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Parkinson Disease: HELP
Articles from Radboud University
Based on 288 articles published since 2009
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These are the 288 published articles about Parkinson Disease that originated from Radboud University during 2009-2019.
 
+ Citations + Abstracts
Pages: 1 · 2 · 3 · 4 · 5 · 6 · 7 · 8 · 9 · 10 · 11 · 12
1 Guideline Neurogenic bowel dysfunction: Clinical management recommendations of the Neurologic Incontinence Committee of the Fifth International Consultation on Incontinence 2013. 2018

Cotterill, Nikki / Madersbacher, Helmut / Wyndaele, Jean J / Apostolidis, Apostolos / Drake, Marcus J / Gajewski, Jerzy / Heesakkers, John / Panicker, Jalesh / Radziszewski, Piotr / Sakakibara, Ryuji / Sievert, Karl-Dietrich / Hamid, Rizwan / Kessler, Thomas M / Emmanuel, Anton. ·Bristol Urological Institute, North Bristol NHS Trust, Bristol, UK. · University Clinic for Neurourology, Innsbruck, Austria. · University Hospital, Antwerp, Belgium. · Aristotle University of Thessaloniki, Thessaloniki, Greece. · Urology Consultants, Halifax, Canada. · University Medical Center St Radboud, Nijmegen, The Netherlands. · National Hospital for Neurology and Neurosurgery, Queen Square, London, UK. · Medical University of Warsaw, Warsaw, Poland. · Sakura Medical Center, Toho University, Sakura, Japan. · University of Tuebingen, Tuebingen, Germany. · University College London Hospitals, London, UK. · Balgrist University Hospital, Zurich, Switzerland. · St. Mark's Hospital, London, UK. ·Neurourol Urodyn · Pubmed #28640977.

ABSTRACT: BACKGROUND: Evidence-based guidelines for the management of neurological disease and lower bowel dysfunction have been produced by the International Consultations on Incontinence (ICI). These are comprehensive guidelines, and were developed to have world-wide relevance. AIMS: To update clinical management of neurogenic bowel dysfunction from the recommendations of the 4th ICI, 2009. MATERIALS AND METHODS: A series of evidence reviews and updates were performed by members of the working group. The resulting guidelines were presented at the 2012 meeting of the European Association of Urology for consultation, and modifications applied to deliver evidence based conclusions and recommendations for the scientific report of the 5th edition of the ICI in 2013. RESULTS: The current review is a synthesis of the conclusions and recommendations, including the algorithms for initial and specialized management of neurogenic bowel dysfunction. The pathophysiology is described in terms of spinal cord injury, multiple sclerosis, and Parkinson's disease. Assessment requires detailed history and clinical assessment, general investigations, and specialized testing, if required. Treatment primarily focuses on optimizing stool consistency and regulating bowel evacuation to improve quality of life. Symptom management covers conservative and interventional measures to promote good habits and assist stool evacuation, along with prevention of incontinence. Education is essential to achieving optimal bowel management. DISCUSSION: The review offers a pragmatic approach to management in the context of complex pathophysiology and varied evidence base.

2 Guideline Consensus-based clinical practice recommendations for the examination and management of falls in patients with Parkinson's disease. 2014

van der Marck, Marjolein A / Klok, Margit Ph C / Okun, Michael S / Giladi, Nir / Munneke, Marten / Bloem, Bastiaan R / Anonymous4170783. ·Radboud university medical center, Nijmegen Centre for Evidence Based Practice, Department of Neurology, Nijmegen, The Netherlands. · University of Florida Center for Movement Disorders and Neurorestoration, Gainesville, FL, USA. · Movement Disorders Unit, Department of Neurology, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel. · Radboud university medical center, Nijmegen Centre for Evidence Based Practice, Department of Neurology, Nijmegen, The Netherlands; Radboud university medical center, Nijmegen Centre for Evidence Based Practice, Scientific Institute for Quality of Healthcare, Nijmegen, The Netherlands. · Radboud university medical center, Donders Institute for Brain, Cognition and Behavior, Department of Neurology, Nijmegen, The Netherlands. Electronic address: Bas.Bloem@radboudumc.nl. ·Parkinsonism Relat Disord · Pubmed #24484618.

ABSTRACT: Falls in Parkinson's disease (PD) are common and frequently devastating. Falls prevention is an urgent priority, but there is no accepted program that specifically addresses the risk profile in PD. Therefore, we aimed to provide consensus-based clinical practice recommendations that systematically address potential fall risk factors in PD. We developed an overview of both generic (age-related) and PD-specific factors. For each factor, we specified: best method of ascertainment; disciplines that should be involved in assessment and treatment; and which interventions could be engaged. Using a web-based tool, we asked 27 clinically active professionals from multiple relevant disciplines to evaluate this overview. The revised version was subsequently reviewed by 12 experts. Risk factors and their associated interventions were included in the final set of recommendations when at least 66% of reviewing experts agreed. These recommendations included 31 risk factors. Nearly all required a multidisciplinary team approach, usually involving a neurologist and PD-nurse specialist. Finally, the expert panel proposed to first identify the specific fall type and to tailor screening and treatment accordingly. A routine evaluation of all risk factors remains reserved for high-risk patients without prior falls, or for patients with seemingly unexplained falls. In conclusion, this project produced a set of consensus-based clinical practice recommendations for the examination and management of falls in PD. These may be used in two ways: for pragmatic use in current clinical practice, pending further evidence; and as the active intervention in clinical trials, aiming to evaluate the effectiveness and cost-effectiveness of large scale implementation.

3 Editorial Intensive inpatient rehabilitation for persons with Parkinson's disease: last resort or pre-emptive strike? 2018

Radder, Danique L M / Nonnekes, Jorik / Bloem, Bastiaan R. ·Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands. · Donders Institute for Brain Cognition and Behaviour, Department of Rehabilitation, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands. ·J Neurol Neurosurg Psychiatry · Pubmed #29535145.

ABSTRACT: -- No abstract --

4 Editorial Toward affordable falls prevention in Parkinson's disease. 2016

de Vries, Nienke M / Nonnekes, Jorik / Bloem, Bastiaan R. ·Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, The Netherlands. · Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, The Netherlands. ·Mov Disord · Pubmed #26660664.

ABSTRACT: -- No abstract --

5 Editorial How I examine my patient: the art of neurological examination for Parkinson's disease. 2014

Bloem, Bastiaan R / Brundin, Patrik. ·Radboud University Medical Center, Donders Institute for Brain, Cognition and Behavior, Department of Neurology, Nijmegen, The Netherlands. · Laboratory of Translational Parkinson's Disease Research, Center for Neurodegenerative Science, Van Andel Research Institute, Grand Rapids, MI, USA. ·J Parkinsons Dis · Pubmed #25281608.

ABSTRACT: -- No abstract --

6 Editorial Bicycling breaks the ice for freezers of gait. 2011

Snijders, Anke H / Toni, Ivan / Ružička, Evžen / Bloem, Bastiaan R. ·Department of Neurology and Parkinson Centre Nijmegen, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen Medical Centre, The Netherlands. ·Mov Disord · Pubmed #21462254.

ABSTRACT: Patients with freezing of gait (FOG) have episodic problems with generating adequate steps. This phenomenon is both common and debilitating in patients with Parkinson's disease (PD) or atypical parkinsonism. We recently presented a video case of a patient with longstanding PD and severe FOG, who showed a remarkably preserved ability to ride a bicycle. Here, we comment on the scientific and clinical implications of this single case observation, and show the video of a similar case. We first consider several pathophysiological explanations for this striking discrepancy between walking and cycling in PD. We then discuss the merits and shortcomings of cycling as a potential new avenue for rehabilitation and exercise training in patients grounded by FOG. Finally, we provide some directions for future research stimulated by this fascinating observation.

7 Review Management of Parkinson's Disease 20 Years from Now: Towards Digital Health Pathways. 2018

Klucken, Jochen / Krüger, Rejko / Schmidt, Peter / Bloem, Bastiaan R. ·Department of Molecular Neurology, University Hospital Erlangen, Friedrich-Alexander University (FAU) Erlangen-Nürnberg, Germany. · Research Group Digital Health Pathways, Fraunhofer Institute for Integrated Circuits (IIS), Erlangen, Germany. · Luxembourg Centre for Systems Biomedicine (LCSB), University of Luxembourg, Luxembourg. · Centre Hospitalier de Luxembourg (CHL), Luxembourg. · Brody School of Medicine, East Carolina University, Greenville, NC, USA. · Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behavior, Nijmegen, The Netherlands. ·J Parkinsons Dis · Pubmed #30584171.

ABSTRACT: Current best medical treatment for patients with Parkinson's disease (PD) involves a medical professional who applies state-of-the-art knowledge of diagnostics and treatment- as derived from cohort studies and clinical trials- to the healthcare process of individual patients. Thus, the much-needed personalization of medicine depends on the abilities, experience and intuition of medical professionals to adjust group-based knowledge to individual decision making. Within 20 years from now, such personal clinical decisions will be largely supported by digital means, also defining a new ecosystem of healthcare often referred to as "digital medicine". We expect that the next phase of digitalization will include new "digital health pathways": data-driven personalized decision support that is based on a combination of multimodal data sources, including evidence-based medical knowledge (e.g., clinical guidelines), personal disease profiles (including genetic determinants of disease progression and treatment response), insights into individual disease trajectories (thereby defining subgroups of patients) and individual patients' needs. Here, we illustrate the potential of this development by sketching the contours of a digitally supported care pathway for gait disability and falls. Such digital health pathways will support the introduction of personalized medicine for PD patients, allowing patients to benefit optimally from individually tailored treatments. This should result in a better quality of life for patients and lower costs for society.

8 Review The Future of Brain Imaging in Parkinson's Disease. 2018

Helmich, Rick C / Vaillancourt, David E / Brooks, David J. ·Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Donders Centre for Cognitive Neuroimaging, Nijmegen, The Netherlands. · University of Florida, Applied Physiology and Kinesiology, Neurology, and Biomedical Engineering, Gainesville, FL, USA. · Department of Nuclear Medicine and PET Centre, Aarhus University Hospital, Aarhus, Denmark, Division of Neuroscience, Newcastle University, Newcastle, UK. ·J Parkinsons Dis · Pubmed #30584163.

ABSTRACT: Parkinson's disease (PD) is a progressive neurodegenerative disorder that is associated with distinct abnormalities in brain function and structure. Here we discuss how future developments in functional, structural and nuclear brain imaging may help us to better understand, diagnose, and potentially even treat PD. These new horizons may be reached by developing tracers that specifically bind to alpha synuclein, by looking into different places in the body (such as the gut) or in smaller cerebral nuclei (with improved spatial resolution), and by developing new approaches for quantifying and interpreting altered dynamics in large-scale brain networks.

9 Review Continuous Drug Delivery Aiming Continuous Dopaminergic Stimulation in Parkinson's Disease. 2018

van Wamelen, Daniel J / Grigoriou, Sotirios / Chaudhuri, K Ray / Odin, Per. ·Institute of Psychiatry, Psychology & Neuroscience at King's College London, Department of Basic & Clinical Neuroscience, De Crespigny Park, London, United Kingdom. · Parkinson Foundation International Centre of Excellence, King's College Hospital, Denmark Hill, London, United Kingdom. · Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Centre, Nijmegen, The Netherlands. · University of Lund, Faculty of Medicine, Lund, Sweden. · University Hospital Reinkenheide, Bremerhaven, Germany. ·J Parkinsons Dis · Pubmed #30584160.

ABSTRACT: Continuous dopaminergic stimulation in Parkinson's disease (PD) has several advantages over pulsatile, non-continuous, stimulation. These therapies currently consist of pump-based and transcutaneous therapies and are based on a more constant delivery of the dopaminergic drug resulting in continuous dopaminergic stimulation and a more stable treatment effect. Several clinical and experimental observations have shown that continuous stimulation of dopaminergic receptors induces fewer complications, such as dyskinesia, compared to pulsatile stimulation. Currently available non-oral pharmacological continuous therapies in PD include the transdermal Rotigotine (RTG) patch, infusion therapies with Apomorphine and Intrajejunal Levodopa (IJLI) and the Rivastigmine patch. Here we aim to provide a concise review of these current therapies and discuss ongoing and future developments of continuous non-oral pharmacological dopaminergic therapies in PD.

10 Review The Emerging Evidence of the Parkinson Pandemic. 2018

Dorsey, E Ray / Sherer, Todd / Okun, Michael S / Bloem, Bastiaan R. ·Department of Neurology and Center for Health+Technology, University of Rochester Medical Center, Rochester, NY, USA. · Michael J. Fox Foundation for Parkinson's Research, New York, NY, USA. · Fixel Center for Neurological Diseases, Program for Movement Disorders and Neurorestoration, Department of Neurology, University of Florida, Gainesville, FL, USA. · Radboud University Medical Center, Donders Institute for Brain, Cognition and Behavior, Department of Neurology, Nijmegen, The Netherlands. ·J Parkinsons Dis · Pubmed #30584159.

ABSTRACT: Neurological disorders are now the leading source of disability globally, and the fastest growing neurological disorder in the world is Parkinson disease. From 1990 to 2015, the number of people with Parkinson disease doubled to over 6 million. Driven principally by aging, this number is projected to double again to over 12 million by 2040. Additional factors, including increasing longevity, declining smoking rates, and increasing industrialization, could raise the burden to over 17 million. For most of human history, Parkinson has been a rare disorder. However, demography and the by-products of industrialization have now created a Parkinson pandemic that will require heightened activism, focused planning, and novel approaches.

11 Review Towards Personalized Rehabilitation for Gait Impairments in Parkinson's Disease. 2018

Nonnekes, Jorik / Nieuwboer, Alice. ·Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Rehabilitation, Nijmegen, The Netherlands. · Department of Rehabilitation, Sint Maartenskliniek, Nijmegen, The Netherlands. · Department of Rehabilitation Sciences, Katholieke Universiteit Leuven, Tervuursevest, Belgium. ·J Parkinsons Dis · Pubmed #30584154.

ABSTRACT: Non-pharmacological interventions are essential in the management of gait impairments in Parkinson's disease. The evidence for these interventions is growing rapidly. However, studies evaluating these interventions do generally evaluate a one-size-fits-all concept, and do usually not distinguish between subgroups, treatment dose and delivery mode. For two main reasons, this approach will not reach the full potential of gait rehabilitation. First, non-pharmacological interventions (e.g., external cueing) can improve gait in certain patients, but have no effect or sometimes even exacerbate gait deficits in others. Second, the success and benefit of gait rehabilitation relies on therapy adherence and training intensity achieved, and multi-target therapy not tailored to the individual runs the risk of hitting nothing. Hence, to apply non-pharmacological interventions in an individualized and evidence-based manner, clinicians and therapists need to know which patient characteristics predict the efficacy of various training modes and what type of training delivery works best. Current evidence is not sufficient to develop such personalized rehabilitation programs. In this viewpoint, however, we describe how tailored use of gait rehabilitation can be reached within a 20-year time frame.

12 Review The patchy tremor landscape: recent advances in pathophysiology. 2018

Nieuwhof, Freek / Panyakaew, Pattamon / van de Warrenburg, Bart P / Gallea, Cecile / Helmich, Rick C. ·Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroimaging, Radboud University. · Department of Neurology, Donders Institute for Brain, Cognition, and Behaviour, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands. · Department of Medicine, Faculty of Medicine, Chulalongkorn University, Chulalongkorn Excellence Centre on Parkinson Disease and Related Disorders, King Chulalongkorn Memorial Hospital Division of Neurology, Bangkok, Thailand. · Sorbonne Universités, UPMC University Paris 06, UMR S 1127, F-75013. · Inserm, U 1127, F-75013, Paris, France. ·Curr Opin Neurol · Pubmed #29750732.

ABSTRACT: PURPOSE OF REVIEW: We focus on new insights in the pathophysiology of Parkinson's disease tremor, essential tremor, tremor in dystonia, and orthostatic tremor. RECENT FINDINGS: Neuroimaging findings suggest that Parkinson's disease resting tremor is associated with dopaminergic dysfunction, serotonergic dysfunction, or both. Not all tremors in Parkinson's disease have the same pathophysiology: postural tremor in Parkinson's disease can be subdivided into pure postural tremor, which involves nondopaminergic mechanisms, and re-emergent tremor, which has a dopaminergic basis. Unlike Parkinson's disease tremor, essential tremor has an electrophysiological signature suggestive of a single (or several tightly coupled) oscillators. Visual feedback increases essential tremor and enhances cerebral activity in the cerebello-thalamo-cortical circuit, supplementary motor area, and parietal cortex. Little is known about dystonic tremor but the available evidence suggests that both the basal ganglia and the cerebellum play a role. Finally, recent work in orthostatic tremor points towards the role of the pontine tegmentum and dysfunctional cerebellar-SMA circuitry. SUMMARY: Many pathological tremors involve the cerebello-thalamo-cortical circuitry, and the clinical and pathophysiological boundaries between tremor disorders are not always clear. Differences between tremor disorders - or even individual patients - may be explained by the specific balance of neurotransmitter degeneration, by distinct circuit dynamics, or by the role of regions interconnected to the cerebello-thalamo-cortical circuit.

13 Review Freezing of gait: Promising avenues for future treatment. 2018

Gilat, Moran / Lígia Silva de Lima, Ana / Bloem, Bastiaan R / Shine, James M / Nonnekes, Jorik / Lewis, Simon J G. ·Parkinson's Disease Research Clinic, Brain and Mind Centre, The University of Sydney, NSW, Australia. · Radboud University Medical Center, Donders Institute for Brain, Cognition and Behavior, Department of Neurology, Nijmegen, The Netherlands; CAPES Foundation, Ministry of Education of Brazil, Brasília, DF, Brazil. · Radboud University Medical Center, Donders Institute for Brain, Cognition and Behavior, Department of Neurology, Nijmegen, The Netherlands. · Radboud University Medical Center, Donders Institute for Brain, Cognition and Behavior, Department of Rehabilitation, Nijmegen, The Netherlands. · Parkinson's Disease Research Clinic, Brain and Mind Centre, The University of Sydney, NSW, Australia. Electronic address: Profsimonlewis@gmail.com. ·Parkinsonism Relat Disord · Pubmed #29550375.

ABSTRACT: Freezing of gait is a devastating symptom of Parkinson's disease and other forms of parkinsonism. It poses a major burden on both patients and their families, as freezing often leads to falls, fall-related injuries and a loss of independence. Treating freezing of gait is difficult for a variety of reasons: it has a paroxysmal and unpredictable nature; a multifaceted pathophysiology, with an interplay between motor elements (disturbed stepping mechanisms) and non-motor elements (cognitive decline, anxiety); and a complex (and likely heterogeneous) underlying neural substrate, involving multiple failing neural networks. In recent years, advances in translational neuroscience have offered new insights into the pathophysiology underlying freezing. Furthermore, the mechanisms behind the effectiveness of available treatments (or lack thereof) are better understood. Driven by these concepts, researchers and clinicians have begun to improve currently available treatment options, and develop new and better treatment methods. Here, we evaluate the range of pharmacological (i.e. closed-looped approaches), surgical (i.e. multi-target and adaptive deep brain and spinal cord stimulation) and behavioural (i.e. biofeedback and cueing on demand) treatment options that are under development, and propose novel avenues that are likely to play a crucial role in the clinical management of freezing of gait in the near future. The outcomes of this review suggest that the successful future management of freezing of gait will require individualized treatments that can be implemented in an on-demand manner in response to imminent freezing. With this review we hope to guide much-needed advances in treating this devastating symptom of Parkinson's disease.

14 Review Using Medical Claims Analyses to Understand Interventions for Parkinson Patients. 2018

Bloem, Bastiaan R / Ypinga, Jan H L / Willis, Allison / Canning, Colleen G / Barker, Roger A / Munneke, Marten / De Vries, Nienke M. ·Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behavior, Nijmegen, The Netherlands. · Department Care Purchasing, CZ Groep, Goes, The Netherlands. · Departments of Neurology and of Biostatistics, Epidemiology and Informatics, University of Pennsylvania School of Medicine, Philadelphia, PA, USA. · Discipline of Physiotherapy, Faculty of Health Sciences, University of Sydney, Sydney, Australia. · Department of Clinical Neurosciences, John van Geest Centre for Brain Repair, University of Cambridge, UK. ·J Parkinsons Dis · Pubmed #29254108.

ABSTRACT: The scientific evidence to support the value of a range of non-pharmacological interventions for people with Parkinson's disease (PD) is increasing. However, showing unequivocally that specific interventions are better than usual care is not straightforward because of generic drawbacks of clinical trials. Here, we address these challenges, specifically related to the context of evaluating complex non-pharmacological interventions for people with PD. Moreover, we discuss the potential merits of undertaking "real world" analyses using medical claims data. We illustrate this approach by discussing an interesting recent publication in The Lancet Neurology, which used such an approach to demonstrate the value of specialized physiotherapy for PD patients, over and above usual care physiotherapy.

15 Review Pedunculopontine nucleus deep brain stimulation in Parkinson's disease: A clinical review. 2018

Thevathasan, Wesley / Debu, Bettina / Aziz, Tipu / Bloem, Bastiaan R / Blahak, Christian / Butson, Christopher / Czernecki, Virginie / Foltynie, Thomas / Fraix, Valerie / Grabli, David / Joint, Carole / Lozano, Andres M / Okun, Michael S / Ostrem, Jill / Pavese, Nicola / Schrader, Christoph / Tai, Chun-Hwei / Krauss, Joachim K / Moro, Elena / Anonymous621156. ·Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Australia and the Bionics Institute of Australia, Melbourne, Australia. · Movement Disorders Center, Division of Neurology, Centre Hospitalier Universitaire (CHU) Grenoble, Grenoble Alpes University, Grenoble, France. · Department of Neurosurgery, John Radcliffe Hospital, University of Oxford, Oxford, UK. · Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, the Netherlands. · Department of Neurology, Universitätsmedizin Mannheim, University of Heidelberg, Heidelberg, Germany. · Department of Bioengineering, Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, USA. · Department of Neurology, Institut de Cerveau et de la Moelle épinière, Sorbonne Universités, University Pierre-and-Marie-Curie (UPMC) Université, Paris, France. · Sobell Department of Motor Neuroscience, University College London (UCL) Institute of Neurology, United Kingdom. · Department of Neurology, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtière University Hospital, Paris, France. · Department of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, Canada. · Departments of Neurology and Neurosurgery, University of Florida Center for Movement Disorders, Gainesville, Florida, USA. · Department of Neurology, UCSF Movement Disorder and Neuromodulation Center, University of California, San Francisco, USA. · Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK. · Department of Clinical Medicine, Centre for Functionally Integrative Neuroscience, University of Aarhus, Aarhus, Denmark. · Department of Neurology, Hannover Medical School, Hannover, Germany. · Department of Neurology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan. · Department of Neurosurgery, Hannover Medical School, Hannover, Germany. ·Mov Disord · Pubmed #28960543.

ABSTRACT: Pedunculopontine nucleus region deep brain stimulation (DBS) is a promising but experimental therapy for axial motor deficits in Parkinson's disease (PD), particularly gait freezing and falls. Here, we summarise the clinical application and outcomes reported during the past 10 years. The published dataset is limited, comprising fewer than 100 cases. Furthermore, there is great variability in clinical methodology between and within surgical centers. The most common indication has been severe medication refractory gait freezing (often associated with postural instability). Some patients received lone pedunculopontine nucleus DBS (unilateral or bilateral) and some received costimulation of the subthalamic nucleus or internal pallidum. Both rostral and caudal pedunculopontine nucleus subregions have been targeted. However, the spread of stimulation and variance in targeting means that neighboring brain stem regions may be implicated in any response. Low stimulation frequencies are typically employed (20-80 Hertz). The fluctuating nature of gait freezing can confound programming and outcome assessments. Although firm conclusions cannot be drawn on therapeutic efficacy, the literature suggests that medication refractory gait freezing and falls can improve. The impact on postural instability is unclear. Most groups report a lack of benefit on gait or limb akinesia or dopaminergic medication requirements. The key question is whether pedunculopontine nucleus DBS can improve quality of life in PD. So far, the evidence supporting such an effect is minimal. Development of pedunculopontine nucleus DBS to become a reliable, established therapy would likely require a collaborative effort between experienced centres to clarify biomarkers predictive of response and the optimal clinical methodology. © 2017 International Parkinson and Movement Disorder Society.

16 Review Promising non-pharmacological therapies in PD: Targeting late stage disease and the role of computer based cognitive training. 2018

Van de Weijer, S C F / Hommel, A L A J / Bloem, B R / Nonnekes, J / De Vries, N M. ·Department of Neurology, Maastricht University Medical Center, Maastricht UMC+, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands. · Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, PO Box 9101, 6500 HB, Nijmegen, The Netherlands; Groenhuysen Organisation, Roosendaal, The Netherlands. · Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, PO Box 9101, 6500 HB, Nijmegen, The Netherlands. Electronic address: bas.bloem@radboudumc.nl. · Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, PO Box 9101, 6500 HB, Nijmegen, The Netherlands. ·Parkinsonism Relat Disord · Pubmed #28923292.

ABSTRACT: Non-pharmacological interventions are increasingly being acknowledged as valuable treatment options to overcome or reduce functional problems in patients with Parkinson's disease (PD). There is a wide range of such non-pharmacological treatments for which the supportive evidence is emerging. Physiotherapy is one good example in this domain. However, there are also several promising non-pharmacological treatment strategies that have thus far received less research attention. Here, we describe two relatively new, but encouraging approaches. First, we focus on a hitherto largely overseen subgroup of PD, namely those with late-stage disease, a population that is often excluded from clinical studies. Importantly, the aims and therapeutic strategies in late-stage PD differ considerably from those in early-stage PD, and an emphasis on non-pharmacological management is particularly important for this vulnerable subgroup. Second, we focus on computer-based cognitive training, as an example of a relatively new intervention that includes innovative elements such as personalized training, artificial intelligence, and virtual reality. We review the latest evidence, practical considerations and future research perspectives, both for non-pharmacological approaches in late-stage PD and for computer-based cognitive training.

17 Review Subthalamic Nucleus Deep Brain Stimulation: Basic Concepts and Novel Perspectives. 2017

Hamani, Clement / Florence, Gerson / Heinsen, Helmut / Plantinga, Birgit R / Temel, Yasin / Uludag, Kamil / Alho, Eduardo / Teixeira, Manoel J / Amaro, Edson / Fonoff, Erich T. ·Division of Neurosurgery Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada. · Division of Neuroimaging, Centre for Addiction and Mental Health, Toronto, Ontario, Canada. · Division of Neurosurgery, Department of Neurology, University of São Paulo Medical School, São Paulo, Brazil. · Department of Radiology, University of São Paulo Medical School, São Paulo, Brazil. · Department of Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University Clinic of Würzburg, Würzburg, Germany. · Department of Biomedical Image Analysis, Eindhoven University of Technology, Eindhoven, The Netherlands. · Department of Neurosurgery, Maastricht University Medical Center, Maastricht, The Netherlands. · Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands. · Department of Cognitive Neuroscience, Maastricht University, Maastricht, The Netherlands. · Instituto de Ensino e Pesquisa Hospital Sírio-Libanês, São Paulo, Brazil. ·eNeuro · Pubmed #28966978.

ABSTRACT: Over the last decades, extensive basic and clinical knowledge has been acquired on the use of subthalamic nucleus (STN) deep brain stimulation (DBS) for Parkinson's disease (PD). It is now clear that mechanisms involved in the effects of this therapy are far more complex than previously anticipated. At frequencies commonly used in clinical practice, neural elements may be excited or inhibited and novel dynamic states of equilibrium are reached. Electrode contacts used for chronic DBS in PD are placed near the dorsal border of the nucleus, a highly cellular region. DBS may thus exert its effects by modulating these cells, hyperdirect projections from motor cortical areas, afferent and efferent fibers to the motor STN. Advancements in neuroimaging techniques may allow us to identify these structures optimizing surgical targeting. In this review, we provide an update on mechanisms and the neural elements modulated by STN DBS.

18 Review A Guideline for Parkinson's Disease Nurse Specialists, with Recommendations for Clinical Practice. 2017

Lennaerts, Herma / Groot, Marieke / Rood, Berna / Gilissen, Koen / Tulp, Hella / van Wensen, Erik / Munneke, Marten / van Laar, Teus / Bloem, Bastiaan R. ·Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Nijmegen, The Netherlands. · Department of Anaesthesiology, Pain and Palliative Care, Radboud University Medical Center, Nijmegen, The Netherlands. · Department of Neurology, Medical centre Alkmaar, Alkmaar, The Netherlands. · Department of Neurology, Elkerliek Hospital, Helmond, The Netherlands. · Department of Neurology, Gelre Hospital, Apeldoorn, The Netherlands. · Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands. ·J Parkinsons Dis · Pubmed #28800338.

ABSTRACT: BACKGROUND: Parkinson's Disease Nurse Specialists (PDNS) play an important role in the care for patients with Parkinson's disease (PD) and their caregivers. Until now, there were no nursing guidelines in PD, and interventions were based solely on daily clinical practice because there is no evidence to support the merits of nursing interventions. Consequently, there is little uniformity in current care delivery. OBJECTIVE: Developing a guideline for PDNS. METHODS: We developed a guideline based on a questionnaire among PDNS and a literature review, supplemented with expert opinion plus the input of patients and caregivers. The questionnaire was filled in by 97 PDNS and 51 generic nurses with knowledge of PD to identify barriers in PD nursing care. Subsequently, we did a systematic literature search and transformed these sources of information into practice recommendations, which were developed according to international standards for guideline development. RESULTS: Based on the results of the questionnaire we identified seven specific core areas: defining the role of PDNS in terms of caseload, education, competences and care coordination; medication adherence; provision of information and education; coping; caregiver support; urogenital function and orthostatic hypotension. The systematic literature search identified 186 studies, of which 33 studies were finally analyzed. Furthermore, we developed practice recommendations based on good clinical practice for the following areas: self-care, mental functioning, mobility, nutrition, sexuality, work, sleep, palliative care and complementary (integrative) care. CONCLUSION: This guideline provide ground to harmonize care delivery by PDNS in clinical practice, and offer a foundation for future research.

19 Review What a neurologist should know about depression in Parkinson's disease. 2017

Timmer, Monique H M / van Beek, Maria H C T / Bloem, Bas R / Esselink, Rianne A J. ·Department of Psychiatry, Radboud University Medical Center, Nijmegen, The Netherlands. · Department of Neurology and Parkinson Center, Radboud University Medical Center, Nijmegen, The Netherlands. · Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands. ·Pract Neurol · Pubmed #28739866.

ABSTRACT: Depression is a frequent non-motor symptom of Parkinson's disease. Its prevalence varies widely across studies (between 2.7% and 90%); around 35% have clinically significant depressive symptoms. Although depression can have an immense impact on the quality of life of affected patients and their caregivers, depressive symptoms in Parkinson's disease frequently remain unrecognised and, as a result, remain untreated. Here we overview the diagnostic challenges and pitfalls, including the factors contributing to the underdiagnosis of depression. We also discuss current ideas on the underlying pathophysiology. Finally, we offer a treatment approach based on currently available evidence.

20 Review Palliative Care for Patients and Families With Parkinson's Disease. 2017

Bouça-Machado, Raquel / Titova, Nataliya / Chaudhuri, K Ray / Bloem, Bas R / Ferreira, Joaquim J. ·Clinical Pharmacology Unit, Instituto de Medicina Molecular, Lisbon, Portugal; CNS-Campus Neurológico Sénior, Torres Vedras, Portugal. · Federal State Budgetary Educational Institution of Higher Education "N.I. Pirogov Russian National Research Medical University" of the Ministry of Healthcare of the Russian Federation, Moscow, Russia. · National Parkinson Foundation International Centre of Excellence, Kings College and Kings College Hospital, London, United Kingdom; Maurice Wohl Clinical Neuroscience Institute, Kings College, London, United Kingdom; National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre (BRC) and Dementia Unit at South London and Maudsley NHS Foundation Trust, London, United Kingdom. · Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands. · Clinical Pharmacology Unit, Instituto de Medicina Molecular, Lisbon, Portugal; CNS-Campus Neurológico Sénior, Torres Vedras, Portugal; Laboratory of Clinical Pharmacology and Therapeutics, Faculty of Medicine, University of Lisbon, Lisbon, Portugal. Electronic address: joaquimjferreira@gmail.com. ·Int Rev Neurobiol · Pubmed #28554419.

ABSTRACT: Parkinson's disease is the second most common neurodegenerative disease worldwide. There is widespread consensus that Parkinson patients, their carers, and clinicians involved in their care would benefit from a fully integrated, need-based provision of palliative care. However, the concept of palliative care in Parkinson's disease is still poorly defined and, consequently, poorly implemented into daily clinical practice. A particular challenge is the gradually progressive nature of Parkinson's disease-with insidiously increasing disability-making it challenging to clearly define the onset of palliative care needs for Parkinson patients. As people with Parkinson's disease are now living longer than in the past, future research needs to develop a more robust evidence-based approach to clarify the disease events associated with increased palliative care needs, and to examine these, prospectively, in an integrated palliative care service. The modern palliative care outlook, termed "simultaneous care,",is no longer restricted to the final stage of disease. It involves incorporating a continuity of care, effective management of the chronic-palliative interface, and a multidisciplinary network of professionals working both in the community and in specialized clinics, with active involvement of caregivers. Although promising, there is still a need to demonstrate the effectiveness of palliative care for patients with Parkinson's disease.

21 Review Pathophysiology and Management of Parkinsonian Tremor. 2017

Helmich, Rick C / Dirkx, Michiel F. ·Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroimaging, Radboud University Nijmegen, Nijmegen, The Netherlands. ·Semin Neurol · Pubmed #28511253.

ABSTRACT: Parkinson's tremor is one of the cardinal motor symptoms of Parkinson's disease. The pathophysiology of Parkinson's tremor is different from that of other motor symptoms such as bradykinesia and rigidity. In this review, the authors discuss evidence suggesting that tremor is a network disorder that arises from distinct pathophysiological changes in the basal ganglia and in the cerebellothalamocortical circuit. They also discuss how interventions in this circuitry, for example, deep brain surgery and noninvasive brain stimulation, can modulate or even treat tremor. Future research may focus on understanding sources for the large variability between patients in terms of treatment response, on understanding the contextual factors that modulate tremor (stress, voluntary movements), and on focused interventions in the tremor circuitry.

22 Review [Helpful instrumental examinations in idiopathic Parkinson's disease]. 2017

Walter, U / Zach, H / Liepelt-Scarfone, I / Maetzler, W. ·Klinik und Poliklinik für Neurologie, Universitätsmedizin Rostock, Rostock, Deutschland. · Universitätsklinik für Neurologie, Medizinische Universität Wien, Wien, Österreich. · Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Radboud University Medical Centre, Nijmegen, Niederlande. · Hertie Institut für klinische Hirnforschung, Universität Tübingen und Deutsches Zentrum für Neurodegenerative Erkrankungen, Tübingen, Deutschland. · Klinik für Neurologie, Universitätsklinikum Schleswig-Holstein, Arnold-Heller-Straße 3, 24105, Kiel, Deutschland. w.maetzler@neurologie.uni-kiel.de. ·Nervenarzt · Pubmed #28289798.

ABSTRACT: BACKGROUND: The clinical diagnosis of idiopathic Parkinson's disease (iPD) can be challenging. In these cases, additional diagnostic methods are available that can help to improve diagnostic accuracy. OBJECTIVES, MATERIAL AND METHODS: This article provides an overview of currently available and promising novel ancillary methods for the early and differential diagnosis of iPD. RESULTS: Imaging tools, such as 1.5 Tesla magnetic resonance imaging (MRI) and computed tomography (CT) are mainly used for the differentiation between iPD and symptomatic parkinsonian syndromes (PS). High-resolution diffusion tensor imaging and iron and neuromelanin-sensitive high-field MRI sequences can become important in the future, particularly for earlier diagnosis. Transcranial B‑mode sonography of the substantia nigra and basal ganglia is established for early and differential diagnostics, especially in the combination of diagnostic markers but necessitates an adequately trained investigator and the use of validated digital image analysis instruments. DATScan can discriminate iPD from essential tremor, medication-induced parkinsonism and psychogenic movement disorder but not iPD from atypical PS. For the latter differential diagnosis, fluorodeoxyglucose positron emission tomography and myocardial metaiodobenzylguanidine scintigraphy can be helpful. Olfactory testing should preferably be used in combination with other diagnostic tests. Genetic, biochemical and histopathological tests are currently not recommended for routine use. Novel sensor-based techniques have a high potential to support clinical diagnosis of iPD but have not yet reached a developmental stage that is sufficient for clinical use. Novel sensor-based techniques have high potential to support clinical diagnosis of iPD, but have not yet reached a development stage that is sufficient for clinical use. CONCLUSION: Ancillary diagnostic methods can support the early and differential diagnosis of iPD.

23 Review Ocular and visual disorders in Parkinson's disease: Common but frequently overlooked. 2017

Ekker, Merel S / Janssen, Sabine / Seppi, Klaus / Poewe, Werner / de Vries, Nienke M / Theelen, Thomas / Nonnekes, Jorik / Bloem, Bastiaan R. ·Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Nijmegen, The Netherlands. · Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Nijmegen, The Netherlands; University of Twente, MIRA Institute for Biomedical Technology and Technical Medicine, Biomedical Signal and Systems Group, Enschede, The Netherlands. Electronic address: sabineneuro.janssen@radboudumc.nl. · Medizinische Universität Innsbruck, Department of Neurology, Innsbruck, Austria. · Radboud University Medical Centre, Department of Ophthalmology, Nijmegen, The Netherlands. · Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Rehabilitation, Nijmegen, The Netherlands. ·Parkinsonism Relat Disord · Pubmed #28284903.

ABSTRACT: Patients with Parkinson's disease (PD) often compensate for their motor deficits by guiding their movements visually. A wide range of ocular and visual disorders threatens the patients' ability to benefit optimally from visual feedback. These disorders are common in patients with PD, yet they have received little attention in both research and clinical practice, leading to unnecessary - but possibly treatable - disability. Based on a literature search covering 50 years, we review the range of ocular and visual disorders in patients with PD, and classify these according to anatomical structures of the visual pathway. We discuss six common disorders in more detail: dry eyes; diplopia; glaucoma and glaucoma-like visual problems; impaired contrast and colour vision; visuospatial and visuoperceptual impairments; and visual hallucinations. In addition, we review the effects of PD-related pharmacological and surgical treatments on visual function, and we offer practical recommendations for clinical management. Greater awareness and early recognition of ocular and visual problems in PD might enable timely instalment of tailored treatments, leading to improved patient safety, greater independence, and better quality of life.

24 Review Freezing of gait and fall detection in Parkinson's disease using wearable sensors: a systematic review. 2017

Silva de Lima, Ana Lígia / Evers, Luc J W / Hahn, Tim / Bataille, Lauren / Hamilton, Jamie L / Little, Max A / Okuma, Yasuyuki / Bloem, Bastiaan R / Faber, Marjan J. ·Radboud university medical center, Donders Institute for Brain, Cognition and Behavior, Nijmegen, The Netherlands. ana.silvadelima@radboudumc.nl. · Department of Neurology, Radboud university medical center, Nijmegen, The Netherlands. ana.silvadelima@radboudumc.nl. · CAPES Foundation, Ministry of Education of Brazil, Brasília, DF, Brazil. ana.silvadelima@radboudumc.nl. · Department of Neurology, Radboud university medical center, Nijmegen, The Netherlands. · Michael J Fox Foundation for Parkinson's Research, New York, USA. · Aston University, Birmingham, UK. · Media Lab, Massachusetts Institute of Technology, Cambridge, USA. · Department of Neurology, Juntendo University Shizuoka Hospital, Izunokuni, Shizuoka, Japan. · Radboud university medical center, Donders Institute for Brain, Cognition and Behavior, Nijmegen, The Netherlands. · Radboud university medical center, Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare, Nijmegen, The Netherlands. ·J Neurol · Pubmed #28251357.

ABSTRACT: Despite the large number of studies that have investigated the use of wearable sensors to detect gait disturbances such as Freezing of gait (FOG) and falls, there is little consensus regarding appropriate methodologies for how to optimally apply such devices. Here, an overview of the use of wearable systems to assess FOG and falls in Parkinson's disease (PD) and validation performance is presented. A systematic search in the PubMed and Web of Science databases was performed using a group of concept key words. The final search was performed in January 2017, and articles were selected based upon a set of eligibility criteria. In total, 27 articles were selected. Of those, 23 related to FOG and 4 to falls. FOG studies were performed in either laboratory or home settings, with sample sizes ranging from 1 PD up to 48 PD presenting Hoehn and Yahr stage from 2 to 4. The shin was the most common sensor location and accelerometer was the most frequently used sensor type. Validity measures ranged from 73-100% for sensitivity and 67-100% for specificity. Falls and fall risk studies were all home-based, including samples sizes of 1 PD up to 107 PD, mostly using one sensor containing accelerometers, worn at various body locations. Despite the promising validation initiatives reported in these studies, they were all performed in relatively small sample sizes, and there was a significant variability in outcomes measured and results reported. Given these limitations, the validation of sensor-derived assessments of PD features would benefit from more focused research efforts, increased collaboration among researchers, aligning data collection protocols, and sharing data sets.

25 Review Top Altmetric Scores in the Parkinson's Disease Literature. 2017

Araújo, Rui / Sorensen, Aaron A / Konkiel, Stacy / Bloem, Bastiaan R. ·Department of Neurology Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal. · ÜberResearch - Digital Science, Inc., Cambridge, MA, USA. · Altmetric LLC - Digital Science, Inc., Cambridge, MA, USA. · Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, The Netherlands. ·J Parkinsons Dis · Pubmed #28222540.

ABSTRACT: A new class of social web-based metrics for scholarly publications (altmetrics) has surfaced as a complement to traditional citation-based metrics. Our aim was to study and characterize those recent papers in the field of Parkinson's disease which had received the highest Altmetric Attention Scores and to compare this attention measure to the traditional metrics. The top 20 papers in our analysis covered a variety of topics, mainly new disease mechanisms, treatment options and risk factors for the development of PD. The main media sources for these high attention papers were news items and Twitter. The papers were published predominantly in high impact journals, suggesting a correlation between altmetrics and conventional metrics. One paper published in a relatively modest journal received a significant amount of attention, reflecting that public attention does not always parallel the traditional metrics. None of the most influential papers in PD, as reviewed by Ponce and Lozano (2011) made it to our list, suggesting that recent publications receive higher attention scores, and that altmetrics may omit older, seminal work in the field.

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