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Parkinson Disease: HELP
Articles from University of Arkansas Little Rock
Based on 26 articles published since 2010
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These are the 26 published articles about Parkinson Disease that originated from University of Arkansas Little Rock during 2010-2020.
 
+ Citations + Abstracts
Pages: 1 · 2
1 Editorial Managing treatment fluctuations in Parkinson disease: "On" again-, "off" again. 2019

Metzer, W Steven / Rodrigues, Filipe B. ·From the Department of Neurology (W.S.M.), University of Arkansas for Medical Sciences, Little Rock · UCL Huntington's Disease Centre (F.B.R.), UCL Queen Square Institute of Neurology, London, UK · Clinical Pharmacology Unit (F.B.R.), Instituto de Medicina Molecular, Lisbon · and Laboratory of Clinical Pharmacology and Therapeutics (F.B.R.), Faculty of Medicine, University of Lisbon, Portugal. ·Neurology · Pubmed #30824561.

ABSTRACT: -- No abstract --

2 Review Focus on the pedunculopontine nucleus. Consensus review from the May 2018 brainstem society meeting in Washington, DC, USA. 2019

Garcia-Rill, E / Saper, C B / Rye, David B / Kofler, M / Nonnekes, J / Lozano, A / Valls-Solé, J / Hallett, M. ·Center for Translational Neuroscience, Department of Neurobiology and Developmental Sciences, University of Arkansas for Medical Sciences, Little Rock, AR, USA. Electronic address: garciarilledgar@uams.edu. · Department of Neurology, Division of Sleep Medicine and Program in Neuroscience, Harvard Medical School, Boston, MA, USA. · Department of Neurology, Hochzirl Hospital, Zirl, Austria. · Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Rehabilitation, Nijmegen, the Netherlands. · Division of Neurosurgery, University of Toronto and Krembil Neuroscience Centre, University Health Network, Toronto, Canada. · Neurology Department, Hospital Clínic, University of Barcelona, IDIBAPS (Institut d'Investigació Biomèdica August Pi i Sunyer), Barcelona, Spain. · Human Motor Control Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA. ·Clin Neurophysiol · Pubmed #30981899.

ABSTRACT: The pedunculopontine nucleus (PPN) is located in the mesopontine tegmentum and is best delimited by a group of large cholinergic neurons adjacent to the decussation of the superior cerebellar peduncle. This part of the brain, populated by many other neuronal groups, is a crossroads for many important functions. Good evidence relates the PPN to control of reflex reactions, sleep-wake cycles, posture and gait. However, the precise role of the PPN in all these functions has been controversial and there still are uncertainties in the functional anatomy and physiology of the nucleus. It is difficult to grasp the extent of the influence of the PPN, not only because of its varied functions and projections, but also because of the controversies arising from them. One controversy is its relationship to the mesencephalic locomotor region (MLR). In this regard, the PPN has become a new target for deep brain stimulation (DBS) for the treatment of parkinsonian gait disorders, including freezing of gait. This review is intended to indicate what is currently known, shed some light on the controversies that have arisen, and to provide a framework for future research.

3 Review Bottom-up gamma maintenance in various disorders. 2019

Garcia-Rill, E / Mahaffey, S / Hyde, James R / Urbano, F J. ·Center for Translational Neuroscience, University of Arkansas for Medical Sciences, Little Rock, AR, USA. Electronic address: GarciaRillEdgar@uams.edu. · Center for Translational Neuroscience, University of Arkansas for Medical Sciences, Little Rock, AR, USA. · University of Pittsburgh, Pittsburgh, PA, USA. · IFIBYNE (CONICET-UBA), DFBMC, Universidad de Buenos Aires, Buenos Aires, Argentina. ·Neurobiol Dis · Pubmed #29353013.

ABSTRACT: Maintained gamma band activity is a key element of higher brain function, participating in perception, executive function, and memory. The pedunculopontine nucleus (PPN), as part of the reticular activating system (RAS), is a major source of the "bottom-up" flow of gamma activity to higher regions. However, interruption of gamma band activity is associated with a number of neurological and psychiatric disorders. This review will focus on the role of the PPN in activating higher regions to induce arousal and descending pathways to modulate posture and locomotion. As such, PPN deep brain stimulation (DBS) can not only help regulate arousal and stepping, but continuous application may help maintain necessary levels of gamma band activity for a host of other brain processes. We will explore the potential future applications of PPN DBS for a number of disorders that are characterized by disturbances in gamma band maintenance.

4 Review Protein Kinases and Parkinson's Disease. 2016

Mehdi, Syed Jafar / Rosas-Hernandez, Hector / Cuevas, Elvis / Lantz, Susan M / Barger, Steven W / Sarkar, Sumit / Paule, Merle G / Ali, Syed F / Imam, Syed Z. ·Department of Geriatrics, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA. SJMehdi@uams.edu. · Division of Neurotoxicology, National Center for Toxicological Research/US Food and Drug Administration, Jefferson, AR 72079, USA. Hector.Rosas-Hernandez@fda.hhs.gov. · Division of Neurotoxicology, National Center for Toxicological Research/US Food and Drug Administration, Jefferson, AR 72079, USA. Elvis-Yane.Cuevas-Martinez@fda.hhs.gov. · Division of Neurotoxicology, National Center for Toxicological Research/US Food and Drug Administration, Jefferson, AR 72079, USA. Susan.Lantz@fda.hhs.gov. · Department of Geriatrics, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA. BargerStevenW@uams.edu. · Geriatric Research Education and Clinical Center, Central Arkansas Veterans Healthcare System, Little Rock, AR 72205, USA. BargerStevenW@uams.edu. · Division of Neurotoxicology, National Center for Toxicological Research/US Food and Drug Administration, Jefferson, AR 72079, USA. Sumit.Sarkar@fda.hhs.gov. · Division of Neurotoxicology, National Center for Toxicological Research/US Food and Drug Administration, Jefferson, AR 72079, USA. Merle.Paule@fda.hhs.gov. · Division of Neurotoxicology, National Center for Toxicological Research/US Food and Drug Administration, Jefferson, AR 72079, USA. Syed.Ali@fda.hhs.gov. · Department of Geriatrics, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA. Syed.Imam@fda.hhs.gov. · Division of Neurotoxicology, National Center for Toxicological Research/US Food and Drug Administration, Jefferson, AR 72079, USA. Syed.Imam@fda.hhs.gov. ·Int J Mol Sci · Pubmed #27657053.

ABSTRACT: Currently, the lack of new drug candidates for the treatment of major neurological disorders such as Parkinson's disease has intensified the search for drugs that can be repurposed or repositioned for such treatment. Typically, the search focuses on drugs that have been approved and are used clinically for other indications. Kinase inhibitors represent a family of popular molecules for the treatment and prevention of various cancers, and have emerged as strong candidates for such repurposing because numerous serine/threonine and tyrosine kinases have been implicated in the pathobiology of Parkinson's disease. This review focuses on various kinase-dependent pathways associated with the expression of Parkinson's disease pathology, and evaluates how inhibitors of these pathways might play a major role as effective therapeutic molecules.

5 Review Arousal, motor control, and parkinson's disease. 2015

Garcia-Rill, E / Luster, B / D'Onofrio, S / Mahaffey, S. ·Center for Translational Neuroscience, University of Arkansas for Medical Sciences, Little Rock, AR, USA. ·Transl Neurosci · Pubmed #27747095.

ABSTRACT: This review highlights the most important discovery in the reticular activating system (RAS) in the last 10 years, the manifestation of gamma (γ) band activity in cells of the RAS, especially in the pedunculopontine nucleus (PPN), which is in charge of the high frequency states of waking and rapid eye movement sleep. This discovery is critical to understanding the modulation of movement by the RAS and how it sets the background over which we generate voluntary and triggered movements. The presence of γ band activity in the RAS is proposed to participate in the process of preconscious awareness, and provide the essential stream of information for the formulation of many of our actions. Early findings using stimulation of this region to induce arousal, and also to elicit stepping, are placed in this context. This finding also helps explain the novel use of PPN deep brain stimulation for the treatment of Parkinson's disease, although considerable work remains to be done.

6 Review Molecular diagnostics of neurodegenerative disorders. 2015

Agrawal, Megha / Biswas, Abhijit. ·Department of Biology, University of Arkansas at Little Rock Little Rock, AR, USA. · Department of Electrical Engineering, Center for Nano Science and Technology, University of Notre Dame Notre Dame, IN, USA. ·Front Mol Biosci · Pubmed #26442283.

ABSTRACT: Molecular diagnostics provide a powerful method to detect and diagnose various neurological diseases such as Alzheimer's and Parkinson's disease. The confirmation of such diagnosis allows early detection and subsequent medical counseling that help specific patients to undergo clinically important drug trials. This provides a medical pathway to have better insight of neurogenesis and eventual cure of the neurodegenerative diseases. In this short review, we present recent advances in molecular diagnostics especially biomarkers and imaging spectroscopy for neurological diseases. We describe advances made in Alzheimer's disease (AD), Parkinson's disease (PD), Amyotrophic lateral sclerosis (ALS) and Huntington's disease (HD), and finally present a perspective on the future directions to provide a framework for further developments and refinements of molecular diagnostics to combat neurodegenerative disorders.

7 Review Understanding the Influence of Parkinson Disease on Adolf Hitler's Decision-Making during World War II. 2015

Gupta, Raghav / Kim, Christopher / Agarwal, Nitin / Lieber, Bryan / Monaco, Edward A. ·Department of Biology, College of New Jersey, Ewing, New Jersey, USA. · Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA. Electronic address: agarwaln@upmc.edu. · Department of Neurosurgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA. · Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA. ·World Neurosurg · Pubmed #26093359.

ABSTRACT: Parkinson disease (PD) is a common neurodegenerative disorder characterized by the presence of Lewy bodies and a reduction in the number of dopaminergic neurons in the substantia nigra of the basal ganglia. Common symptoms of PD include a reduction in control of voluntary movements, rigidity, and tremors. Such symptoms are marked by a severe deterioration in motor function. The causes of PD in many cases are unknown. PD has been found to be prominent in several notable people, including Adolf Hitler, the Chancellor of Germany and Führer of Nazi Germany during World War II. It is believed that Adolf Hitler suffered from idiopathic PD throughout his life. However, the effect of PD on Adolf Hitler's decision making during World War II is largely unknown. Here we examine the potential role of PD in shaping Hitler's personality and influencing his decision-making. We purport that Germany's defeat in World War II was influenced by Hitler's questionable and risky decision-making and his inhumane and callous personality, both of which were likely affected by his condition. Likewise his paranoid disorder marked by intense anti-Semitic beliefs influenced his treatment of Jews and other non-Germanic peoples. We also suggest that the condition played an important role in his eventual political decline.

8 Clinical Trial Association of metabolic syndrome and change in Unified Parkinson's Disease Rating Scale scores. 2017

Leehey, Maureen / Luo, Sheng / Sharma, Saloni / Wills, Anne-Marie A / Bainbridge, Jacquelyn L / Wong, Pei Shieen / Simon, David K / Schneider, Jay / Zhang, Yunxi / Pérez, Adriana / Dhall, Rohit / Christine, Chadwick W / Singer, Carlos / Cambi, Franca / Boyd, James T. ·From the Department of Neurology (M.L.) and Department of Clinical Pharmacy (J.L.B.), Skaggs School of Pharmacy and Pharmaceutical Sciences, Department of Neurology, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora · Department of Biostatistics (S.L., Y.Z.), University of Texas Health Science Center at Houston · Center for Human Experimental Therapeutics (S.S.), University of Rochester, NY · Department of Neurology (A.-M.A.W.), Massachusetts General Hospital and Harvard Medical School, Boston · Department of Pharmacy (P.S.W.), Singapore General Hospital · Department of Neurology (D.K.S.), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA · Department of Pathology, Anatomy, & Cell Biology (J.S.), Thomas Jefferson University, Philadelphia, PA · Department of Biostatistics (Y.Z.), School of Public Health, University of Texas Health Science Center, Houston · Department of Biostatistics (A.P.), School of Public Health, University of Texas Health Science Center at Houston-UTHealth, Austin · Department of Neurology (R.D.), University of Arkansas for Medical Sciences, Little Rock · Department of Neurology (C.W.C.), University of California San Francisco · Department of Neurology (C.S.), Leonard M. Miller School of Medicine, University of Miami, FL · Department of Neurology (F.C.), University of Pittsburgh, PA · and Department of Neurological Sciences (J.T.B.), Larner College of Medicine, University of Vermont, Burlington. Dr. Luo is currently with the Department of Biostatistics and Bioinformatics, Duke University, Durham, NC. ·Neurology · Pubmed #28972194.

ABSTRACT: OBJECTIVE: To explore the association between metabolic syndrome and the Unified Parkinson's Disease Rating Scale (UPDRS) scores and, secondarily, the Symbol Digit Modalities Test (SDMT). METHODS: This is a secondary analysis of data from 1,022 of 1,741 participants of the National Institute of Neurological Disorders and Stroke Exploratory Clinical Trials in Parkinson Disease Long-Term Study 1, a randomized, placebo-controlled trial of creatine. Participants were categorized as having or not having metabolic syndrome on the basis of modified criteria from the National Cholesterol Education Program Adult Treatment Panel III. Those who had the same metabolic syndrome status at consecutive annual visits were included. The change in UPDRS and SDMT scores from randomization to 3 years was compared in participants with and without metabolic syndrome. RESULTS: Participants with metabolic syndrome (n = 396) compared to those without (n = 626) were older (mean [SD] 63.9 [8.1] vs 59.9 [9.4] years; CONCLUSIONS: Persons with Parkinson disease meeting modified criteria for metabolic syndrome experienced a greater increase in total UPDRS scores over time, mainly as a result of increases in motor scores, compared to those who did not. Further studies are needed to confirm this finding. CLINICALTRIALSGOV IDENTIFIER: NCT00449865.

9 Article Dopamine replacement improves motor learning of an upper extremity task in people with Parkinson disease. 2020

Paul, Serene S / Dibble, Leland E / Olivier, Genevieve N / Walter, Christopher / Duff, Kevin / Schaefer, Sydney Y. ·Department of Physical Therapy and Athletic Training, University of Utah, 520 Wakara Way, Salt Lake City, UT, 84108, USA; Discipline of Physiotherapy, Faculty of Health Sciences, The University of Sydney, 75 East St, Lidcombe, NSW, 2141, Australia. Electronic address: serene.paul@sydney.edu.au. · Department of Physical Therapy and Athletic Training, University of Utah, 520 Wakara Way, Salt Lake City, UT, 84108, USA. · Department of Physical Therapy and Athletic Training, University of Utah, 520 Wakara Way, Salt Lake City, UT, 84108, USA; Department of Physical Therapy, University of Arkansas for Medical Sciences, 1125 N College Ave, Fayetteville, AR, 72703, USA. · Center for Alzheimer's Care, Imaging & Research, Department of Neurology, University of Utah, 650 Komas Dr 106A, Salt Lake City, UT, 84108, USA. · Department of Physical Therapy and Athletic Training, University of Utah, 520 Wakara Way, Salt Lake City, UT, 84108, USA; Department of Biological and Health Systems Engineering, Arizona State University, 501 E Tyler Mall, MC 9709, Tempe, AZ, 85287, USA. ·Behav Brain Res · Pubmed #31526767.

ABSTRACT: BACKGROUND: Dopamine replacement medication has positive effects on existing motor skills for people with Parkinson disease (PD), but may have detrimental effects on the learning of motor skills necessary for effective rehabilitation according to the dopamine overdose hypothesis. OBJECTIVES: This study aimed to determine whether dopamine replacement medication (i.e. levodopa) affects: learning of a novel upper extremity task, decrements in skill following withdrawal of practice, the rate of learning, and the transfer of movement skill to untrained upper extremity tasks compared to training "off" medication, in people with PD. METHODS: Participants with mild-moderate PD (Hoehn and Yahr stage 2) were randomized to train "on" (n = 12) or "off" (n = 11) levodopa medication. Participants practiced 10 blocks of five trials of a functional motor task with their non-dominant upper extremity over three consecutive days (acquisition period), followed by a single block of five trials two and nine days later. Participants were also assessed "on" levodopa with two transfer tasks (the nine-hole peg test and a functional dexterity task) prior to any practice and nine days after the end of the acquisition period. RESULTS: Participants who practiced "on" levodopa medication learned the upper extremity task to a greater extent that those who practiced "off" medication, as determined by retained performance two days after practice. Skill decrement and skill transfer were not significantly different between groups. Rate of learning was unable to be modelled in this sample. CONCLUSIONS: Levodopa medication improved the learning of an upper extremity task in people with mild-moderate PD.

10 Article Objective impairment of tandem gait in Parkinson's disease patients increases with disease severity. 2019

Sharma, Rohan / Pillai, Lakshmi / Glover, Aliyah / Virmani, Tuhin. ·Department of Neurology, University of Arkansas for Medical Sciences, Little Rock, AR, USA. · Department of Neurology, University of Arkansas for Medical Sciences, Little Rock, AR, USA; Center for Translational Neuroscience, University of Arkansas for Medical Sciences, Little Rock, AR, USA. Electronic address: TVirmani@uams.edu. ·Parkinsonism Relat Disord · Pubmed #31621615.

ABSTRACT: INTRODUCTION: Tandem gait abnormalities have been reported to increase with advancing age, play a role in fall-prediction in Parkinson's disease, and distinguish it from atypical parkinsonism. Tandem gait has been scored based on the number of side steps off a straight line in these studies. Objective measurement of spatiotemporal tandem gait parameters in Parkinson's disease has not been previously reported. METHODS: Subjects (74 Parkinson's disease and 28 controls) were enrolled after IRB approval. Those with more than 1 fall/day or a Montreal Cognitive Assessment score <10 were excluded. Subjects tandem walked ("heel to toe") on a 20 foot pressure-sensor mat. Data was collected and analyzed using PKMAS software (Protokinetics). RESULTS: Compared to controls, on tandem gait, Parkinson's subjects had increased step width, stride width and path width, with a slower stride velocity and an increased time spent in all phases of the gait cycle. Parkinson's subjects also applied greater pressure with each step and had greater step-to-step variability in tandem gait measures. While Hoehn & Yahr stage 1 subjects were not significantly different from controls, stage 2 and 2.5 + groups were different. Parkinson's subjects with freezing of gait also walked with a wider base compared to those without gait freezing. Tandem gait spatiotemporal parameters were not correlated with fall frequency. CONCLUSIONS: Tandem gait is impaired in Parkinson's disease in a stage-dependent manner, with wider base and increased step-to-step variability, which could suggest involvement of cerebellar and mediolateral balance pathways.

11 Article Qualitative Evaluation of the Personal KinetiGraphTM Movement Recording System in a Parkinson's Clinic. 2019

Santiago, Anthony / Langston, James W / Gandhy, Rita / Dhall, Rohit / Brillman, Salima / Rees, Linda / Barlow, Carrolee. ·Formerly of Parkinson's Institute and Clinical Center, Sunnyvale, CA, USA. · Department of Neurology, University of Arkansas, Little Rock, AR, USA. · Parkinson's Institute and Clinical Center, Sunnyvale, CA, USA. ·J Parkinsons Dis · Pubmed #30412506.

ABSTRACT: BACKGROUND: Wearable sensors provide accurate, continuous objective measurements, quantifying the variable motor states of patients with Parkinson's disease (PD) in real time. OBJECTIVES: To evaluate the impact of using continuous objective measurement using the Personal KinetiGraph™ (PKG®) Movement Recording System in the routine clinical care of patients with PD (PwP). METHODS: Physicians employed the use of the PKG in patients for whom they were seeking objective measurement. Patients wore a PKG data logger for ≥6 days during routine daily living activities. During the survey period of December 2015 through July 2016, physician surveys were completed by four Movement Disorder Specialists for whom measurements from the PKG were available during a subsequent routine clinic visit. RESULTS: Of 112 completed physician surveys, 46 (41%) indicated the PKG provided relevant additional information sufficient to consider adjusting their therapeutic management plan; 66 (59%) indicated the PKG provided no further information to support a therapeutic decision differing from that made during a routine clinical evaluation. Upon further review of these 46 surveys, 36 surveys (78%) revealed the information provided by the PKG ultimately resulted in adjusting the patient's medical management. CONCLUSIONS: The PKG provided novel additional information beyond that captured during a routine clinic visit sufficient to change the medical management of PwP. Physicians adjusted treatment nearly a third of the time based on data provided by real-time, remote monitoring outside the clinic setting. The use of the PKG may provide for better informed therapeutic decisions, improving the quality of life for PwP.

12 Article Procedural Variables Influencing Stereotactic Accuracy and Efficiency in Deep Brain Stimulation Surgery. 2019

Mirzadeh, Zaman / Chen, Tsinsue / Chapple, Kristina M / Lambert, Margaret / Karis, John P / Dhall, Rohit / Ponce, Francisco A. ·Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona. · Department of Neuroradiology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona. · Department of Neurology, University of Arkansas for Medical Sciences, Little Rock, Arkansas. ·Oper Neurosurg (Hagerstown) · Pubmed #30339204.

ABSTRACT: BACKGROUND: Deep brain stimulation (DBS) is well-established, evidence-based therapy for Parkinson disease, essential tremor, and primary dystonia. Clinical outcome studies have recently shown that "asleep" DBS lead placement, performed using intraoperative imaging with stereotactic accuracy as the surgical endpoint, has motor outcomes comparable to traditional "awake" DBS using microelectrode recording (MER), but with shorter case times and improved speech fluency. OBJECTIVE: To identify procedural variables in DBS surgery associated with improved surgical efficiency and stereotactic accuracy. METHODS: Retrospective review of 323 cases with 546 leads placed (August 2011-October 2014). In 52% (n = 168) of cases, patients were asleep under general anesthesia without MER. Multivariate regression identified independent predictors of reduced surgery time and improved stereotactic accuracy. RESULTS: MER was an independent contributor to increased procedure time (+44 min; P = .03). Stereotactic accuracy was better in asleep patients. Accuracy was improved with frame-based stereotaxy at head of bed 0° vs frameless stereotaxy at head of bed 30°. Improved accuracy was also associated with shorter procedures (r = 0.17; P = .049). Vector errors were evenly distributed around the planned target for the globus pallidus internus, but directionally skewed for the subthalamic (medial-posterior) and ventral intermediate nuclei (medial-anterior). CONCLUSION: Distinct procedural variables in DBS surgery are associated with reduced case times and improved stereotactic accuracy.

13 Article Dopamine Replacement Medication Does Not Influence Implicit Learning of a Stepping Task in People With Parkinson's Disease. 2018

Paul, Serene S / Schaefer, Sydney Y / Olivier, Genevieve N / Walter, Christopher S / Lohse, Keith R / Dibble, Leland E. ·1 The University of Sydney, Australia. · 2 University of Utah, Salt Lake City, UT, USA. · 3 Arizona State University, Tempe, AZ, USA. · 4 University of Arkansas for Medical Sciences, Fayetteville, AR, USA. ·Neurorehabil Neural Repair · Pubmed #30409107.

ABSTRACT: INTRODUCTION: Treatment of Parkinson's disease (PD) with exogenous dopamine (ie, levodopa) may positively affect motor symptoms, but may negatively affect other functions such as the learning of motor skills necessary for rehabilitation. This study aimed to determine whether levodopa medication affects general and sequence-specific learning of a stepping task and the transfer of movement skill to untrained balance tasks in people with PD. METHODS: Participants with PD were randomized to practice "on" (n = 14) or "off" (n = 13) levodopa medication. Participants practiced 6 blocks of 6 trials of 24 steps of a stepping task over an acquisition period of 3 consecutive days, followed by single retention blocks of 6 trials 2 and 9 days later. Participants were also assessed on untrained balance (ie, transfer) tasks "on" levodopa before practice and following late retention. RESULTS: There were no between-group differences in general learning, sequence-specific learning, or transfer of skill to untrained balance tasks ( P > .05). Both groups demonstrated general and sequence-specific learning ( P < .001) and trends for improvement in untrained tasks ( P < .001 to P = .26) following practice. Detailed analysis of early acquisition revealed no difference between medication groups. CONCLUSION: People with PD improved performance on the stepping task with practice. The between-group effect sizes were small, suggesting that levodopa medication status ("on" versus "off") during practice did not significantly affect general or sequence-specific learning of the task or components of early acquisition. The practice dose required to optimally result in functional improvements in untrained balance tasks, including reductions in falls, remains to be determined.

14 Article Use of a Modified STROOP Test to Assess Color Discrimination Deficit in Parkinson's Disease. 2018

Langston, Rebekah G / Virmani, Tuhin. ·College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, United States. · Department of Neurology, University of Arkansas for Medical Sciences, Little Rock, AR, United States. ·Front Neurol · Pubmed #30258399.

ABSTRACT:

15 Article Nucleus Basalis of Meynert Stimulation for Dementia: Theoretical and Technical Considerations. 2018

Kumbhare, Deepak / Palys, Viktoras / Toms, Jamie / Wickramasinghe, Chathurika S / Amarasinghe, Kasun / Manic, Milos / Hughes, Evan / Holloway, Kathryn L. ·Department of Neurosurgery, Virginia Commonwealth University Health System, Richmond, VA, United States. · McGuire Research Institute, Hunter Holmes McGuire VA Medical Center, Richmond, VA, United States. · Department of Neurosurgery, University of Arkansas for Medical Sciences, Little Rock, AR, United States. · Southeast PD Research, Education and Clinical Center, Hunter Holmes McGuire VA Medical Center, Richmond, VA, United States. · Department of Computer Science, Virginia Commonwealth University, Richmond, VA, United States. · School of Medicine, Virginia Commonwealth University, Richmond, VA, United States. ·Front Neurosci · Pubmed #30233297.

ABSTRACT: Deep brain stimulation (DBS) of nucleus basalis of Meynert (NBM) is currently being evaluated as a potential therapy to improve memory and overall cognitive function in dementia. Although, the animal literature has demonstrated robust improvement in cognitive functions, phase 1 trial results in humans have not been as clear-cut. We hypothesize that this may reflect differences in electrode location within the NBM, type and timing of stimulation, and the lack of a biomarker for determining the stimulation's effectiveness in real time. In this article, we propose a methodology to address these issues in an effort to effectively interface with this powerful cognitive nucleus for the treatment of dementia. Specifically, we propose the use of diffusion tensor imaging to identify the nucleus and its tracts, quantitative electroencephalography (QEEG) to identify the physiologic response to stimulation during programming, and investigation of stimulation parameters that incorporate the phase locking and cross frequency coupling of gamma and slower oscillations characteristic of the NBM's innate physiology. We propose that modulating the baseline gamma burst stimulation frequency, specifically with a slower rhythm such as theta or delta will pose more effective coupling between NBM and different cortical regions involved in many learning processes.

16 Article Increased foot strike variability in Parkinson's disease patients with freezing of gait. 2018

Shah, Jesal / Pillai, Lakshmi / Williams, David K / Doerhoff, Shannon M / Larson-Prior, Linda / Garcia-Rill, Edgar / Virmani, Tuhin. ·College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA. · Department of Neurology, University of Arkansas for Medical Sciences, Little Rock, AR, USA. · Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, AR, USA. · Department of Neurology, University of Arkansas for Medical Sciences, Little Rock, AR, USA; Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, USA; Department of Neurobiology & Developmental Sciences, University of Arkansas for Medical Sciences, Little Rock, AR, USA. · Department of Neurobiology & Developmental Sciences, University of Arkansas for Medical Sciences, Little Rock, AR, USA. · Department of Neurology, University of Arkansas for Medical Sciences, Little Rock, AR, USA. Electronic address: TVirmani@uams.edu. ·Parkinsonism Relat Disord · Pubmed #29773512.

ABSTRACT: INTRODUCTION: Freezing of gait (FOG) is a debilitating, late motor complication of Parkinson's disease (PD) that occurs in 50-80% of patients. Gait freezing significantly worsens quality of life by decreasing mobility and increasing falls. Studies have shown that patients with episodic freezing episodes also have deficits in continuous gait. We evaluated whether there was an objective gait correlate to the increased stumbling reported by many patients with gait freezing. METHODS: PD subjects and healthy controls (HC) were enrolled after IRB approval. Subjects with more than 1 fall/day or a Montreal Cognitive Assessment score <10 were excluded. Subjects walked at their normal pace, 8 lengths of a 20 × 4 foot pressure-sensor mat. Data was collected and analyzed using PKMAS software (Protokinetics) and statistical analysis performed using SPSS 22 (IBM). RESULTS: 72 age matched subjects (22 PD FOG, 27 PD no-FOG, and 23 HC) were enrolled. Disease duration and Hoehn & Yahr scores were not significantly different between the PD groups. Mean dimensions of foot strike were not significantly different between groups, but PD FOG subjects had increased step-to-step variability in foot strike as measured by the percent coefficient of variation (%CV) in foot strike length compared to PD no-FOG and HC, independent of stride velocity. In PD no-FOG subjects, fallers also had higher variability in foot strike length compared to non-fallers. CONCLUSION: PD subjects with FOG had increased variability in foot strike suggesting that in addition to stride length variability, foot strike variability could contribute to imbalance leading to falls.

17 Article Clinical outcomes following awake and asleep deep brain stimulation for Parkinson disease. 2018

Chen, Tsinsue / Mirzadeh, Zaman / Chapple, Kristina M / Lambert, Margaret / Shill, Holly A / Moguel-Cobos, Guillermo / Tröster, Alexander I / Dhall, Rohit / Ponce, Francisco A. ·Departments of1Neurosurgery. · 2Neurology, and. · 3Clinical Neuropsychology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; and. · 4Department of Neurology, University of Arkansas for Medical Sciences, Little Rock, Arkansas. ·J Neurosurg · Pubmed #29547091.

ABSTRACT: OBJECTIVE: Recent studies have shown similar clinical outcomes between Parkinson disease (PD) patients treated with deep brain stimulation (DBS) under general anesthesia without microelectrode recording (MER), so-called “asleep” DBS, and historical cohorts undergoing “awake” DBS with MER guidance. However, few studies include internal controls. This study aims to compare clinical outcomes after globus pallidus internus (GPi) and subthalamic nucleus (STN) DBS using awake and asleep techniques at a single institution. METHODS: PD patients undergoing awake or asleep bilateral GPi or STN DBS were prospectively monitored. The primary outcome measure was stimulation-induced change in motor function off medication 6 months postoperatively, measured using the Unified Parkinson’s Disease Rating Scale part III (UPDRS-III). Secondary outcomes included change in quality of life, measured by the 39-item Parkinson’s Disease Questionnaire (PDQ-39), change in levodopa equivalent daily dosage (LEDD), stereotactic accuracy, stimulation parameters, and adverse events. RESULTS: Six-month outcome data were available for 133 patients treated over 45 months (78 GPi [16 awake, 62 asleep] and 55 STN [14 awake, 41 asleep]). UPDRS-III score improvement with stimulation did not differ between awake and asleep groups for GPi (awake, 20.8 points [38.5%]; asleep, 18.8 points [37.5%]; p = 0.45) or STN (awake, 21.6 points [40.3%]; asleep, 26.1 points [48.8%]; p = 0.20) targets. The percentage improvement in PDQ-39 and LEDD was similar for awake and asleep groups for both GPi (p = 0.80 and p = 0.54, respectively) and STN cohorts (p = 0.85 and p = 0.49, respectively). CONCLUSIONS: In PD patients, bilateral GPi and STN DBS using the asleep method resulted in motor, quality-of-life, and medication reduction outcomes that were comparable to those of the awake method.

18 Article Awake versus asleep deep brain stimulation for Parkinson's disease: a critical comparison and meta-analysis. 2018

Ho, Allen L / Ali, Rohaid / Connolly, Ian D / Henderson, Jaimie M / Dhall, Rohit / Stein, Sherman C / Halpern, Casey H. ·Department of Neurosurgery, Stanford University School of Medicine, Stanford, USA. · Department of Neurology, University of Arkansas for Medical Sciences, Little Rock, USA. · Department of Neurosurgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, USA. ·J Neurol Neurosurg Psychiatry · Pubmed #28250028.

ABSTRACT: OBJECTIVE: No definitive comparative studies of the efficacy of 'awake' deep brain stimulation (DBS) for Parkinson's disease (PD) under local or general anaesthesia exist, and there remains significant debate within the field regarding differences in outcomes between these two techniques. METHODS: We conducted a literature review and meta-analysis of all published DBS for PD studies (n=2563) on PubMed from January 2004 to November 2015. Inclusion criteria included patient number >15, report of precision and/or clinical outcomes data, and at least 6 months of follow-up. There were 145 studies, 16 of which were under general anaesthesia. Data were pooled using an inverse-variance weighted, random effects meta-analytic model for observational data. RESULTS: There was no significant difference in mean target error between local and general anaesthesia, but there was a significantly less mean number of DBS lead passes with general anaesthesia (p=0.006). There were also significant decreases in DBS complications, with fewer intracerebral haemorrhages and infections with general anaesthesia (p<0.001). There were no significant differences in Unified Parkinson's Disease Rating Scale (UPDRS) Section II scores off medication, UPDRS III scores off and on medication or levodopa equivalent doses between the two techniques. Awake DBS cohorts had a significantly greater decrease in treatment-related side effects as measured by the UPDRS IV off medication score (78.4% awake vs 59.7% asleep, p=0.022). CONCLUSIONS: Our meta-analysis demonstrates that while DBS under general anaesthesia may lead to lower complication rates overall, awake DBS may lead to less treatment-induced side effects. Nevertheless, there were no significant differences in clinical motor outcomes between the two techniques. Thus, DBS under general anaesthesia can be considered at experienced centres in patients who are not candidates for traditional awake DBS or prefer the asleep alternative.

19 Article Arousal and the control of perception and movement. 2016

Garcia-Rill, E / Virmani, T / Hyde, J R / D'Onofrio, S / Mahaffey, S. ·Center for Translational Neuroscience, University of Arkansas for Medical Sciences, Little Rock, AR. · Department of Neurology, University of Arkansas for Medical Sciences, Little Rock, AR. · Department of Psychiatry and Center for Neural Basis of Cognition, University of Pittsburgh, Pittsburgh, PA. ·Curr Trends Neurol · Pubmed #28690375.

ABSTRACT: Recent discoveries on the nature of the activity generated by the reticular activating system (RAS) suggest that arousal is much more involved in perception and movement than previously thought. The RAS is not simply an amorphous, unspecific region but rather a distinct group of nuclei with specific cell and transmitter types that control waking and modulate such processes as perception and movement. Thus, disturbances in the RAS will affect a number of neurological disorders. The discovery of gamma band activity in the RAS determined that high threshold calcium channels are responsible for generating gamma band activity in the RAS. Results showing that waking is mediated by CaMKII modulation of P/Q-type channels and REM sleep is modulated by cAMP/PK modulation of N-type channels points to different intracellular pathways influencing each state. Few studies address these important breakthroughs. Novel findings also show that the same primate RAS neurons exhibiting activity in relation to arousal are also involved in locomotion. Moreover, deep brain stimulation of this region, specifically the pedunculopontine nucleus (PPN DBS), in Parkinson's disease has salutary effects on movement, sleep, and cognition. Gamma oscillations appear to participate in sensory perception, problem solving, and memory, and coherence at these frequencies may occur at cortical or thalamocortical levels. However, rather than participating in the temporal binding of sensory events, gamma band activity generated in the RAS may help stabilize coherence related to arousal, providing a stable activation state during waking, and relay such activation to the cortex. Continuous sensory input will thus induce gamma band activity in the RAS to participate in the processes of preconscious awareness, and provide the essential stream of information for the formulation of many of our perceptions and actions. Such a role has received little attention but promises to help understand and treat a number of neurological disorders.

20 Article Motor fluctuations due to interaction between dietary protein and levodopa in Parkinson's disease. 2016

Virmani, Tuhin / Tazan, Sirinan / Mazzoni, Pietro / Ford, Blair / Greene, Paul E. ·Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY USA ; Current addresses: University of Arkansas for Medical Sciences, 4301 W. Markham St., #500, Little Rock, AR 72205 USA. · Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY USA ; Healthcare Partners, 3565 Del Amo Blvd., Ste 200, Torrance, CA 90503 USA. · Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY USA. · Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY USA ; Mt. Sinai School of Medicine, Box 1637, New York, NY 10029 USA. ·J Clin Mov Disord · Pubmed #27231577.

ABSTRACT: BACKGROUND: The modulation of levodopa transport across the blood brain barrier by large neutral amino acids is well documented. Protein limitation and protein redistribution diets may improve motor fluctuations in patients with Parkinson's disease but the pharmacokinetics and pharmacodynamics of levodopa and amino acids are highly variable. METHODS: Clinical records of 1037 Parkinson's disease patients were analyzed to determine the proportion of patients with motor fluctuations related to protein interaction with levodopa. Motor fluctuations due to protein interaction with levodopa were defined as dietary protein being associated with (i) longer time to levodopa effectiveness, (ii) reduced benefit or duration of benefit, (iii) dose failures or (iv) earlier wearing off from a previously effective dose. Dose failures, sudden, painful or behavioral wearing-off periods, gait freezing, nausea, hallucinations, orthostasis, and dyskinesias were taken as markers of motor fluctuations, disease severity, and levodopa side effects potentially influenced by protein. RESULTS: 5.9 % of Parkinson's disease patients on levodopa, and 12.4 % with motor fluctuations on levodopa correlated their fluctuations with the relative timing of levodopa and protein intake. These patients were younger at disease onset, had worse motor fluctuations and had a higher incidence of family members with Parkinson's disease. Early wearing off or decreased dose efficacy were most commonly associated with protein interaction. 60 % of patients who modified their diets had weight loss. CONCLUSIONS: This study suggests that clinically significant protein interaction with levodopa may occur mostly in a subset of Parkinson's disease patients with earlier disease onset and those with familial disease.

21 Article The effect of MAPT haplotype on neocortical Lewy body pathology in Parkinson disease. 2016

Robakis, Daphne / Cortes, Etty / Clark, Lorraine N / Vonsattel, Jean Paul G / Virmani, Tuhin / Alcalay, Roy N / Crary, John F / Levy, Oren A. ·Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, 10032, USA. · Departments of Neurology, Yale School of Medicine, New Haven, CT, USA. · Department of Pathology and Cell Biology, Taub Institute for Research on Alzheimer's Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, New York, NY, USA. · Department of Neurology, University of Arkansas for Medical Sciences, Little Rock, AR, USA. · Departments of Pathology and Neuroscience, Friedman Brain Institute, Ronald M. Loeb Center for Alzheimer's Disease, Icahn School of Medicine at Mount Sinai, New York, NY, USA. · Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, 10032, USA. ol2102@cumc.columbia.edu. ·J Neural Transm (Vienna) · Pubmed #27098667.

ABSTRACT: The H1 haplotype of the microtubule-associated protein tau gene (MAPT) is associated with an increased risk of Parkinson disease (PD) compared with the H2 haplotype, but its effect on Lewy body (LB) formation is unclear. In this study, we compared the MAPT haplotype frequency between pathologically confirmed PD patients (n = 71) and controls (n = 52). We analyzed Braak LB stage, Braak neurofibrillary tangle (NFT) stage, and CERAD amyloid score by haplotype. We further tested the association between MAPT haplotype and semi-quantitative counts of LBs, NFTs, and neuritic plaques (NPs) in multiple neocortical regions. Consistent with previous reports, PD cases had an increased likelihood of carrying an H1/H1 genotype compared to controls (OR = 5.72, 95 % CI 1.80-18.21, p = 0.003). Braak LB, Braak NFT and CERAD scores did not differ by haplotype. However, H1/H1 carriers had higher LB counts in parietal cortex (p = 0.02) and in overall neocortical LBs (p = 0.03) compared to non-H1/H1 cases. Our analyses suggest that PD patients homozygous for the H1 haplotype have a higher burden of neocortical LB pathology.

22 Article Factors predicting incremental administration of antihypertensive boluses during deep brain stimulator placement for Parkinson's disease. 2014

Rajan, Shobana / Deogaonkar, Milind / Kaw, Roop / Nada, Eman Ms / Hernandez, Adrian V / Ebrahim, Zeyd / Avitsian, Rafi. ·Department of General Anesthesiology, Anesthesiology Institute, Cleveland Clinic, 9500 Euclid Avenue, E-31, Cleveland, OH 44195, USA. · Department of Neurosurgery, Center for Neuromodulation, Ohio State University Medical Center, Columbus, OH, USA. · Department of Hospital Medicine and Outcomes Research, Cleveland Clinic, Cleveland, OH, USA. · Department of General Anesthesiology, University of Arkansas for Medical Sciences, Little Rock, AR, USA. · Postgraduate School, Universidad Peruana de Ciencias Aplicadas (UPC), Lima, Peru. · Department of General Anesthesiology, Anesthesiology Institute, Cleveland Clinic, 9500 Euclid Avenue, E-31, Cleveland, OH 44195, USA. Electronic address: avitsir@ccf.org. ·J Clin Neurosci · Pubmed #24915957.

ABSTRACT: Hypertension is common in deep brain stimulator (DBS) placement predisposing to intracranial hemorrhage. This retrospective review evaluates factors predicting incremental antihypertensive use intraoperatively. Medical records of Parkinson's disease (PD) patients undergoing DBS procedure between 2008-2011 were reviewed after Institutional Review Board approval. Anesthesia medication, preoperative levodopa dose, age, preoperative use of antihypertensive medications, diabetes mellitus, anxiety, motor part of the Unified Parkinson's Disease Rating Scale score and PD duration were collected. Univariate and multivariate analysis was done between each patient characteristic and the number of antihypertensive boluses. From the 136 patients included 60 were hypertensive, of whom 32 were on angiotensin converting enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARB), told to hold on the morning of surgery. Antihypertensive medications were given to 130 patients intraoperatively. Age (relative risk [RR] 1.01; 95% confidence interval [CI] 1.00-1.02; p=0.005), high Joint National Committee (JNC) class (p<0.0001), diabetes mellitus (RR 1.4; 95%CI 1.2-17; p<0.0001) and duration of PD >10 years (RR 1.2; 95%CI 1.1-1.3; p=0.001) were independent predictors for antihypertensive use. No difference was noted in the mean dose of levodopa (p=0.1) and levodopa equivalent dose (p=0.4) between the low (I/II) and high severity (III/IV) JNC groups. Addition of dexmedetomidine to propofol did not influence antihypertensive boluses required (p=0.38). Intraoperative hypertension during DBS surgery is associated with higher age group, hypertensive, diabetic patients and longer duration of PD. Withholding ACEI or ARB is an independent predictor of hypertension requiring more aggressive therapy. Levodopa withdrawal and choice of anesthetic agent is not associated with higher intraoperative antihypertensive medications.

23 Minor Impaired step-length setting prior to turning in Parkinson's disease patients with freezing of gait. 2018

Virmani, Tuhin / Pillai, Lakshmi / Glover, Aliyah / Doerhoff, Shannon M / Williams, David K / Garcia-Rill, Edgar / Larson-Prior, Linda. ·Department of Neurology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA. · Center for Translational Neuroscience, Department of Neurobiology & Developmental Sciences, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA. · Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA. · Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA. ·Mov Disord · Pubmed #30306629.

ABSTRACT: -- No abstract --

24 Minor Lumbar Radiculopathy - Incremental Value of Magnetic Resonance Neurography over Non-Contributory Magnetic Resonance Imaging. 2016

Wadhwa, Vibhor / Belzberg, Allan J / Carrino, John A / Chhabra, Avneesh. ·Department of Radiology, University of Arkansas for Medical Sciences, USA. ·Ann Acad Med Singapore · Pubmed #27683745.

ABSTRACT: -- No abstract --

25 Minor In Reply to the Letter to the Editor, "Influence of Parkinsonism on Hitler's Decision-Making". 2016

Gupta, Raghav / Kim, Christopher / Agarwal, Nitin / Lieber, Bryan A / Monaco, Edward A. ·Department of Biology, College of New Jersey, Ewing, New Jersey, USA. · Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA. Electronic address: agarwaln@upmc.edu. · Department of Neurosurgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA. · Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA. ·World Neurosurg · Pubmed #26856784.

ABSTRACT: -- No abstract --

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