therapy (i.e. levodopa and dopamine agonist) influenced testosterone levels. We used a cohort of consecutive male patients from the INSPECT trial--a multi-center, prospective, study that primarily investigated the effects of short-term treatment with pramipexole or levodopa on [(123)I] B-CIT SPECT imaging in early PD. METHODS: Testosterone levels were drawn on consenting male subjects with early PD who enrolled in the INSPECT trial at three study visits (baseline, 12 weeks post-treatment, and 8-12 weeks post-washout). Subjects were randomized to: no treatment, pramipexole (up to 3 mg) or levodopa (up to 600 mg). Testosterone levels were obtained twice (prior to 10 AM) and averaged for each of three study visits. RESULTS: Thirty two male patients participated in this sub-study and there were no significant differences in disease characteristics in the 3 groups at baseline. Twenty-nine patients completed the follow-up visits and were suitable for analysis. There were statistically significant differences in the change in free testosterone level, increased in both the levodopa group and pramipexole group but decreased in the untreated group at 12-weeks post-treatment. There were no significant differences in the changes of UPDRS total or motor scores, although there was a strong trend toward improvement in motor scores. The testosterone level persisted in its increase only in the pramipexole group at the end of the washout period. CONCLUSION: These preliminary data support the premise that dopaminergic medications do not reduce testosterone levels in early PD patients.

11 Article The "brittle response" to Parkinson's disease medications: characterization and response to deep brain stimulation. 2014

Martinez-Ramirez, Daniel / Giugni, Juan / Vedam-Mai, Vinata / Wagle Shukla, Aparna / Malaty, Irene A / McFarland, Nikolaus R / Rodriguez, Ramon L / Foote, Kelly D / Okun, Michael S. ·Department of Neurology, Center for Movement Disorders and Neurorestoration, University of Florida, Gainesville, Florida, United States of America. · Department of Neurology, Center for Movement Disorders and Neurorestoration, University of Florida, Gainesville, Florida, United States of America; Department of Neurosurgery, Center for Movement Disorders and Neurorestoration, University of Florida, Gainesville, Florida, United States of America. · Department of Neurosurgery, Center for Movement Disorders and Neurorestoration, University of Florida, Gainesville, Florida, United States of America. ·PLoS One · Pubmed #24733172.

ABSTRACT: OBJECTIVE: Formulate a definition and describe the clinical characteristics of PD patients with a "brittle response" (BR) to medications versus a "non-brittle response" (NBR), and characterize the use of DBS for this population. METHODS: An UF IRB approved protocol used a retrospective chart review of 400 consecutive PD patients presenting to the UF Center for Movement Disorders and Neurorestoration. Patient records were anonymized and de-identified prior to analysis. SPSS statistics were used to analyze data. RESULTS: Of 345 included patients, 19 (5.5%) met criteria for BR PD. The BR group was comprised of 58% females, compared to 29% in the NBR group (P = .008). The former had a mean age of 63.4 compared to 68.1 in the latter. BR patients had lower mean weight (63.5 vs. 79.6, P = <.001), longer mean disease duration (12.6 vs. 8.9 years, P = .003), and had been on LD for more years compared to NBR patients (9.8 vs. 5.9, P = .001). UPDRS motor scores were higher (40.4 vs. 30.0, P = .001) in BR patients. No differences were observed regarding the Schwab and England scale, PDQ-39, and BDI-II. Sixty-three percent of the BR group had undergone DBS surgery compared to 18% (P = .001). Dyskinesias were more common, severe, and more often painful (P = <.001) in the BR group. There was an overall positive benefit from DBS. CONCLUSION: BR PD occurred more commonly in female patients with a low body weight. Patients with longer disease duration and longer duration of LD therapy were also at risk. The BR group responded well to DBS.

12 Article An eight-year clinic experience with clozapine use in a Parkinson's disease clinic setting. 2014

Hack, Nawaz / Fayad, Sarah M / Monari, Erin H / Akbar, Umer / Hardwick, Angela / Rodriguez, Ramon L / Malaty, Irene A / Romrell, Janet / Wagle Shukla, Aparna A / McFarland, Nikolaus / Ward, Herbert E / Okun, Michael S. ·Department of Neurology, University of Florida Center for Movement Disorders and Neurorestoration, Gainesville, Florida, United States of America. · Department of Neurology, University of Florida Center for Movement Disorders and Neurorestoration, Gainesville, Florida, United States of America; Department of Psychiatry, University of Florida, Gainesville, Florida, United States of America. ·PLoS One · Pubmed #24646688.

ABSTRACT: BACKGROUND: To examine our eight year clinic-based experience in a Parkinson's disease expert clinical care center using clozapine as a treatment for refractory psychosis in Parkinson's disease (PD). METHODS: The study was a retrospective chart review which covered eight years of clozapine registry use. Statistical T-tests, chi-square, correlations and regression analysis were used to analyze treatment response for potential associations of age, disease duration, and Hoehn & Yahr (H&Y) score, and degree of response to clozapine therapy. RESULTS: There were 36 participants included in the analysis (32 PD, 4 parkinsonism-plus). The characteristics included 30.6% female, age 45-87 years (mean 68.3±10.15), disease duration of 17-240 months (mean 108.14±51.13) and H&Y score of 2 to 4 (mean 2.51±0.51). The overall retention rate on clozapine was 41% and the most common reasons for discontinuation were frequent blood testing (28%), nursing home (NH) placement (11%) and leucopenia (8%). Responses to clozapine across the cohort were: complete (33%), partial (33%), absent (16%), and unknown (16%). Age (r = -0.36, p<0.01) and H&Y score (r = -0.41, p<0.01) were shown to be related to response to clozapine therapy, but disease duration was not an associated factor (r = 0.21, p>0.05). CONCLUSIONS: This single-center experience highlights the challenges associated with clozapine therapy in PD psychosis. Frequent blood testing remains a significant barrier for clozapine, even in patients with therapeutic benefit. Surprisingly, all patients admitted to a NH discontinued clozapine due to logistical issues of administration and monitoring within that setting. Consideration of the barriers to clozapine therapy will be important to its use and to its continued success in an outpatient setting.

13 Article Driving errors in Parkinson's disease: moving closer to predicting on-road outcomes. 2014

Classen, Sherrilene / Brumback, Babette / Monahan, Miriam / Malaty, Irene I / Rodriguez, Ramon L / Okun, Michael S / McFarland, Nikolaus R. ·Sherrilene Classen, PhD, MPH, OTR/L, is Professor and Director, School of Occupational Therapy, Elborn College, Room 2555B, 1201 Western Road, Western University, London, Ontario N6G 1H1 Canada. At the time of the study, she was Director, Institute for Mobility, Activity and Participation, and Associate Professor, Department of Occupational Therapy, College of Public Health and Health Professions, University of Florida, Gainesville; sclassen@uwo.ca. · Babette Brumback, PhD, is Professor and Program Director, Department of Biostatistics, University of Florida, Gainesville. · Miriam Monahan, MS OT, CDRS, is Occupational Therapist and Certified Driving Rehabilitation Specialist, Department of Occupational Therapy and Institute for Mobility, Activity and Participation, University of Florida, Gainesville. · Irene I. Malaty, MD, is Assistant Professor, Center for Movement Disorders and Neurorestoration, Department of Neurology, University of Florida, Gainesville. · Ramon L. Rodriguez, MD, is Director, Movement Disorders Clinic, Center for Movement Disorders and Neurorestoration, Department of Neurology, University of Florida, Gainesville. · Michael S. Okun, MD, is Co-Director, Center for Movement Disorders and Neurorestoration, Department of Neurology, University of Florida, Gainesville. · Nikolaus R. McFarland, MD, PhD, is Assistant Professor, Department of Neurology, University of Florida, Gainesville. ·Am J Occup Ther · Pubmed #24367958.

ABSTRACT: Age-related medical conditions such as Parkinson's disease (PD) compromise driver fitness. Results from studies are unclear on the specific driving errors that underlie passing or failing an on-road assessment. In this study, we determined the between-group differences and quantified the on-road driving errors that predicted pass or fail on-road outcomes in 101 drivers with PD (mean age = 69.38 ± 7.43) and 138 healthy control (HC) drivers (mean age = 71.76 ± 5.08). Participants with PD had minor differences in demographics and driving habits and history but made more and different driving errors than HC participants. Drivers with PD failed the on-road test to a greater extent than HC drivers (41% vs. 9%), χ²(1) = 35.54, HC N = 138, PD N = 99, p < .001. The driving errors predicting on-road pass or fail outcomes (95% confidence interval, Nagelkerke R² =.771) were made in visual scanning, signaling, vehicle positioning, speeding (mainly underspeeding, t(61) = 7.004, p < .001, and total errors. Although it is difficult to predict on-road outcomes, this study provides a foundation for doing so.

14 Article A Novel DYT-5 Mutation with Phenotypic Variability within a Colombian Family. 2013

Bernal-Pacheco, Oscar / Oyama, Genko / Briton, Angela / Singleton, Andrew B / Fernandez, Hubert H / Rodriguez, Ramon L / Malaty, Irene A / Okun, Michael S. ·Departments of Neurology, and Neurosurgery, University of Florida, Center for Movement Disorders & Neurorestoration, Gainesville, FL, USA ; Military Central Hospital, Bogota, Colombia. ·Tremor Other Hyperkinet Mov (N Y) · Pubmed #24255805.

ABSTRACT: BACKGROUND: DYT-5 dystonia usually presents as a dopa-responsive dystonia (DRD) with early or late parkinsonian manifestations and/or dystonic features. Genetically, these patients have been described as having a wide array of independent mutations in the guanosine triphosphate cyclohydrolase 1 gene (GCH1), and these patients may also have a wide array of clinical manifestations. METHODS: A Colombian family with six affected female members was characterized. RESULTS: Three members, including the index case, revealed mild parkinsonism, whereas three granddaughters of the index case showed severe generalized dystonia. No men were affected. There was anticipation, and a female predominance was uncovered. Treatment with levodopa was generally effective except in a case with severe skeletal deformities and contractions. Detailed genetic analysis in the index case revealed a new mutation in exon 1 of GCH1 (c.159delG). DISCUSSION: This study revealed a new mutation of GCH1 that resulted in heterogeneous clinical presentations of DRD within a large family.

15 Article Postural/Gait and cognitive function as predictors of driving performance in Parkinson's disease. 2013

Crizzle, Alexander M / Classen, Sherrilene / Lanford, Desiree N / Malaty, Irene A / Okun, Michael S / Wang, Yanning / Wagle Shukla, Aparna / Rodriguez, Ramon L / McFarland, Nikolaus R. ·Department of Occupational Therapy, University of Florida, Gainesville, FL 32601-0164, USA. acrizzle@sympatico.ca ·J Parkinsons Dis · Pubmed #23938345.

ABSTRACT: BACKGROUND: The primary influence of motor symptoms on driving performance remains unclear due to the inconsistent use of various motor rating scales used in prior studies. OBJECTIVE: This study aimed to determine which of three measures utilized in PD, the Unified Parkinson's Disease Rating Scale (UPDRS) motor section; the Modified Hoehn and Yahr; and the Rapid Paced Walk Test would best predict pass/fail outcomes on a road test in a sample of PD drivers. METHODS: All participants (N = 55; 79% men) completed a road test. Receiver Operating Characteristics were then contrasted for all subjects based on assessments from all three disease severity indices. MMSE scores were then modelled with significant disease severity measures (if any) to determine if the predictive accuracy could be improved. RESULTS: The Rapid Paced Walk Test and the Modified Hoehn & Yahr both predicted pass/fail outcomes on the road test (Area under the curve of 0.73 and 0.82, respectively). UPDRS motor scores, however, did not predict safe driving. When optimal cut-off points on the Modified Hoehn & Yahr (≥ 2.5) and Rapid Paced Walk Test (>6.22 seconds) were modelled with MMSE scores indicative of mild cognitive impairment (<27), the model accurately classified 92% and 100% as failing the road test, respectively. CONCLUSION: Although the Rapid Paced Walk Test had a slight advantage in differentiating between pass/fail outcomes compared to the Modified Hoehn & Yahr, both tests alone cannot be used in isolation to predict driving safety. Predictive accuracy can be improved using both select cut-off points on the Modified Hoehn & Yahr and Rapid Paced Walk test with MMSE scores in PD drivers. Though these findings are useful, an on-road test is still the gold standard, and screening should always be followed by formal testing.

16 Article Valproate as a treatment for dopamine dysregulation syndrome (DDS) in Parkinson's disease. 2013

Sriram, Ashok / Ward, Herbert E / Hassan, Anhar / Iyer, Sanjay / Foote, Kelly D / Rodriguez, Ramon L / McFarland, Nikolaus R / Okun, Michael S. ·Department of Neurology, Center for Movement Disorders and Neurorestoration, Gainesville, FL 32611, USA. drashok@gmail.com ·J Neurol · Pubmed #23007193.

ABSTRACT: It has been previously well established that the use of dopaminergic agents in Parkinson's disease may contribute to behavioral disturbances such as dopamine dysregulation syndrome (DDS), impulse control disorders (ICD), and punding. ICD and punding have been most commonly addressed by reducing dose or by discontinuing the use of a dopamine agonist. Treatment of DDS has proven more challenging, and to date there has been no standard approach. In this paper, we review a series of four patients who met criteria for DDS, who were all refractory to medication adjustments. The DDS symptoms responded by the addition of valproic acid in all cases.

17 Article Taking a better history for behavioral issues pre- and post-deep brain stimulation: issues missed by standardized scales. 2013

Bernal-Pacheco, Oscar / Oyama, Genko / Foote, Kelly D / Dai, Yunfeng E / Wu, Samuel S / Jacobson, Charles E / Limotai, Natlada / Zeilman, Pamela R / Romrell, Janet / Hwynn, Nelson / Rodriguez, Ramon L / Malaty, Irene A / Okun, Michael S. ·Departments of Neurology Center for Movement Disorders and Neurorestoration, University of Florida, Gainesville, FL, USA. ·Neuromodulation · Pubmed #22748071.

ABSTRACT: OBJECTIVES: To screen for potentially underreported behavioral changes in patients with idiopathic Parkinson's disease (PD) pre- and post-deep brain stimulation (DBS), a retrospective data base review was performed. METHODS: In total, 113 patients who underwent unilateral or bilateral DBS at the University of Florida in either subthalamic nucleus or globus pallidus internus for PD were screened for behavioral issues by asking about the presence or absence of seven neuropsychiatric symptoms (panic, fear, paranoia, anger, suicidal flashes, crying, and laughing). RESULTS: There was a high prevalence of fear (16.3%), panic (14.0%), and anger (11.6%) at baseline in this cohort. In the first six months following DBS implantation, anger (32.6%), fear (26.7%), and uncontrollable crying (26.7%) were the most frequent symptoms reported. Those symptoms also were present following six months of DBS surgery (30.2%, 29.1%, and 19.8%, respectively). New uncontrollable crying occurred more in the acute postoperative stage (less than or equal to six months) (p = 0.033), while new anger occurred more in the chronic postoperative stage (greater than six months) (p = 0.017). The frequency of uncontrollable laughing significantly increased with bilateral DBS (p = 0.033). CONCLUSIONS: Many of the neuropsychiatric issues were identified at preoperative baseline and their overall occurrence was more than expected. There was a potential for worsening of these issues post-DBS. There were subtle differences in time course, and in unilateral vs. bilateral implantations. Clinicians should be aware of these potential behavioral issues that may emerge following DBS therapy, and should consider including screening questions in preoperative and postoperative interviews. Standardized scales may miss the presence or absence of these clinically relevant issues.

18 Article Are selective serotonin reuptake inhibitors associated with greater apathy in Parkinson's disease? 2012

Zahodne, Laura B / Bernal-Pacheco, Oscar / Bowers, Dawn / Ward, Herbert / Oyama, Genko / Limotai, Natlada / Velez-Lago, Frances / Rodriguez, Ramon L / Malaty, Irene / McFarland, Nikolaus R / Okun, Michael S. ·Department of Neurology, Center for Movement Disorders and Neuro-restoration, University of Florida, Gainesville, FL, USA. ·J Neuropsychiatry Clin Neurosci · Pubmed #23037646.

ABSTRACT: Apathy is a common neuropsychiatric feature of Parkinson's disease (PD), but little is known of relationships between apathy and specific medications in PD. Following a retrospective database and chart review of 181 Parkinson's patients, relationships between Apathy Scale scores and use of psychotropic and antiparkinsonian medications were examined with multiple regression. Controlling for age, sex, education, and depression, the use of selective serotonin reuptake inhibitors (SSRIs), but not other antidepressants, was associated with greater apathy. Use of monoamine oxidase B inhibitors was associated with less apathy. Longitudinal studies are needed to evaluate a potential SSRI-induced apathy syndrome in PD.

19 Article Mood and motor trajectories in Parkinson's disease: multivariate latent growth curve modeling. 2012

Zahodne, Laura B / Marsiske, Michael / Okun, Michael S / Rodriguez, Ramon L / Malaty, Irene / Bowers, Dawn. ·Department of Clinical and Health Psychology, University of Florida, P. O. Box 100165, Gainesville, FL 32610-0165, USA. lzahodne@phhp.ufl.edu ·Neuropsychology · Pubmed #22142359.

ABSTRACT: OBJECTIVE: Apathy is a common feature of Parkinson's disease (PD) that can manifest independently of depression, but little is known about its natural progression in medically managed patients. The present study sought to characterize and compare trajectories of apathy, depression, and motor symptoms in PD over 18 months. METHOD: Data from a sample of 186 PD patients (mean disease duration of 8.2 years) followed by the University of Florida Movement Disorders Center were obtained from a clinical research database. Scores on the Unified Parkinson's disease Rating Scale (motor portion), Apathy Scale, and Beck Depression Inventory at three time-points (baseline, 6 months, 18 months) were analyzed in a structural equation modeling framework. RESULTS: A multivariate growth model controlling for age, sex, education, and disease duration identified linear worsening of both apathy (slope estimate = 0.73; p < .001) and motor symptoms (slope estimate = 1.51; p < .001), and quadratic changes in depression (slope estimate = 1.18; p = .07). All symptoms were positively correlated. Higher education was associated with lower apathy, depression, and motor severity. Advanced age was associated with greater motor and apathy severity. Female sex and longer disease duration were associated with attenuated motor worsening. Antidepressant use was associated only with depression scores. CONCLUSIONS: These longitudinal results support the differentiation of apathy and depression in PD. Like motor progression, apathy progression may be linked at least partially to dopaminergic neurodegeneration. Empirically supported treatments for apathy in PD are needed.

20 Article Alternate but do not swim: a test for executive motor dysfunction in Parkinson disease. 2011

Falchook, Adam D / Decio, Danilo / Williamson, John B / Okun, Michael S / Malaty, Irene A / Rodriguez, Ramon L / Heilman, Kenneth M. ·Department of Neurology, University of Florida, Gainesville, FL 32610, USA. adam.falchook@neurology.ufl.edu ·J Int Neuropsychol Soc · Pubmed #22882811.

ABSTRACT: The objective of this study is to learn if participants with Parkinson disease (PD), when compared to normal controls, are impaired in making simultaneous but independent right and left hand movements. Participants were tested with Luria's Alternating Hand Postures (AHP) test and modified AHP tests. Twelve PD participants without dementia and twelve matched controls were assessed for their ability to perform the parallel AHP test (both hands remaining in the same coronal plane) and with modifications of this test into swimming (alternative arm extension with finger extension and arm flexion with finger flexion) and reverse swimming (alternative arm extension-finger flexion and arm flexion-finger extension) movements. The participants with PD were significantly impaired when performing the parallel and the reverse swimming movements AHP tests, but not impaired on the swimming movements AHP test. Swimming movements may be phylogenetically and ontogenetically more primitive and not as heavily dependent on frontal-basal ganglia networks; thus performance of swimming movements during the parallel AHP test may decrease this test's sensitivity.

21 Article Usefulness of screening tools for predicting driving performance in people with Parkinson's disease. 2011

Classen, Sherrilene / Witter, D P / Lanford, D N / Okun, M S / Rodriguez, R L / Romrell, J / Malaty, I / Fernandez, H H. ·Institute for Mobility, Activity and Participation, University of Florida, PO Box 100164, Gainesville, FL 32611-0164, USA. sclassen@phhp.ufl.edu ·Am J Occup Ther · Pubmed #22026326.

ABSTRACT: OBJECTIVE: We used screening tests administered by a certified driving rehabilitation specialist and by Parkinson's disease (PD) specialty neurologists to develop a model to predict on-road outcomes for patients with PD. METHOD: We administered a battery of screening tests to 41 patients with PD and 41 age-matched control participants before on-road testing. We used statistical models to predict actual on-road performance. RESULTS: The PD group had a higher failure rate, indicating more on-road errors. For the PD participants, the Useful Field of View (UFOV) Subtest 2 and Rapid Pace Walk were responsible for most of the variance in the on-road test. The model accurately categorized pass-fail outcomes for 81% of PD patients. CONCLUSION: Clinical screening batteries may be predictive of driving performance in PD. The UFOV Subtest 2, administered in approximately 15 min, may be the single most useful clinical test for such predictions.

22 Article Unilateral GPi-DBS as a treatment for levodopa-induced respiratory dyskinesia in Parkinson disease. 2011

Oyama, Genko / Foote, Kelly D / Iyer, Sanjay S / Zeilman, Pamela / Hwynn, Nelson / Jacobson, Charles E / Malaty, Irene A / Fernandez, Hubert H / Rodriguez, Ramon L / Okun, Michael S. ·Department of Neurology, University of Florida Movement Disorders Center, Gainesville, FL 32610, USA. ·Neurologist · Pubmed #21881473.

ABSTRACT: BACKGROUND: Respiratory dyskinesia is a rare but disabling complication of levodopa therapy for Parkinson disease; however, its treatment has been limited to medication optimization. CASE REPORT: A 72-year-old woman with a 6-year history of Parkinson disease presented with severe and debilitating levodopa-induced respiratory dyskinesia, which manifested with a short and shallow breathing pattern and panting. These symptoms were observed coincident with limb and truncal dyskinesias. Both respiratory and limb/trunk dyskinesias were addressed by the implantation of a unilateral globus pallidus interna deep brain stimulator (GPi-DBS). CONCLUSIONS: Although the mechanism of involvement of the respiratory system in dyskinesia is unknown, GPi-DBS seems to be a potentially viable treatment option for these patients.

23 Article DBS candidates that fall short on a levodopa challenge test: alternative and important indications. 2011

Morishita, Takashi / Rahman, Maryam / Foote, Kelly D / Fargen, Kyle M / Jacobson, Charles E / Fernandez, Hubert H / Rodriguez, Ramon L / Malaty, Irene A / Bowers, Dawn / Hass, Christopher J / Katayama, Yoichi / Yamamoto, Takamitsu / Okun, Michael S. ·Department of Neurosurgery, College of Medicine/Shands Hospital. takashi.morishita@neurosurgery.ufl.edu ·Neurologist · Pubmed #21881468.

ABSTRACT: INTRODUCTION: Candidacy for deep brain stimulation (DBS) in Parkinson disease (PD) is typically assessed by the preoperative motor response to levodopa along with an interdisciplinary evaluation. However, recent cases treated at our institution have achieved good outcomes with DBS despite a sub-30% improvement in motor scores. The aim of this study was to examine the outcomes of DBS in a subset of patients who failed to reach the 30% motor improvement threshold. METHODS: A review of all DBS patients treated at the University of Florida Movement Disorders Center between 2002 and 2009 was performed utilizing a DBS database. All patients with sub-30% improvement in Unified Parkinson Disease Rating Scale Part III after dopaminergic medication administration were included. RESULTS: Nine patients were identified; DBS was performed for severe dyskinesia (n=5), "on/off motor" fluctuations (n=1) and medication-refractory tremor (n=3). The target symptoms were improved in all patients. Postoperatively, scores on the Unified Parkinson Disease Rating Scale Part II and III and subscores on Parkinson disease questionnaire-39 improved (P<0.05). CONCLUSIONS: Although motor response to levodopa remains the primary selection criteria for DBS candidacy in Parkinson disease, patients who do not meet the 30% threshold and have disabling symptoms may still benefit from DBS. Select patients with severe dyskinesia, "on/off" motor fluctuations, and/or medication-refractory tremor may experience significant benefits from DBS and should be considered on a case by case basis through an interdisciplinary team evaluation.

24 Article Did General Douglas MacArthur have Parkinson disease? A video and archival analysis. 2011

Bowen, Lauren N / Malaty, Irene A / Rodriguez, Ramon L / Okun, Michael S. ·Department of Neurology, Gainesville, FL 32611, USA. lauren.bowen@ufl.edu ·Neurology · Pubmed #21555736.

ABSTRACT: BACKGROUND: Historians have suggested that MacArthur had Parkinson disease (PD), and that this may have influenced his military judgment. There is little evidence to support or to refute this suggestion. OBJECTIVE: We aimed in this article to review multiple cinematic images, as well as the personal writings of Douglas MacArthur to determine the likelihood that he had PD. METHODS: A complete review of the Western literature on Douglas MacArthur, including YouTube, Google Scholar/Google Images/Google Video, PubMed, and HighWirePress was undertaken. Over 200 minutes of film footage was analyzed, including such factors as MacArthur's facial profiles, facial expression, gait, posture, and movement. Handwriting samples from over 6 decades were compared for evidence of micrographia. Videos and handwriting samples were independently reviewed by 3 fellowship-trained movement disorders neurologists. RESULTS: Examination of video footage showed evidence of progression of head tremors, postural action tremors, and voice tremors. There were no clear indications of a masked face, rigidity, bradykinesia, or a resting tremor on film footage recorded from 1906 to 1964. There was no evidence of micrographia in handwriting samples. Oral testimony and letters written by an attending gastroenterologist present at MacArthur's death in 1964 revealed no evidence of parkinsonian features. CONCLUSIONS: We conclude that MacArthur had mild essential tremor that was more evident in his postmilitary career. There was no evidence to suggest that he had a clinical diagnosis of progressive PD.

25 Article Do stable patients with a premorbid depression history have a worse outcome after deep brain stimulation for Parkinson disease? 2011

Okun, Michael S / Wu, Samuel S / Foote, Kelly D / Bowers, Dawn / Gogna, Shilpa / Price, Catherine / Malaty, Irene / Rodriguez, Ramon L / Jacobson, Charles E / Ward, Herbert. ·UF Center for Movement Disorders & Neurorestoration, Gainesville, Florida 32607, USA. okun@neurology.ufl.edu ·Neurosurgery · Pubmed #21415789.

ABSTRACT: BACKGROUND: Deep brain stimulation (DBS) has been associated with mood sequelae in a subset of patients operated on in either the subthalamic nucleus or the globus pallidus internus for the treatment of Parkinson disease. OBJECTIVE: To compare mood and motor outcomes in those with and without a presurgical history of depression. METHODS: Unilateral subthalamic nucleus or unilateral globus pallidus internus DBS patients followed up for a minimum of 6 months were included. All patients underwent a comprehensive outpatient psychiatric evaluation by a board-certified psychiatrist. Psychiatric diagnoses were based on Diagnostic and Statistical Manual, fourth edition, text revision, nomenclature (American Psychiatric Association, 2000). Motor and mood outcomes were compared. RESULTS: A total of 110 patients were included. There were no significant differences in baseline variables between the 2 groups. Those with a preoperative history of depression had significantly higher Beck Depression Inventory scores than the nondepression group after DBS (8.97 ± 7.55 vs 5.92 ± 5.71; P = .04). Patients with a depression history had less improvement (11.6%) in pre/post-DBS change when Unified Parkinson Disease Rating Scale motor scores were compared (P = .03) after adjustment for stimulation site and baseline demographic and clinical variables. Patients with a higher levodopa equivalent dose had a worse clinical motor outcome. CONCLUSION: Patients with a preoperative depression history had higher Beck Depression Inventory scores after DBS and significantly less (albeit small) improvement in pre/post-DBS change in Unified Parkinson Disease Rating Scale motor scores than patients without a history of depression.

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