Utility of an objective dyskinesia rating scale for Parkinson's disease: Inter‐ and intrarater reliability assessment

Goetz, Christopher G.; Stebbins, Glenn T.; Shale, Heidi; Lang, Anthony E.; Chernik, Doris A.; Chmura, Teresa A.; Ahlskog, J. Eric; Dorflinger, Ernest

doi:10.1002/mds.870090403

Cited by 262 publications

(162 citation statements)

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“…This scoring system coincides with the Obeso's scale included in the Core Assessment Program for Intracerebral Transplantation 38 subsequently modified and validated for clinical assessment of dyskinesias in PD patients. 39 The CM lesion was made between 4 and 12 months after the last MPTP injection in all monkeys and after 1 to 8 months of initiating levodopa/apomorphine treatment (see later).…”

Section: Mptp Intoxicationmentioning

confidence: 99%

Lesion of the centromedian thalamic nucleus in MPTP‐treated monkeys

et al. 2008

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The caudal intralaminar nuclei are a major source of glutamatergic afferents to the basal ganglia. Experiments in the 6-hydroxydopamine rat model have shown that the parafascicular nucleus is overactive and its lesion alleviates basal ganglia neurochemical abnormalities associated with dopamine depletion. Accordingly, removal of this excitatory innervation of the basal ganglia could have a beneficial value in the parkinsonian state. To test this hypothesis, unilateral kainate-induced chemical ablation of the centromedian thalamic nucleus (CM) has been performed in MPTPtreated monkeys. Successful lesions restricted to the CM boundaries (n = 2) without spreading over other neighboring thalamic nuclei showed an initial, short-lasting, and mild change in the parkinsonian motor scale but no effect against levodopa-induced dyskinesias. The lack of significant and persistent motor improvement leads us to conclude that unilateral selective lesion of the CM alone cannot be considered as a suitable surgical approach for the treatment of PD or levo-dopa-induced dyskinesias. The role of the caudal intralaminar nuclei in the pathophysiology of movement disorders of basal ganglia origin remains to be clarified. HHS Public Access Author Manuscript Author ManuscriptAuthor Manuscript Author ManuscriptThe centromedian-parafascicular thalamic complex (CM-Pf) is one major source of glutamatergic innervation of several basal ganglia nuclei, including the striatum, 1-15 the subthalamic nucleus (STN), 4,7,[12][13][14][15][16][17][18][19][20][21] the globus pallidus, and the substantia nigra. 15,21,22 Projections arising from the caudal intralaminar nuclei are excitatory and use glutamate as neurotransmitter. [23][24][25] In recent years, a number of studies have suggested a possible role for the CM-Pf complex on the pathophysiology of movement disorders. 26,27 In rats, Pf neurons that innervate the STN 28,29 and the striatum 25 are known to be hyperactive after unilateral midbrain dopaminergic lesion with 6-hydroxydopamine (6-OHDA). Indeed, the chemical ablation of Pf in rodents is highly effective in reversing the increases on STN metabolic activity typically observed after dopamine depletion. 30 Interestingly, early observations considered the CM/Pf as a target by deep brain stimulation (DBS) for the treatment of levodopainduced dyskinesias in Parkinson's disease, [31][32][33] and this has recently been proposed in combination with DBS of the globus pallidus pars interna (GPi). 34 On the other hand, important cell loss has been described in the CM-Pf of PD patients 35 as well as in rodents after nigrostriatal damage. 25,36 To further assess the relevance of the CM/Pf as a potential therapeutic target for parkinsonism and levodopa-induced dyskinesias, we have performed chemical ablation of the caudal intralaminar nuclei in MPTP-treated monkeys and determined its impact on parkinsonian motor signs and dyskinesias. SUBJECTS AND METHODSA total number of five young adult male Macaca fascicularis primates (body weight ranging fr...

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Section: Mptp Intoxicationmentioning

confidence: 99%

Lesion of the centromedian thalamic nucleus in MPTP‐treated monkeys

et al. 2008

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“…Picking up and drinking from a cup of water 5. Walking Videotapes were rated independently by two blinded raters (RK and AE), using modified versions of the Goetz rating scale 16 and the Abnormal Involuntary Movements Scale (AIMS). 17 Both are five point (0-4) scales: AIMS rates visible dyskinesias in various body parts, and Goetz rates overall impairment caused by dyskinesias during motor tasks.…”

Section: Dyskinesia Assessmentsmentioning

confidence: 99%

Mucuna pruriens in Parkinson's disease: a double blind clinical and pharmacological study

Katzenschlager

Evans²,

Manson³

et al. 2004

Journal of Neurology, Neurosurgery & Psychiatry

245

138

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Background: The seed powder of the leguminous plant, Mucuna pruriens has long been used in traditional Ayurvedic Indian medicine for diseases including parkinsonism. We have assessed the clinical effects and levodopa (L-dopa) pharmacokinetics following two different doses of mucuna preparation and compared them with standard L-dopa/carbidopa (LD/CD). Methods: Eight Parkinson's disease patients with a short duration L-dopa response and on period dyskinesias completed a randomised, controlled, double blind crossover trial. Patients were challenged with single doses of 200/50 mg LD/CD, and 15 and 30 g of mucuna preparation in randomised order at weekly intervals. L-Dopa pharmacokinetics were determined, and Unified Parkinson's Disease Rating Scale and tapping speed were obtained at baseline and repeatedly during the 4 h following drug ingestion. Dyskinesias were assessed using modified AIMS and Goetz scales. Results: Compared with standard LD/CD, the 30 g mucuna preparation led to a considerably faster onset of effect (34.6 v 68.5 min; p = 0.021), reflected in shorter latencies to peak L-dopa plasma concentrations. Mean on time was 21.9% (37 min) longer with 30 g mucuna than with LD/CD (p = 0.021); peak L-dopa plasma concentrations were 110% higher and the area under the plasma concentration v time curve (area under curve) was 165.3% larger (p = 0.012). No significant differences in dyskinesias or tolerability occurred. Conclusions: The rapid onset of action and longer on time without concomitant increase in dyskinesias on mucuna seed powder formulation suggest that this natural source of L-dopa might possess advantages over conventional L-dopa preparations in the long term management of PD. Assessment of long term efficacy and tolerability in a randomised, controlled study is warranted.

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“…5 The conditions of evaluation were not randomized and onset-of-dose dyskinesia was evaluated in "off "-stimulation condition at least 30 minutes after the neurostimulator was switched off. The patients were blinded but not the examiner.…”

mentioning

confidence: 99%

“…4 "Off "-period dystonia, onset-of-dose, and peak-dose dyskinesias were assessed separately using three scales encompassing the face, neck, and the four limbs, each scored from zero to four proportionally to severity. 5 The conditions of evaluation were not randomized and onset-of-dose dyskinesia was evaluated in "off "-stimulation condition at least 30 minutes after the neurostimulator was switched off. The patients were blinded but not the examiner.…”

mentioning

confidence: 99%

Effect of subthalamic nucleus stimulation on levodopa-induced dyskinesia in Parkinson’s disease

Fraix

Pollak²,

Blercom³

et al. 2000

Neurology

117

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Article abstract-The authors studied the effect of bilateral subthalamic nucleus stimulation on levodopa-induced dyskinesias in 24 consecutive parkinsonian patients with disabling dyskinesias. The improvement in the three subtypes of levodopa-induced dyskinesias was significant from the third postoperative month and was mainly due to the decrease in the daily dose of levodopa allowed by the stimulation-induced improvement in the motor score. NEUROLOGY 2000;55:1921-1923 A few years after beginning levodopa treatment, many patients with idiopathic PD develop motor fluctuations and levodopa-induced dyskinesias (LID), which may be more disabling than parkinsonism, especially in patients with young-onset PD. Chronic stimulation of the subthalamic nucleus (STN) is effective in treating parkinsonian motor symptoms and can be suggested to patients with severe motor fluctuations.1 Operating on the STN might theoretically be harmful to LID. Hemiballism can be induced by spontaneous lesions of the STN and by experimental high frequency stimulation of the STN in patients with PD as well. 2 We investigated the effect of STN stimulation on different types of LID in parkinsonian patients.Patients and methods. Twenty-four consecutive patients-12 men and 12 women-with severe PD and motor complications were bilaterally operated. The characteristics of these patients are summarized in table 1. The neurosurgical procedure has been described. 1Clinical evaluation was based on the Core Assessment Program for Intracerebral Transplantation (CAPIT) protocol and was performed after a 12-hour withdrawal of antiparkinsonian drugs.3 Patients were assessed twice before surgery and 3 and 12 months after the operation in "off "-drug and "on"-drug conditions, using Unified PD Rating Scale (UPDRS) motor scores and the dyskinesia duration and disability items of the UPDRS part IV. Levodopa-induced dyskinesias were evaluated during a levodopa challenge using the same suprathreshold dose as preoperatively.4 "Off "-period dystonia, onset-of-dose, and peak-dose dyskinesias were assessed separately using three scales encompassing the face, neck, and the four limbs, each scored from zero to four proportionally to severity. 5 The conditions of evaluation were not randomized and onset-of-dose dyskinesia was evaluated in "off "-stimulation condition at least 30 minutes after the neurostimulator was switched off. The patients were blinded but not the examiner. Results are presented as mean Ϯ SD values. The data were analyzed by analysis of variance for repeated measures, and by the paired t-test and the Wilcoxon signed-rank test when required. Results.Results are presented in table 2 and the figure. STN stimulation significantly reduced the UPDRS motor score. In the "off "-drug condition, the UPDRS motor scores decreased from 54.4 Ϯ 13.1 before surgery to 45.8 Ϯ 19.7 and 49.3 Ϯ 17.9 in the "off "-stimulation condition and to 18.3 Ϯ 12.3 and 18.2 Ϯ 8.8 in the "on"-stimulation condition at 3-and 12-month follow-ups, respectively. In the "on"-drug condition t...

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Utility of an objective dyskinesia rating scale for Parkinson's disease: Inter‐ and intrarater reliability assessment

Cited by 262 publications

References 4 publications

Lesion of the centromedian thalamic nucleus in MPTP‐treated monkeys

Lesion of the centromedian thalamic nucleus in MPTP‐treated monkeys

Mucuna pruriens in Parkinson's disease: a double blind clinical and pharmacological study

Effect of subthalamic nucleus stimulation on levodopa-induced dyskinesia in Parkinson’s disease

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