Barbara Hagenah Brumbach

Introduction: Pain, anxiety, and mood symptoms are common non-motor manifestations of Parkinson’s disease (PD). Studies demonstrate these non-motor symptoms may improve with DBS, though improvement may differ depending on stimulation target. The objective of this study was to describe the association between medication adjustments with mood, anxiety, and pain symptoms following bilateral STN or GPi DBS in PD. Methods: Thirty-three PD patients undergoing bilateral STN or GPi DBS were prospectively enrolled and followed for 6 months during a three-year period. Data related to medications, mood and anxiety symptoms, and pain assessments were collected at baseline and at multiple time points after surgery. Results: Patients who underwent DBS had significantly lower anxiety scores (Beck Anxiety Inventory; p=0.002) after surgery, compared to baseline. Fluctuation-related pain scores (King’s Parkinson’s Disease Pain Scale; p=0.02) were significantly lower after surgery. Conclusions: Bilateral DBS is associated with greater relief of fluctuation-related pain and decreased anxiety in PD. These findings highlight the need for future research on the impact of non-motor outcomes in ideal DBS target selection for PD patients.

Introduction:Pain, anxiety, and mood symptoms are common non-motor manifestations of Parkinson’s disease (PD). Studies demonstrate these non-motor symptoms may improve with DBS, though improvement may differ depending on stimulation target. The objective of this study was to describe the association between medication adjustments with mood, anxiety, and pain symptoms following bilateral STN or GPi DBS in PD.Methods:Thirty-three PD patients undergoing bilateral STN or GPi DBS were prospectively enrolled and followed for 6 months during a three-year period. Data related to medications, mood and anxiety symptoms, and pain assessments were collected at baseline and at multiple time points after surgery.Results:Patients who underwent DBS had significantly lower anxiety scores (Beck Anxiety Inventory; p=0.002) after surgery, compared to baseline. Fluctuation-related pain scores (King’s Parkinson’s Disease Pain Scale; p=0.02) were significantly lower after surgery.Conclusions:Bilateral DBS is associated with greater relief of fluctuation-related pain and decreased anxiety in PD. These findings highlight the need for future research on the impact of non-motor outcomes in ideal DBS target selection for PD patients.

Background: Essential Tremor (ET) is increasingly recognized as phenotypically heterogeneous disorder, which may encompass alterations in gait, balance and cognitive dysfunction. Disruption in cerebellar-thalamic-cortical circuits results in varying patterns of executive and memory dysfunction and balance disorders. The current study proposed two aims: 1) identify cognitive subtypes within individuals with essential tremor, and 2) examine for a correlation between these subtypes and gait and balance dysfunction. We hypothesize that gait and balance dysfunction are more common in individuals with ET who demonstrate greater cognitive difficulties. Methods: Seventy-one individuals underwent neuropsychological and physical therapy examinations as part of presurgical deep brain stimulation (DBS) evaluations that included measures of gait and balance (Mini-BESTest; Timed Up and Go, SARA). People with ET were categorized into Cognitively Normal (N = 29), Low Executive Function/Processing Speed (N = 17), and Low Memory Multi-domain groups (N = 25). Results: Regression analyses show that scores on the Mini-Balance Evaluation Systems Test and Scale for the Assessment and Rating of Ataxia were worse in the Low Memory and Low Executive Function groups compared to the cognitively normal group; age was also a significant predictor. Scores on the Timed Up and Go were worse for the Low Executive Function compared to the cognitive normal group; age and education were also significant predictors. Medication use was not associated with any of the clinical gait and balance tests. However, medication use and age were significant predictors of reported falls in daily life. Conclusions: A subset of individuals with ET experience cognitive dysfunction that coalesce into processing speed deficits or immediate memory deficits. These cognitive subtypes were associated with greater difficulty in balance and gait as compared to cognitively normal ET patient and this difference could not be accounted for by medications.

Background: Simultaneous measurement of gastrointestinal transit time (GITT) and plasma levodopa concentration (PLC) is crucial to understanding the effect of dysfunctional motility on levodopa response in patients with Parkinson's disease (PwPD).Objective: The aim is to determine if altered segmental GITT correlates with clinical response and PLC variability in PwPD.Methods: Ten typical and 10 erratic responders ingested the SmartPill (SP) wireless motility capsule. Serial PLC and finger tapping, obtained every 30 minutes for 3 hours after SP/levodopa ingestion, evaluated the correlation between GITT, clinical response, and PLC. Glucose breath testing assessed small intestinal bacterial overgrowth (SIBO).Results: GITT was not significantly different in “typical” and “erratic” responders. SIBO was positive in half of the erratic and negative in most typical responders.Conclusion: SP is a feasible technology for assessing GITT in PwPD. A larger study may be able to significantly differentiate/correlate GITT in different segments of the GI tract with response to levodopa. © 2022 International Parkinson and Movement Disorder Society.

We agree that sexual selection is a more comprehensive explanation for sex differences in direct aggression than social role theory, which is an unparsimonious and vestigial remnant of human exceptionalism. Nevertheless, Archer misses several opportunities to put the theoretical predictions made by himself and by others into direct competition in a way that would further the interests of strong inference.