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Parkinson's disease (PD) is a neurodegenerative disorder marked by progressive degenerative motor symptoms (e.g., tremors, impaired balance and gait) and nonmotor symptoms (e.g., fatigue, sleep disturbances, pain) that can negatively influence health-related quality of life (HRQoL). Previous studies have shown that yoga for individuals with PD improves balance, strength, and mobility. However, little research has been conducted to determine the effect of yoga on nonmotor symptoms of PD. The purpose of this study was to examine changes in nonmotor symptoms among individuals with PD following an 8-week yoga intervention. Data used for analyses were part of a larger study that researched improvements in motor function for individuals with PD. Participants (N = 27) were randomly assigned to experimental (n = 15) and control (n = 12) groups and completed pre- and postintervention quantitative measures. Within-group improvements were statistically significant for fatigue measured by the Parkinson's Fatigue Scale, balance confidence measured by the Activities Balance Confidence Scale, the belief in one's ability to manage falls measured by the Falls Management Scale, activity constraints measured by the Activities Constraint Questionnaire, and PD-specific quality of life measured by the Parkinson's Disease Questionnaire-8. Across-group changes were statistically significant for activity constraints. Findings indicate yoga may be an efficacious intervention for improving nonmotor symptoms as well as HRQoL for individuals with PD.

The novel coronavirus SARS-CoV-2 (severe acute respiratory syndrome coronavirus-2) is the cause of the COVID-19 pandemic [5]. SARS-Cov-2 demonstrates partial resemblance to SARS-CoV and MERS-CoV in phylogenetic analysis, clinical manifestations, and pathological findings [6, 7]. Reports emerging from China have described ataxia as a neurological symptom of the SARS-CoV-2 infection [5]. Opsoclonus consists of back-to-back multidirectional conjugate saccades without an inter-saccadic interval [8]. Myoclonus is defined as a sudden, brief, "shock-like", nonepileptic involuntary movement [9], which has been described as a symptom of SARS-CoV-2 infection [10]. Opsoclonus-Myoclonus-Ataxia syndrome (OMAS) associated COVID-19 infection has been reported recently [1112].

Background Clinical rating of bradykinesia in Parkinson disease (PD) is challenging as it must combine several movement features into a single score. Additionally, in-clinic assessment cannot capture fluctuations throughout the day. Objective To evaluate the reliability and responsiveness of a motion sensor-based tablet app for objective bradykinesia assessment in clinic and at home as compared to clinical ratings. Methods Thirty-two PD patients treated with subthalamic deep brain stimulation (DBS) were outfitted with a motion sensor on the index finger of the more affected hand to perform two repetitions of finger-tapping, hand opening-closing, and arm pronation-supination tasks with DBS on and 10, 20, and 30 minutes after turning DBS off. Tasks were videotaped for blinded clinician rating using the Modified Bradykinesia Rating Scale (MBRS). Participants were then sent home with an app-based system to perform two repetitions of the same tasks six times per day spaced two hours apart, three days per week, for two weeks. Intraclass correlation (ICC) and minimal detectable change (MDC) were calculated. Results As the effects of DBS wore off, motion sensors detected worsening of amplitude sooner than did clinician-rated MBRS for all three tasks. ICCs were significantly higher and MDCs were significantly lower for motion sensors in the clinic and at home than for clinician ratings (p Conclusions The tablet-based app demonstrated higher reliability and responsiveness in capturing bradykinesia-related tasks in the clinic and at home than did clinician ratings. This tool may enhance the assessment of novel therapies.

Raynaud's phenomenon of the nipple is an unusual side-effect of labetalol use. There is one official report from the United Kingdom. The present case concerns a 30-year-old woman, gravida 1, para 0, who developed pre-eclampsia and was treated with labetalol but subsequently reported neuropathic pain of the nipple. Nifedipine was then started as part of her treatment plan for blood pressure control and she no longer reported pain, despite being given six more doses of labetalol. Nifedipine is the first-line of treatment for Raynaud's phenomenon. The concomitant use of labetalol with nifedipine by a woman with Raynaud's phenomenon of the nipple has not been discussed before. The goal of this review is to raise awareness of this drug-induced phenomenon and to add to the limited literature available on this subject., Highlights • Raynaud's phenomenon of the nipple is an unusual presentation after administration of labetalol. • Labetalol is often first-line use in gestational hypertension, so this side effect could be more often than expected. • Healthcare professionals should actively ask questions regarding nipple discomfort when starting labetalol.

Individuals with Parkinson’s Disease (PD) experience significant limitations in motor function, functional gait, postural stability, and balance. These limitations often lead to higher incidences of falls, which have significant complications for individuals with PD. Yoga may improve these functional deficits in individuals with PD. The objective of this study was to determine changes in motor function, functional gait, postural stability, and balance control for community dwelling individuals with PD. This randomized, wait-list controlled pilot study examined the influence of an 8-week yoga intervention for people with PD who met the following inclusion criteria: endorsing a fear of falling, being able to speak English, scoring 4/6 on the minimental state exam, and being willing to attend the intervention twice weekly for 8-weeks. Participants in the yoga group (n=15) experienced improvements in motor function, postural stability, functional gait, and freezing gait, as well as reductions in fall risk. Participants in the wait-list control (n=12) also significantly improved in postural stability, although their fall risk was not reduced. Individuals in the yoga group significantly reduced their fall risk. An 8-week yoga intervention may reduce fall risk and improve postural stability, and functional and freezing gait in individuals with PD. This clinical trial is registered as protocol recordPro00041068in clinicaltrials.gov.

Objective To examine sex differences and trends in comorbid disease and health care utilization in individuals with newly diagnosed Parkinson disease (PD). Design Retrospective cohort study. Participants Over 133,000 Medicare beneficiaries with a new PD diagnosis in 2002 followed through 2008. Methods We compared the prevalence and cumulative incidence of common medical conditions, trends in survival and health care utilization between men and women with PD. Results Female PD patients had higher adjusted incidence rate ratio (IRR) of depression (IRR: 1.28, 1.25–1.31), hip fracture (IRR: 1.51, 1.45–1.56), osteoporosis (3.01, 2.92–3.1), and rheumatoid/osteoarthritis (IRR: 1.47, 1.43–1.51) than men. In spite of greater survival, women with PD used home health and skilled nursing facility care more often, and had less outpatient physician contact than men throughout the study period. Conclusions Women experience a unique health trajectory after PD diagnosis as suggested by differing comorbid disease burden and health care utilization compared to men. Future studies of sex differences in care needs, care quality, comorbidity related disability, PD progression, and non-clinical factors associated with disability are needed to inform research agendas and clinical guidelines that may improve quality survival for women with PD.

Objective:To examine rehabilitation therapy utilization for Parkinson disease (PD).Methods:We identified 174,643 Medicare beneficiaries with a diagnosis of PD in 2007 and followed them through 2009. The main outcome measures were annual receipt of physical therapy (PT), occupational therapy (OT), or speech therapy (ST).Results:Outpatient rehabilitation fee-for-service use was low. In 2007, only 14.2% of individuals with PD had claims for PT or OT, and 14.6% for ST. Asian Americans were the highest users of PT/OT (18.4%) and ST (18.4%), followed by Caucasians (PT/OT 14.4%, ST 14.8%). African Americans had the lowest utilization (PT/OT 7.8%, ST 8.2%). Using logistic regression models that accounted for repeated measures, we found that African American patients (adjusted odds ratio [AOR] 0.63 for PT/OT, AOR 0.63 for ST) and Hispanic patients (AOR 0.97 for PT/OT, AOR 0.91 for ST) were less likely to have received therapies compared to Caucasian patients. Patients with PD with at least one neurologist visit per year were 43% more likely to have a claim for PT evaluation as compared to patients without neurologist care (AOR 1.43, 1.30–1.48), and this relationship was similar for OT evaluation, PT/OT treatment, and ST. Geographically, Western states had the greatest use of rehabilitation therapies, but provider supply did not correlate with utilization.Conclusions:This claims-based analysis suggests that rehabilitation therapy utilization among older patients with PD in the United States is lower than reported for countries with comparable health care infrastructure. Neurologist care is associated with rehabilitation therapy use; provider supply is not.

Objectives To assess the feasibility, predictive value, and user satisfaction of objectively quantifying motor function in Parkinson’s disease (PD) through a tablet-based application (iMotor) using self-administered tests. Methods PD and healthy controls (HCs) performed finger tapping, hand pronation–supination and reaction time tasks using the iMotor application. Results Thirty-eight participants (19 with PD and 17 HCs) were recruited in the study. PD subjects were 53% male, with a mean age of 67.8 years (±8.8), mean disease duration of 6.5 years (±4.6), Movement Disorders Society version of the Unified Parkinson Disease Rating Scale III score 26.3 (±6.7), and Hoehn & Yahr stage 2. In the univariate analysis, most tapping variables were significantly different in PD compared to HC. Tap interval provided the highest predictive ability (90%). In the multivariable logistic regression model reaction time (reaction time test) (p = 0.021) and total taps (two-target test) (p = 0.026) were associated with PD. A combined model with two-target (total taps and accuracy) and reaction time produced maximum discriminatory performance between HC and PD. The overall accuracy of the combined model was 0.98 (95% confidence interval: 0.93–1). iMotor use achieved high rates of patients’ satisfaction as evaluated by a patient satisfaction survey. Conclusion iMotor differentiated PD subjects from HCs using simple alternating tasks of motor function. Results of this feasibility study should be replicated in larger, longitudinal, appropriately designed, controlled studies. The impact on patient care of at-home iMotor-assisted remote monitoring also deserves further evaluation.

Introduction The electroencephalography (EEG) requires the use of electrodes as a vital part of the test in the epilepsy monitoring unit (EMU). These surface electrodes are attached to the patient’s scalp, forehead, and cheeks to enable the recording and characterization of seizures or other sudden activities. As its use is daily, it is important to recognize a potential complication that might be skin breakdown at the electrode sites. The incidence of this complication has been reported in pediatric patients as 10–11.4% but the incidence in adults is less well defined. Additionally have been pointed different kind of risks but at this time the recommendations to prevent this complication have not been clear. This data has been collected from small research studies or cases reports. Methods The goal of this study was to determine the prevalence of this condition according to the literature published, and to classify and clarify risk factors. The published literature was reviewed during the last five years using the following key words: electroencephalography, long term EEG, EEG electrodes, EEG monitoring, breakdown skin, electrothermal burns and pressure ulcers. We pursued a search in different online databases such as PubMed, Medline, Cochrane, LILACS, Google scholar and CINAHL to find articles and studies containing these key words. Initial filters were applied, including peer reviewed articles, meta-analysis, case reports, English language and Spanish language. Supporting the results we documented 4 cases from our institution in different clinical scenarios. Results The literature published is minimal and few articles were reviewed, however the incidence of this complication could be determined as variable between 25% and 35%. And the risk factors were described and classified as common, uncommon and rare. We describe and documented graphically 4 cases from our institution. Conclusion This results are controversial and remain to be supported with better case control studies, however doctors need to be aware of this complication, and its clinic characteristics that seems to be frequent. Additional studies are needed to confirm this findings and developing stronger guidelines to avoid this complication.

Two men with Parkinson disease for approximately a decade complained of involuntary arm elevation developing during the “off” periods between levodopa dose cycles (videos 1 and 2 on the Neurology ® Web site at [Neurology.org][1]; figure). Treatment with tolcapone and subthalamic deep brain stimulation implantation, respectively, reduced “off” time and eliminated this previously unreported motor complication.1 Atypical levodopa-related dystonic complications may develop late in those with relatively younger-onset Parkinson disease.2 The “flamenco dancer” posture, with shoulder abduction and elbow flexion, developed in the initially affected hemibody. The importance of recognizing this unusual “off” dystonia rests on the corrective benefits attained by enhancing dopaminergic or electric stimulation. [1]: http://neurology.org/lookup/doi/10.1212/WNL.0000000000002575/

An informal caregiver (ICG) is a family member and/or friend who provides unpaid care to an individual with a disability or chronic disease. ICGs often put their healthcare second while caring for their loved ones; and this may lead to negative impacts on their well-being. ICGs attended an 8-week therapeutic yoga intervention for their care recipients with Parkinson’s disease. ICGs who participated in the yoga classes were assessed utilizing a retrospective pretest and traditional post-test to determine the presence of depressive symptoms and positive aspects of caregiving. Although the sample size was small, data revealed improvements in depressive symptoms and positive aspects of caregiving. Focus group and individual interview data revealed five qualitative categories: yoga engagement, relationship improvement, psychological improvements, functional improvements, and community engagement. Future research should expand participation of ICGs in yoga trials to determine the extent of changes in psychosocial well-being.

A 56-year-old woman experienced progressive stiffness and painful spasms in the right arm leading to a frozen arm within 2 years. She had previously developed cerebellar ataxia (anti–glutamic acid decarboxylase [GAD] antibodies, 1,550 nmol/L; age 52 years). Examination showed marked rigidity and decreased movement range of the right arm with generalized hyperreflexia (figure and video). There were no antiamphiphysin or other paraneoplastic antibodies. Search for malignancies was negative. Diabetes was ruled out. The patient benefited from diazepam and IV immunoglobulin. Stiff-person syndrome (SPS) affects predominantly the trunk and lower limbs.1 This case illustrates that the cerebellar ataxia-SPS spectrum of anti-GAD autoimmunity may occur sequentially rather than concurrently, and a stiff arm, a variant of paraneoplastic SPS,2 may rarely be a focal form of anti-GAD-mediated (nonparaneoplastic) SPS.

Objective Pilot study to evaluate computer-guided deep brain stimulation (DBS) programming designed to optimize stimulation settings using objective motion sensor-based motor assessments. Materials and Methods Seven subjects (five males; 54–71 years) with Parkinson's disease (PD) and recently implanted DBS systems participated in this pilot study. Within two months of lead implantation, the subject returned to the clinic to undergo computer-guided programming and parameter selection. A motion sensor was placed on the index finger of the more affected hand. Software guided a monopolar survey during which monopolar stimulation on each contact was iteratively increased followed by an automated assessment of tremor and bradykinesia. After completing assessments at each setting, a software algorithm determined stimulation settings designed to minimize symptom severities, side effects, and battery usage. Results Optimal DBS settings were chosen based on average severity of motor symptoms measured by the motion sensor. Settings chosen by the software algorithm identified a therapeutic window and improved tremor and bradykinesia by an average of 35.7% compared with baseline in the “off” state (p < 0.01). Conclusions Motion sensor-based computer-guided DBS programming identified stimulation parameters that significantly improved tremor and bradykinesia with minimal clinician involvement. Automated motion sensor-based mapping is worthy of further investigation and may one day serve to extend programming to populations without access to specialized DBS centers.