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Berg D.,German Parkinson Study GroupMarburg Germany | Rascol O.,French Institute of Health and Medical Research | Eggert K.,German Parkinson Study GroupMarburg Germany | Ceballos-Baumann A.,German Parkinson Study GroupMarburg Germany | And 25 more authors.
Movement Disorders | Year: 2016

Background: This phase 2 randomized, double-blind, placebo-controlled study evaluated the efficacy and safety of the nicotinic acetylcholine receptor α7 agonist AQW051 in patients with Parkinson's disease and levodopa-induced dyskinesia. Methods: Patients with idiopathic Parkinson's disease and moderate to severe levodopa-induced dyskinesia were randomized to AQW051 10 mg (n = 24), AQW051 50 mg (n = 24), or placebo (n = 23) once daily for 28 days. Coprimary end points were change in Modified Abnormal Involuntary Movement Scale and Unified Parkinson's Disease Rating Scale part III scores. Secondary outcomes included pharmacokinetics. Results: In total, 67 patients completed the study. AQW051-treated patients experienced no significant improvements in Modified Abnormal Involuntary Movement Scale or Unified Parkinson's Disease Rating Scale part III scores by day 28. AQW051 was well tolerated; the most common adverse events were dyskinesia, fatigue, nausea, and falls. Conclusions: AQW051 did not significantly reduce dyskinesia or parkinsonian severity. © 2016 Movement Disorder Society.

Kotecha R.,Taussig Cancer Institute | Berriochoa C.A.,Taussig Cancer Institute | Murphy E.S.,Taussig Cancer Institute | Murphy E.S.,Cleveland Clinic | And 6 more authors.
Journal of Neurosurgery | Year: 2016

Patients with implanted neuromodulation devices present potential challenges for radiation therapy treatment planning and delivery. Although guidelines exist regarding the irradiation of cardiac pacemakers and defibrillators, fewer data and less clinical experience exist regarding the effects of radiation therapy on less frequently used devices, such as deep brain stimulators. A 79-year-old woman with a history of coarse tremors effectively managed with deep brain stimulation presented with multiple intracranial metastases from a newly diagnosed lung cancer and was referred for whole-brain radiation therapy. She was treated with a German helmet technique to a total dose of 30 Gy in 10 fractions using 6 MV photons via opposed lateral fields with the neurostimulator turned off prior to delivery of each fraction. The patient tolerated the treatment well with no acute complications and no apparent change in the functionality of her neurostimulator device or effect on her underlying neuromuscular disorder. This represents the first reported case of the safe delivery of whole-brain radiation therapy in a patient with an implanted neurostimulator device. In cases such as this, neurosurgeons and radiation oncologists should have discussions with patients about the risks of brain injury, device malfunction or failure of the device, and plans for rigorous testing of the device before and after radiation therapy. © 2016 AANS.

Pillai J.A.,Cleveland Clinic | Pillai J.A.,Case Western Reserve University | Bermel R.,Cleveland Clinic | Bermel R.,Mellen Center for Multiple Sclerosis | And 11 more authors.
American Journal of Alzheimer's Disease and other Dementias | Year: 2016

Retinal nerve fiber layer (RNFL) thickness, ganglion cell layer (GCL) thickness, and macular volume (MV) utilizing spectral domain optical coherence tomography (SD-OCT) were compared among patients with Alzheimer's disease (AD) dementia, non-Alzheimer's disease (non-AD) dementia, amnestic mild cognitive impairment (aMCI), Parkinson's disease (PD), and age- and sex-matched controls in a cross-sectional cohort study. A total of 116 participants were diagnosed and evaluated (21 AD, 20 aMCI, 20 non-AD, 20 PD, and 34 controls) after comprehensive neurological, neuropsychology, and magnetic resonance imaging (MRI) volumetric evaluations. Retinal nerve fiber layer thickness, GCL thickness, and MV were measured. Analysis of variance models were used to compare groups on MRI volumetric measures, cognitive test results, and SD-OCT measures. Associations between SD-OCT measures and other measures were performed using mixed-effect models. Spectral domain optical coherence tomography analysis of retinal markers, including RNFL thickness, GCL thickness, and MV, did not differ between amnestic MCI, AD dementia, PD, non-AD, dementia, and age- and sex-matched controls in a well-characterized patient cohort. © SAGE Publications.

Machado C.,Institute of Neurology and Neurosurgery | Estevez M.,Institute of Neurology and Neurosurgery | Carrick F.R.,Carrick Institute for Graduate Studies | Rodriguez R.,Center for Neurological Restoration | And 7 more authors.
NeuroRehabilitation | Year: 2012

The term persistent vegetative state (PVS) refers to the only circumstance in which an apparent dissociation of both components of consciousness is found, characterized by preservation of wakefulness with an apparent loss of awareness. Several authors have recently demonstrated by functional neuroimaging studies that a small subset of unresponsive «vegetative» patients may show unambiguous signs of consciousness and command following that is inaccessible to clinical examination at the bedside. The term «estado vegetativo» used in Spanish to describe the PVS syndrome by physicians came from the English-Spanish translation. The Spanish term «vegetativo» is related to unconscious vital functions, and «vegetal» is relative to plants. According to our experience, when a physician informs to patients' relatives that his/her family member's diagnosis is a «estado vegetativo», they understand the he/she is no more a human being, that there is no hope of recovery. The European Task Force on Disorders of Consciousness has recently proposed a new term, unresponsive wakefulness syndrome (UWS), to assist society in avoiding the depreciatory term vegetative state. Our group has embraced the use of the new term UWS and might suggest that we change our concept and use of the term MCS to minimally responsive wakefulness state (MRWS), or minimally aware wakefulness state (MAWS). Medical terms must be current and avoid any pejorative description of patients, which will promote our abilities to serve humankind and challenge neuroscientists to offer society new and realistic hopes for neurorehabilitation. © 2012 - IOS Press and the authors. All rights reserved.

Leisman G.,National Institute Brain And Rehab Science | Rojas R.R.,Center for Neurological Restoration | Batista K.,Center for Neurological Restoration | Carballo M.,Center for Neurological Restoration | And 3 more authors.
2014 IEEE 28th Convention of Electrical and Electronics Engineers in Israel, IEEEI 2014 | Year: 2014

Background: Persistent vegetative states (PVS) and locked-in syndrome (LIS) are well-differentiated disorders of consciousness that can be reached after a localized brain injury in the brainstem. The relations of the lesion topography with the impairment in the whole-brain architecture and functional disconnections are poorly understood. Methods: Two patients (PVS and LIS) and 20 age-matched healthy volunteers were evaluated using diffusion tensor imaging (DTI). Anatomical network was modeled as a graph whose nodes are represented by 71 brain regions. Inter-region connections were quantified through Anatomical Connection Strength (ACS) and Density (ACD). Complex networks properties such as local and global efficiency and vulnerability were studied. Mass univariate testing was performed at every connection using network based statistic approach. Results: LIS patients' network showed significant differences from controls in the brainstem-thalamus-frontal cortex circuitry, while PVS patients showed a widespread disruption of anatomical connectivity in both hemispheres. Both patients showed a reorganization of network attributes, with decreased global and local efficiency, significantly more pronounced in PVS. © Copyright 2015 IEEE All rights reserved.

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