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Atypical Parkinsonisms (APs) -including progressive supranuclear palsy (PSP), multiple system atrophy (MSA), and dementia with Lewy bodies (DLB)- are neurodegenerative diseases lacking satisfying symptomatic therapies. Deep Brain Stimulation (DBS) is an established neurosurgical option for advanced Parkinson disease (PD). Although DBS effectiveness in PD fed expectations for the treatment of APs, DBS is still not recommended for APs on the basis of expert consensus and lack of clinical trials.In this systematic review, we sought to analyze current evidence on the safety and efficacy of DBS in APs, discussing clinical indications, anatomical targets, and ethical issues.Following the PRISMA guidelines, we systematically searched PubMed for studies reporting the outcome of patients with APs treated with DBS.We identified 25 eligible studies for a total of 66 patients with APs treated with DBS: 31 PSP, 22 MSA, 12 DLB, 1 unspecified parkinsonism with tongue tremor. Targeted nuclei were subthalamic nucleus (STN), globus pallidus pars-interna (GPi), pedunculopontine nucleus (PPN), and nucleus basalis of Meynert (nbM). Only 3/25 studies were randomized controlled trials, and most studies showed a high risk of bias.Taking into account study biases and confounding factors, current evidence does not support the use of DBS in APs. However, some interesting insights arise from the literature, such as the high frequency of cognitive/neurobehavioral issues in MSA patients treated with STN-DBS, the low frequency of complications in trials of nbM-DBS for DLB, and the possible good response of dystonic symptoms in PSP with GPi DBS.

Introduction Pisa syndrome is a disabling, medication-resistant, postural abnormality that may affect 7–10% of patients with Parkinson's disease. In this study, we sought to assess the efficacy of botulinum toxin injections in Parkinson's disease-associated Pisa syndrome using a Magnetic Resonance Imaging-, Ultrasonography-, and Electromyography-guided combined approach. Methods We conducted a pilot study to evaluate the efficacy of botulinum toxin type-A injection in paraspinal and non-paraspinal axial muscles after a Magnetic Resonance Imaging and ultrasound-guided electromyography evaluation. Inclusion criteria were Pisa syndrome, idiopathic Parkinson's disease, and stable dopaminergic medications. Exclusion criteria were previous treatment with botulinum toxin, history of major spine surgery, and severe orthopedic diseases. As primary endpoint, we measured the rate of patients improving by at least 5° in the lateral trunk flexion 2 months after therapy. Secondary endpoints were the extent of lateral trunk flexion improvement, and changes in PS-associated pain/discomfort, measured by the Visual Analogue Scale. Results Out the 15 patients initially enrolled, 13 completed the follow-up assessment, while 2 joined a rehabilitation program and were excluded from the analyses. The rate of responders was 84.6% (n = 11/13), with 40% average reduction in trunk bending. Pain/discomfort improved in all patients, with 52.2% amelioration at the Visual Analogue Scale. The procedure was well tolerated in all cases, without side effects or complications. Conclusion A combined imaging and EMG botulinum toxin approach to Pisa syndrome may yield a success rate greater than 80% in Parkinson's disease.

INTRODUCTION:We sought to assess the effect of subthalamic deep brain stimulation (STN DBS) on Parkinson's disease (PD)-associated postural abnormalities. METHODS:A computerized analysis of posture was used to quantify the thoracolumbar, thoracic, and cervical-occipital ventral angles, as well as the thoracolumbar and cervical-occipital lateral angles from the video-repository of three specialized movement disorder centers (n = 158 patients). Data was extracted from frames from video-recordings in the pre-surgical medication-ON (dopaminergic therapy) and post-surgical stimulation-ON/medication-ON states (STN DBS plus dopaminergic therapy). The sum of the five postural angles (global postural angle) was used to compare pre-vs. post-surgical trunk posture alterations. A multivariate analysis was used to examine the association between changes in the postural angles and demographic or clinical variables. RESULTS:There was a 6.7% amelioration in the global postural angle between the pre- and post-surgical assessments (p = 0.031). Motor response to and pre-surgical dosage of levodopa, male gender, and shorter PD duration were identified as predictors for posture improvement after STN DBS. Cases meeting criteria for lower (n = 2) or upper (n = 1) camptocormia respectively improved by 48.1% in the ventral thoracolumbar angle (from 36.4 ± 0.0° to 18.9 ± 4.2°) and 13.8% in the ventral thoracic angle (from 49.1° to 42.3°). Cases meeting criteria for Pisa syndrome (n = 2) improved by 67.5% in the lateral thoracolumbar angle (from 16.9 ± 2.0° to 5.5 ± 4.7°). CONCLUSIONS:STN DBS has a relatively small but significant effect on PD-associated postural abnormalities, potentially enhancing the effect of dopaminergic medications alone. © This manuscript version is made available under the CC-BY-NC-ND 4.0 license https://creativecommons.org/licenses/by-nc-nd/4.0/. Deposited by shareyourpaper.org and openaccessbutton.org. We've taken reasonable steps to ensure this content doesn't violate copyright. However, if you think it does you can request a takedown by emailing help@openaccessbutton.org.

BACKGROUND: Neurological involvement in Coronavirus disease-2019 (COVID-19) is widely recognized. However, the role of pre-existing neurological comorbidities in modulating COVID-19-related mortality still remains unclear. This cohort study evaluates the COVID-19-related case fatality rate (CFR) of patients with pre-existing neurological diseases. METHODS: We retrospectively evaluated all patients consecutively admitted to our hospital with a diagnosis of COVID-19 between March and April 2020. We used a multivariate regression analysis to estimate the association between pre-existing neurological diseases and COVID-19-related mortality. Then, we compared the CFR and survival curves of two cohorts (patients suffering vs. those not suffering from pre-existing neurological disease), matched trough the propensity score (PS). Age and other comorbidities were considered for PS calculation. We applied a 1:1 matching for the entire neurological cohort and, separately, for cerebrovascular, neurodegenerative, and other neurological diseases. RESULTS: Among 332 patients, 75 (22.6%) were affected by pre-existing neurological disease (n = 29 cerebrovascular, n = 26 neurodegenerative, n = 20 others). From the multivariate regression analysis, they resulted with a significant increase of COVID-19-related mortality (OR:2.559; 95%CI 1.181-5.545; p

Parkinson's disease is a neuro-degenerative disorder characterized by the progressive death of dopamine neurons. This leads to delayed and uncoordinated movements, and impacts on the patients’ motor performance with reduced movement intensity, increased axial rigidity and impaired cadence regulation. Turning provides privileged insights in postural instability and fall prediction, as it is regularly performed during daily activities, requires multi-limb coordination. The objective of this work was to define a Quality of Movement (QoM) index, inferred from inertial data related to turns, and strictly correlated with the patient's motor conditions, postural stability, and stage of the disease. Such a concise representation finds its main application in the remote monitoring of patients during daily activities at home. We have recorded and analyzed 180° turns in 72 patients, using inertial sensors embedded in the smartphone. We have set up an algorithm for binary classification of patients: mild vs. moderate/severe conditions, according to the Hoehn and Yahr scale of disease progression and disability degree. Our QoM index is defined as the a posteriori probability output by this binary classifier. It exhibits high correlation (r = 0.73) with the clinical score of postural stability, as well as with the average of four clinical scores related to movement impairment (r = 0.75). These results, together with the widespread smartphone use, provide a step in the direction of a practical, objective and reliable tool for PD patients remote monitoring in domestic environment.

Background Subthalamic Nucleus Deep Brain Stimulation (STN-DBS) represents a valid therapeutic option for advanced Parkinson's disease (PD), leading to a significant amelioration of motor fluctuations and levodopa-induced involuntary movements (IM). This study address the issue of whether stimulation frequency may influence the control of IM in STN-DBS treated patients, comparing the effects of 80 Hz and 130 Hz STN-DBS frequencies in 10 parkinsonian patients with residual IM (dyskinesia in 6 cases and dystonia in 4 cases). Methods Patients were evaluated by means of the Rush Dyskinesias Rating Scale (blinded-video analysis) and Unified Parkinson's Disease Rating Scale at 4 different time-points: baseline, shortly after the switch of stimulation frequency from 130 Hz to 80 Hz, after 1 month and 12 months of chronic 80 Hz stimulation. Results IM improved in most subjects after the switch of stimulation frequency: dyskinesias improved in 6/6 subjects and dystonic features in 3/4 subjects after one month of 80 Hz stimulation. However, the 130 Hz STN stimulation was restored in 4 subjects during the following months, because of a gradual worsening of parkinsonian symptoms. A sustained efficacy on motor features and IM was observed with 80 Hz stimulation frequency in the remaining patients. Conclusions In this limited cohort of STN-DBS patients, we observed an improvement of residual IM after the switch of stimulation frequency from 130 Hz to 80 Hz. However, a moderate worsening of parkinsonian symptoms was observed in a portion of patients, requiring to return at 130 Hz STN-DBS.