Main Topic 1: Parkinson's disease and movement disorders: expanding the boundaries of current pra...

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Main Topic 1: Parkinson's disease and movement disorders: expanding the boundaries of current practice by Mind Map: Main Topic 1: Parkinson's disease and movement disorders: expanding the boundaries of current practice

1. P. Krack

1.1. DeepBrain Stimulation

1.1.1. PD Post operative apathy thobois et al 2010 Clinical predictors of postoperative apathy Dopmaine dysregulation syndrome and impulse control disorders Witjas 2005 Ardouin 2006 Lim 2009 picture picture

1.1.2. Gilles de La Tourette picture Limbic GPi vs thalamic stimulation JL houeto 2005 ML Welter 2008 Servello 2009

1.1.3. OCD A day filled with rituals STOC study group after DBS normal life YBOCS scale 18-20 --> 1-1 after surgery Mallet 2008 DBS Greenberg 2008, Molecular psychiatry

1.1.4. Depression Lozano 2008, Biol Psychiatry Malone 2009, Biol psychiatry stimulation of ventral capsule/ventral striatum for treatment resistent depression Bewernick 2009, Biol psychiatry Nucleus accumbens

1.1.5. Addiction Not discussed due to time

1.1.6. All targets picture it's a mess Neurologists are used to reason DBS from neurology to psychiatry? picture slide 2 What's needed?

1.1.7. Conclusion DBS in psychiatry is still experimental but huge potential

2. J.J. Ferreira

2.1. Parkinson's disease beyond 10 years

2.1.1. What happens after the first 10 years of disease progress? picture picture with errors - Fereira JJ pre-motor signs and symptoms

2.1.2. Hoehn Yahr Staging milestones picture picture

2.1.3. PD progression focused on motor complications picture Elldopa trial Ahlskog JE, Mov. Disord 2001

2.1.4. PD progression focused on clinical trials population De Novo patients or early stage Motor fluctuations wearing off PD Dementia / psychosis picture Clinical characteristics "wearing-off patients" DBS PD Dementia

2.1.5. After 10 years Selection Late stage / end-stage Clinical staging: HY 4 and 5 Longer disease duration specific clinical markers Other Clinical characteristics: motor symptoms Coelho, J. Neurol 2010 S. papapetropoulos, 2007 Non-motor complications Coelho J Neurol 2010 IS dementia inevitable? picture Placebo-adverse events at different disease stage dyskinesias hallucinations Pain Anxiety Peripheral edema Phenotype is different between clinical stages Picture Coelho 2010 Aarsland j am geriatr soc 2000 Clinical markers Medication Picture Mortality picture - w lots of authors Conclusions picture Late / end stage is an orphan domain Initial slide on progression late stage redesigned picture Implications for clinical practice picture Implications for research

3. Kailash Bhatia

3.1. Ion channels & movement Disorders

3.1.1. Basics on Ion channels picture picture most abnormalities in alfa subunits

3.1.2. Ion channel disorder jouveneau 2000 picture Graves and Hanna 2005 review classification of neurological channelopathies according to channel

3.1.3. The paroxysmal dyskinesias often diagnosis is missed Gowers 1885 called it epilepsy Mount and reback 1940 first clear description Paroxysmal dystonic choreoathetosis Lance 1977 PKC PED PDC picture these slides go fast...missed some nice ones. - could not even read them Hypnogenic episodic ataxia

3.1.4. Episodic ataxias There are similarities between paroxysmal dyskinesia and episodic ataxias picture EA type 1 EA type 2 Houser et al, 1999 Bruno et al 2004

3.1.5. Pathophysiology picture picture picture epilepsy theory

3.1.6. Bhatia publications

3.1.7. PDC/PNKD picture treatment no specific drug anticonvulsants help rarely Recent gene found Oxidative stress product Bruno et al neurology 2005 myofibrillogenesis regulator 1 gene mutations cause paroxysmal dystonic choreoathetosis Paroxysmal dyskinesia due to glucose transporter 1 defect Weber, JCI 2008 GLUT1 deficiency

3.1.8. Autosomal dominant nocturnal frontal lobe epilepsy

3.1.9. Diagnostics Serum and CSF glucose studies

3.1.10. Treatment of GLUT1 deficiency ketogenic diet

3.1.11. Autoimmune channelopathis causing movement disorders central nervous system peripheral nerve system Isaac's syndrome

3.1.12. Summary picture picture picture picture