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Despite a strong body of evidence supporting benefits of exercise to reduce severity of motor symptoms of Parkinson's Disease (PD) over time, research on the immediate impact of exercise as an adjunctive therapy for nonpharmacologic management of motor symptoms and mobility performance in people with PD is limited. The purpose of this study was to examine immediate effects of a single bout of high-cadence cycling on motor symptoms of PD and performance-based outcomes. Twenty individuals with idiopathic PD participated in a pretest/posttest study investigating immediate impacts of a single high-cadence cycling session on performance-based outcomes across multiple domains of motor function, mobility, and balance. Outcomes were analyzed based on time since last dose of levodopa/carbidopa medication. Immediate improvements were observed in motor symptoms of PD with significant improvements in performance across multiple balance systems, dynamic gait, and upper-extremity coordination following a cycling intervention. [ABSTRACT FROM AUTHOR]

Circadian rhythms have been shown in the subthalamic nucleus (STN) in Parkinsons disease (PD), but only a few studies have focused on the globus pallidus internus (GPi). This retrospective study investigates GPi circadian rhythms in a large cohort of subjects with PD (130 recordings from 93 subjects) with GPi activity chronically recorded in their home environment. We found a significant change in GPi activity between daytime and nighttime in most subjects (82.4%), with a reduction in GPi activity at nighttime in 56.2% of recordings and an increase in activity in 26.2%. GPi activity in higher frequency bands ( > 20 Hz) was more likely to decrease at night and in patients taking extended-release levodopa medication. Our results suggest that circadian fluctuations in the GPi vary across individuals and that increased power at night might be due to the reemergence of pathological neural activity. These findings should be considered to ensure successful implementation of adaptive neurostimulation paradigms in the real-world.

Background: Antiparkinsonian medication has significantly evolved over the last 2 decades, offering various pharmacologic approaches. The aim of this study was to explore the trends and to determine the statistical significance of the observed changes in the antiparkinsonian medication utilization in Romania during 1998–2022. Methods: This antiparkinsonian drug utilization study used data provided by CEGEDIM Romania, originating from the Pharma and Hospital Report. Quantitative data for each ATC N04 antiparkinsonian medication were converted to total defined daily doses (DDDs) and to DDD/1000inhabitants/day (DDD/TID). The autoregressive integrated moving average (ARIMA) model was employed to determine the statistical significance of the observed changes in the trends of antiparkinsonian drug use. Results: The utilization of antiparkinsonian medication increased considerably (6-folds) in Romania during the 25 years, from 1.03 DDD/TID in 1998 to 6.22 DDD/TID in 2022. Starting 2005, dopamine precursor (levodopa) became the most used antiparkinsonian drug and remained on this position until the end of the study (13-fold increase from 0.17 in 1998 to 2.30 DDD/TID in 2022). MAO-B inhibitors represented the second most used antiparkinsonian drug class for the majority of the years. Selegiline was the most used until 2017 (0.82 DDD/TID), when a decrease in use was observed and continued until 2022 (0.49 DDD/TID). Utilization of dopamine agonists started in 1999, with less than 0.01 DDD/TID, and increased to 1.47 DDD/TID in 2022. Ropinirole was the most used dopamine agonist (0.56 DDD/TID in 2022). Anticholinergic agents represented the most used antiparkinsonian drugs until 2005. Trihexyphenidyl was the main anticholinergic prescribed with a maximum utilization of 0.82 DDD/TID in 2000 followed by a slight decrease until 2022 (0.56 DDD/TID). Amantadine utilization was mainly constant throughout the 25 years, with 0.32 DDD/TID prescribed in 2022. ARIMA analysis showed that the changes in antiparkinsonian drugs consumption were not statistically significant and overall, the trend for antiparkinsonian drug use demonstrates an upward trajectory. Conclusion: Antiparkinsonian medication showed an increasing utilization trend in Romania during 1998–2022. Levodopa was the most used antiparkinsonian medicine after 2005, replacing anticholinergic agents. MAO-inhibitors utilization came in second and was followed by dopamine agonists. Observing the trend in antiparkinsonian medication utilization over time is essential for providing insights into their real-world use and uptake in a large population. [ABSTRACT FROM AUTHOR]

The developed method for simultaneous detection of levodopa and carbidopa was able to separate the peaks of the drug and sodium bisulfite in the in-vitro release samples and stability samples. Levodopa (LD), a pro-drug of dopamine, is used as the gold standard treatment for Parkinson's disease. It is usually prescribed with carbidopa (CD) to prevent the conversion of levodopa to dopamine peripherally, thus reducing undesirable side effects. Both drugs are unstable at pH 7.4 beyond 24 h due to their oxidation, therefore 0.2% sodium bisulfite is added to the formulation as an antioxidant. The separation was performed by gradient elution using the Luna-C18 column (250 × 4.6 mm, 5 µm) at a flow rate of 1 ml/min. The mobile phase was composed of mobile phase A 30 mM potassium phosphate and acetonitrile (95:5, v/v) with 35 mM tetrabutylammonium hydrogen sulphate and mobile phase B containing 30 mM potassium phosphate and acetonitrile (50:50 v/v). Drug peaks were detected at 280 nm with retention times of 3.05 ± 0.001 min for LD and 3.64 ± 0.001 min for CD. The validation of the method according to US FDA guidelines and results were found to be within acceptable limits. The method was linear from 10–100 µg/ml (r2 = 0.999) and 10–100 µg/ml (r2 = 0.999) for LD and CD, respectively. The developed method was applied to studying the drug release from in-situ gel. The environmental impact of the developed method was evaluated using various greenness assessment tools. [ABSTRACT FROM AUTHOR]

Background/Objectives: People with Parkinson's disease (PwP) face high risks of bacterial infections and septic shock, often requiring inotrope treatment and mechanical ventilation. The impact of levodopa on these critical care interventions remains unclear. Methods: This retrospective cohort study analyzed data from the Taipei Medical University Clinical Research Database to explore the relationship between levodopa prescription, inotrope treatment duration, and mechanical ventilation dependence in PwP who experienced septic shock. PwP aged 45 years and older who required intensive care for septic shock were categorized into levodopa and non-levodopa groups. Results: Outcomes included inotrope treatment duration, mechanical ventilation dependence, and 3-month mortality. Among 243 PwP (116 without levodopa, 127 with levodopa), no significant difference was observed in the duration of mechanical ventilation dependence. However, levodopa prescription was associated with a significantly extended inotrope treatment duration (estimate: 3.43 days, p = 0.027). Additionally, a nonsignificant trend was identified between levodopa prescription and reduced 3-month mortality (adjusted hazard ratio = 0.67, p = 0.068). Conclusions: These findings highlight the complex interplay between Parkinson's disease management and critical care interventions during septic shock. While levodopa may prolong inotrope use, its potential to influence survival outcomes warrants further investigation. [ABSTRACT FROM AUTHOR]

Background and Objectives: Although widely described in Parkinson's disease (PD), peripheral neuropathy (PNP) is scarcely reported in progressive supranuclear palsy (PSP). We aimed to compare the frequency, clinical and electrophysiologic characteristics of PNP in PSP and PD patients. Methods: This cross-sectional study included 23 PSP and 93 PD patients. Demographic data, Movement Disorders Society-Unified Parkinson's Disease Rating Scale-III (MDS-UPDRS-III), Hoehn–Yahr staging, Toronto Clinical Neuropathy Score, nerve conduction study (NCS), and sympathetic skin response (SSR) were recorded. Diagnosing isolated large fiber neuropathy required abnormal NCS. Isolated small fiber neuropathy required clinical findings of pinprick and thermal sensory loss and/or allodynia and/or hyperalgesia with/without impaired SSR, along with normal NCS. Results: PNP was commoner in PSP than PD (65.2% vs. 50.5%, P = 0.21). While a comparable proportion in both groups had clinical neuropathy, NCS abnormalities predominated in PSP (65.2% vs. 39.8%, P = 0.03). All patients had distal symmetrical axonal polyneuropathy. A significantly higher proportion of PSP patients had large fiber involvement (65.21% vs. 39.78%, χ2 = 4.82; P = 0.03) and mixed fiber PNP (60.9% vs. 33.3%, P = 0.01). PSP patients with neuropathy had a significantly shorter disease duration [median (interquartile range {IQR} = 2 (2-3) years vs. 6 (3-9) years, P < 0.001], higher MDS-UPDRS-III score [median (IQR) = 47 (36–54) vs. 34 (28–49), P = 0.049], higher Hoehn–Yahr stage [median (IQR) = 4 (2–5) vs. 3 (1–5), P < 0.001], and shorter duration of levodopa use [median (IQR) = 2 (1-2) years vs. 3.5 (2-5) years, P = 0.006]. NCS parameters were comparable between PSP and PD patients with neuropathy. While PNP in PSP was not associated with any of the clinical variables, a longer disease duration was independently associated with PNP in PD. Conclusions: PNP affected two-thirds of PSP patients and was more prevalent than PD. Both groups had distal symmetrical axonal polyneuropathy, with mixed fiber PNP predominating in PSP. A longer disease duration in PD was associated with PNP. [ABSTRACT FROM AUTHOR]