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Professional Art Therapy and Visuospatial Exploration in Parkinson's Disease: an Experimental Protocol and Preliminary Feasibility Data [Meeting Abstract]

Cucca, Alberto; Mania, Daniella F.; Acosta, Ikuko; Berberian, Marygrace; Bertish, Hilary C.; Hudson, Todd; Lemen, Amy C.; Rizzo, John R.; Biagioni, Milton; Di Rocco, Alessandro
ISI:000453090800027
ISSN: 0028-3878
CID: 3562062

Infection-mediated autoimmune movement disorders

Cucca, Alberto; Migdadi, Hamzeh A; Di Rocco, Alessandro
Infectious diseases remain the most common cause of neurological disability in the world. A number of movement disorders can develop in adults and children in response to infections. These can occur in isolation or as part of a broader neurological illness, with movement abnormalities consequent to an encephalopathy or a broader brain dysfunction. While most infection-related movement disorders are direct consequences of an active infectious process affecting cerebral structures implied in the motor network, at times a delayed immune-mediated process in response to a previous infectious is responsible for the neurological dysfunction. This immunological response can occur as a consequence of a number of pathogens, and develop at variable times after the initial infection. The most common infection-mediated autoimmune movement disorders are chorea, which is especially common in children, and other hyperkinetic disorders, but Parkinsonism and other hypokinetic movement disorders may also occur.
PMID: 28756176
ISSN: 1873-5126
CID: 2655432

Comorbid Normal Pressure Hydrocephalus with Parkinsonism: A Clinical Challenge and Call for Awareness

Cucca, A; Biagioni, M C; Sharma, K; Golomb, J; Gilbert, R M; Di Rocco, A; Fleisher, J E
Idiopathic normal pressure hydrocephalus (iNPH) is the most common cause of hydrocephalus in adults. The diagnosis may be challenging, requiring collaborative efforts between different specialists. According to the International Society for Hydrocephalus and Cerebrospinal Fluid Disorders, iNPH should be considered in the differential of any unexplained gait failure with insidious onset. Recognizing iNPH can be even more difficult in the presence of comorbid neurologic disorders. Among these, idiopathic Parkinson's disease (PD) is one of the major neurologic causes of gait dysfunction in the elderly. Both conditions have their peak prevalence between the 6th and the 7th decade. Importantly, postural instability and gait dysfunction are core clinical features in both iNPH and PD. Therefore, diagnosing iNPH where diagnostic criteria of PD have been met represents an additional clinical challenge. Here, we report a patient with parkinsonism initially consistent with PD who subsequently displayed rapidly progressive postural instability and gait dysfunction leading to the diagnosis of concomitant iNPH. In the following sections, we will review the clinical features of iNPH, as well as the overlapping and discriminating features when degenerative parkinsonism is in the differential diagnosis. Understanding and recognizing the potential for concomitant disease are critical when treating both conditions.
PMCID:5828340
PMID: 29610690
ISSN: 2090-6668
CID: 3025292

Aerobic exercise combined with rTMS for Parkinson's disease: A randomized trial [Meeting Abstract]

Migdadi, H.; Biagioni, M.; Agarwal, S.; Cucca, A.; Kumar, P.; Quartarone, A.; Rossi, R.; Ghilardi, M.; Di Rocco, A.
ISI:000402672304233
ISSN: 0885-3185
CID: 3195522

Pairing TMS and Physical Therapy for Treatment of Gait and Balance Disorders in Parkinson's disease: A Randomized Pilot Trial [Meeting Abstract]

Cucca, A.; Migdadi, H.; Biller, T.; Agarwal, S.; Kumar, P.; Son, A.; Ko, M.; Gallo, E.; Fisher, S.; Di Rocco, A.; Biagioni, M.
ISI:000402672302326
ISSN: 0885-3185
CID: 3195502

Beta Oscillatory Changes and Retention of Motor Skills during Practice in Healthy Subjects and in Patients with Parkinson's Disease

Nelson, Aaron B; Moisello, Clara; Lin, Jing; Panday, Priya; Ricci, Serena; Canessa, Andrea; Di Rocco, Alessandro; Quartarone, Angelo; Frazzitta, Giuseppe; Isaias, Ioannis U; Tononi, Giulio; Cirelli, Chiara; Ghilardi, M Felice
Recently we found that modulation depth of beta power during movement increases with practice over sensory-motor areas in normal subjects but not in patients with Parkinson's disease (PD). As such changes might reflect use-dependent modifications, we concluded that reduction of beta enhancement in PD represents saturation of cortical plasticity. A few questions remained open: What is the relation between these EEG changes and retention of motor skills? Would a second task exposure restore beta modulation enhancement in PD? Do practice-induced increases of beta modulation occur within each block? We thus recorded EEG in patients with PD and age-matched controls in two consecutive days during a 40-min reaching task divided in fifteen blocks of 56 movements each. The results confirmed that, with practice, beta modulation depth over the contralateral sensory-motor area significantly increased across blocks in controls but not in PD, while performance improved in both groups without significant correlations between behavioral and EEG data. The same changes were seen the following day in both groups. Also, beta modulation increased within each block with similar values in both groups and such increases were partially transferred to the successive block in controls, but not in PD. Retention of performance improvement was present in the controls but not in the patients and correlated with the increase in day 1 modulation depth. Therefore, the lack of practice-related increase beta modulation in PD is likely due to deficient potentiation mechanisms that permit between-block saving of beta power enhancement and trigger mechanisms of memory formation.
PMCID:5339296
PMID: 28326029
ISSN: 1662-5161
CID: 2491972

Are we missing non-motor seizures in Parkinson's disease? Two case reports

Son, Andre Y; Cucca, Alberto; Agarwal, Shashank; Liu, Anli; Di Rocco, Alessandro; Biagioni, Milton C
BACKGROUND: Parkinson's disease (PD) is predominantly recognized for its motor symptoms, but patients struggle from a morbid and heterogeneous collection of non-motor symptoms (NMS-PD) that can affect their quality of life even more. NMS-PD is a rather generalized term and the heterogeneity and non-specific nature of many symptoms poses a clinical challenge when a PD patient presents with non-motor complaints that may not be NMS-PD. CASE PRESENTATION: We report two patients with idiopathic PD who presented with acute episodes of cognitive changes. Structural brain images, cardiovascular and laboratory assessment were unremarkable. Both patients experienced a considerable delay before receiving an epilepsy-evaluation, at which point electroencephalogram abnormalities supported the diagnosis of focal non-motor seizures with alteration of awareness. Antiepileptic therapy was implemented and was effective in both cases. CONCLUSIONS: Diagnosing non-motor seizures can be challenging. However, PD patients pose an even greater challenge given their eclectic non-motor clinical manifestations and other disease-related complications that could confound and mislead adequate clinical interpretation. Our two cases provide examples of non-motor seizures that may mimic non-motor symptoms of PD. Treating physicians should always consider other possible causes of non-motor symptoms that may coexist in PD patients. Epilepsy work-up should be contemplated in the differential of acute changes in cognition, behavior, or alertness.
PMCID:5583992
PMID: 28879018
ISSN: 2054-7072
CID: 2687612

Multifocal repetitive TMS for motor and mood symptoms of Parkinson disease: A randomized trial

Brys, Miroslaw; Fox, Michael D; Agarwal, Shashank; Biagioni, Milton; Dacpano, Geraldine; Kumar, Pawan; Pirraglia, Elizabeth; Chen, Robert; Wu, Allan; Fernandez, Hubert; Shukla, Aparna Wagle; Lou, Jau-Shin; Gray, Zachary; Simon, David K; Di Rocco, Alessandro; Pascual-Leone, Alvaro
OBJECTIVE: To assess whether multifocal, high-frequency repetitive transcranial magnetic stimulation (rTMS) of motor and prefrontal cortex benefits motor and mood symptoms in patients with Parkinson disease (PD). METHODS: Patients with PD and depression were enrolled in this multicenter, double-blind, sham-controlled, parallel-group study of real or realistic (electric) sham rTMS. Patients were randomized to 1 of 4 groups: bilateral M1 ( + sham dorsolateral prefrontal cortex [DLPFC]), DLPFC ( + sham M1), M1 + DLPFC, or double sham. The TMS course consisted of 10 daily sessions of 2,000 stimuli for the left DLPFC and 1,000 stimuli for each M1 (50 x 4-second trains of 40 stimuli at 10 Hz). Patients were evaluated at baseline, at 1 week, and at 1, 3, and 6 months after treatment. Primary endpoints were changes in motor function assessed with the Unified Parkinson's Disease Rating Scale-III and in mood with the Hamilton Depression Rating Scale at 1 month. RESULTS: Of the 160 patients planned for recruitment, 85 were screened, 61 were randomized, and 50 completed all study visits. Real M1 rTMS resulted in greater improvement in motor function than sham at the primary endpoint (p < 0.05). There was no improvement in mood in the DLPFC group compared to the double-sham group, as well as no benefit to combining M1 and DLPFC stimulation for either motor or mood symptoms. CONCLUSIONS: In patients with PD with depression, M1 rTMS is an effective treatment of motor symptoms, while mood benefit after 2 weeks of DLPFC rTMS is not better than sham. Targeting both M1 and DLPFC in each rTMS session showed no evidence of synergistic effects. CLINICALTRIALSGOV IDENTIFIER: NCT01080794. CLASSIFICATION OF EVIDENCE: This study provides Class I evidence that in patients with PD with depression, M1 rTMS leads to improvement in motor function while DLPFC rTMS does not lead to improvement in depression compared to sham rTMS.
PMCID:5100715
PMID: 27708129
ISSN: 1526-632x
CID: 2274202

Freezing of gait in Parkinson's disease: from pathophysiology to emerging therapies

Cucca, Alberto; Biagioni, Milton C; Fleisher, Jori E; Agarwal, Shashank; Son, Andre; Kumar, Pawan; Brys, Miroslaw; Di Rocco, Alessandro
Freezing of gait (FOG) is 'an episodic inability to generate effective stepping in the absence of any known cause other than parkinsonism or high level gait disorders'. FOG is one of the most disabling symptoms in Parkinson's disease, especially in its more advanced stages. Early recognition is important as FOG is related to higher fall risk and poorer prognosis. Although specific treatments are still elusive, there have been recent advances in the development of new therapeutic approaches. The aim of this review is to present the latest knowledge regarding the phenomenology, pathogenesis, diagnostic assessment and conventional treatment of FOG in Parkinson's disease. A review of the evidence supporting noninvasive brain stimulation will follow to highlight the potential of these strategies.
PMID: 27599588
ISSN: 1758-2032
CID: 2238562

Changes in handwriting following repetitive transcranial magnetic stimulation over pre-motor cortex in Parkinson's disease [Meeting Abstract]

Son, A. Y.; Biagioni, M. C.; Pirraglia, E.; DiRocco, A.
ISI:000382559803166
ISSN: 0885-3185
CID: 3195492