Publications by authors named "Delaram Safarpour"

6 Publications

  • Page 1 of 1

Measuring freezing of gait during daily-life: an open-source, wearable sensors approach.

J Neuroeng Rehabil 2021 Jan 4;18(1). Epub 2021 Jan 4.

Department of Neurology, School of Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, OP-32, Portland, OR, 97239, USA.

Background: Although a growing number of studies focus on the measurement and detection of freezing of gait (FoG) in laboratory settings, only a few studies have attempted to measure FoG during daily life with body-worn sensors. Here, we presented a novel algorithm to detect FoG in a group of people with Parkinson's disease (PD) in the laboratory (Study I) and extended the algorithm in a second cohort of people with PD at home during daily life (Study II).

Methods: In Study I, we described of our novel FoG detection algorithm based on five inertial sensors attached to the feet, shins and lumbar region while walking in 40 participants with PD. We compared the performance of the algorithm with two expert clinical raters who scored the number of FoG episodes from video recordings of walking and turning based on duration of the episodes: very short (< 1 s), short (2-5 s), and long (> 5 s). In Study II, a different cohort of 48 people with PD (with and without FoG) wore 3 wearable sensors on their feet and lumbar region for 7 days. Our primary outcome measures for freezing were the % time spent freezing and its variability.

Results: We showed moderate to good agreement in the number of FoG episodes detected in the laboratory (Study I) between clinical raters and the algorithm (if wearable sensors were placed on the feet) for short and long FoG episodes, but not for very short FoG episodes. When extending this methodology to unsupervised home monitoring (Study II), we found that percent time spent freezing and the variability of time spent freezing differentiated between people with and without FoG (p < 0.05), and that short FoG episodes account for 69% of the total FoG episodes.

Conclusion: Our findings showed that objective measures of freezing in PD using inertial sensors on the feet in the laboratory are matching well with clinical scores. Although results found during daily life are promising, they need to be validated. Objective measures of FoG with wearable technology during community-living would be useful for managing this distressing feature of mobility disability in PD.
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http://dx.doi.org/10.1186/s12984-020-00774-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7784003PMC
January 2021

Clinical Epidemiology, Evaluation, and Management of Dementia in Parkinson Disease.

Am J Alzheimers Dis Other Demen 2016 11 13;31(7):585-594. Epub 2016 Jun 13.

Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA Leonard Davis Institute of Health Economics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA

The prevalence of neurodegenerative diseases such as Parkinson disease (PD) will increase substantially, due to the aging of the population and improved treatments leading to better disease-related outcomes. Dementia is the most common nonmotor symptom in PD, and most patients with PD will have cognitive dysfunction and cognitive decline in the course of their disease. The development of cognitive dysfunction in PD greatly limits the ability to participate in activities of daily living and can be a tipping point for nursing home placement or major caregiver stress. Understanding the different causes of dementia and how to reduce the incidence and impact of secondary cognitive dysfunction in PD are necessary skills for primary care physicians and neurologists. In this review, we discuss the clinical epidemiology of dementia in PD with an emphasis on preventable cognitive dysfunction, present tools for outpatient evaluation of cognitive dysfunction, and describe current pharmacological treatments for dementia in PD.
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http://dx.doi.org/10.1177/1533317516653823DOI Listing
November 2016

Botulinum Toxin Treatment of Neuropathic Pain.

Semin Neurol 2016 Feb 11;36(1):73-83. Epub 2016 Feb 11.

Department of Neurology, Yale University School of Medicine, New Haven, Connecticut.

Neuropathic pain (NP), a common form of human pain, often poorly responds to analgesic medications. In this review the authors discuss the pathophysiology and conventional treatment of neuropathic pain and provide evidenced-based statements on the efficacy of botulinum neurotoxins (BoNTs) in this form of pain. The level of efficacy for BoNT treatment in each category of NP is defined according to the published guidelines of the American Academy of Neurology. The data indicate that BoNT treatment (most of the literature is with onabotulinumtoxinA) is effective (level A evidence) in postherpetic neuralgia and trigeminal neuralgia. It is probably effective (level B) in posttraumatic neuralgia and painful diabetic neuropathy. The data on complex regional pain syndrome, carpal tunnel syndrome, occipital neuralgia, and phantom limb pain are preliminary and await conduction of randomized, blinded clinical trials. Much remains to be learned about the most-effective dosage and technique of injection, optimum dilutions, and differences among BoNTs in the treatment of neuropathic pain.
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http://dx.doi.org/10.1055/s-0036-1571953DOI Listing
February 2016

Nursing home and end-of-life care in Parkinson disease.

Neurology 2015 Aug 2;85(5):413-9. Epub 2015 Jul 2.

From the Departments of Neurology (D.S., D.P.T., A.W.W.) and Biostatistics and Epidemiology (A.W.W.), Center for Clinical Epidemiology and Biostatistics (D.S., A.W.W.), and Leonard Davis Institute of Health Economics (A.W.W.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Department of Neurology (C.L.D., B.A.R.), Washington University School of Medicine, St. Louis, MO; Departments of Medicine (C.M.B.) and Health Policy and Management (C.M.B.), Johns Hopkins School of Medicine, Baltimore, MD; Department of Neurology (E.R.D.), Center of Human Experimental Therapeutics, University of Rochester Medical Center, NY; and School of Public Health (B.A.R.), Faculty of Health Sciences, University of the Witwatersrand, Parktown, South Africa.

Objective: To examine long-term care facility (LTCF or nursing home) use and end-of-life care for individuals with Parkinson disease (PD).

Methods: In this nationwide retrospective cohort study, we compared LTCF and hospice utilization among Medicare beneficiaries diagnosed with PD by demographic, clinical, and physician characteristics. We also examined the impact of outpatient neurologist care for institutionalized patients with PD on end-of-life care.

Results: We identified 469,055 individuals with PD who received Medicare benefits in 2002. Nearly 25% (more than 100,000 in total) resided in an LTCF. Women with PD had greater odds of nursing facility residence (adjusted odds ratio [AOR] 1.34, 95% confidence interval [CI] 1.30-1.38) compared with men. Black individuals with PD were 34% more likely than white individuals to reside in an LTCF (AOR 1.34, 95% CI 1.30-1.38), contrary to the race patterns typically observed for LTCF use. Hip fracture (AOR 2.10, 95% CI 2.04-2.15) and dementia (AOR 4.06, 95% CI 4.00-4.12) were the strongest clinical predictors of LTCF placement. Only 33% (n = 38,334) of nursing home residents with PD had outpatient neurologist care. Eighty-four percent (n = 80,877) of LTCF residents with PD died by December 31, 2005. Hospice utilization varied little by race and sex. LTCF residents who had outpatient neurologist care were twice as likely to utilize hospice services before death (AOR 2.35, 95% CI 2.24-2.47).

Conclusions And Relevance: A large proportion of the Medicare PD population resides in an LTCF. There is substantial unmet need for palliative care in the PD population. Increased efforts to provide specialist care to dependent individuals with PD may improve end-of-life care.
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http://dx.doi.org/10.1212/WNL.0000000000001715DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4534080PMC
August 2015

Botulinum toxin A (Botox) for treatment of proximal myofascial pain in complex regional pain syndrome: two cases.

Pain Med 2010 Sep 23;11(9):1415-8. Epub 2010 Aug 23.

Department of Neurology, Yale University School of Medicine, New Haven, Connecticut, USA.

Objectives: To describe development of myofascial pain syndrome (MFPS) with trigger points in the proximal muscles of the patients with complex regional pain syndrome (CRPS1) and improvement of distal symptoms of CRPS 1 after successful treatment of proximal MFPS.

Setting And Design: In our practice, we frequently encounter patients in whom a proximal myofascial pain syndrome develops ipsilateral to the distal limb of CRPS1 patients. We describe two such patients in detail with their treatment. PATIENT 1: A 48-year-old woman experienced severe allodynia, swelling and autonomic changes in the right hand after surgery for carpal tunnel syndrome. Over the succeeding months, she developed painful trigger points in the right trapezius and upper back muscles which was treated with administration of botulinum toxin A (BoNT-A) into the trigger points (20 unit/point). PATIENT 2: A 41-year-old woman following a traumatic forearm injury suffered from CRPS1 affecting the left hand and forearm. Proximal MFPS gradually developed on the same side over 12 months and was treated with administration of BoNT-A into the trapezius, splenius capitis, and rhomboid muscle trigger points.

Results: In both patients treatment with BoNT-A improved the proximal pain of MFPS and the distal symptoms of CRPS1.

Conclusion: proximal MFPS develops ipsilateral to the distal painful limb in patients with CRPS1. Administration of BoNT-A into the affected proximal muscles may alleviate both MFPS and the distal allodynia, discoloration and, tissue swelling of CRPS.
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http://dx.doi.org/10.1111/j.1526-4637.2010.00929.xDOI Listing
September 2010

Botulinum toxin A for treatment of allodynia of complex regional pain syndrome: a pilot study.

Pain Med 2010 Sep 30;11(9):1411-4. Epub 2010 Jun 30.

Department of Neurology, Yale University School of Medicine, New Haven, Connecticut, USA.

Objective: To investigate the efficacy and tolerability of Botulinum toxin A (BoNT-A) in allodynia of patients with complex regional pain syndrome.

Design: A total of 14 patients were studied. Eight patients were participants of a randomized, prospective, double-blind, placebo-controlled protocol. Six patients were studied prospectively in an open-label protocol. Patients were rated at baseline and at 3 weeks and 2 months after BoNT-A administration. Ratings included brief pain inventory, McGill pain questionnaire, clinical pain impact questionnaire, quantitative skin sensory test, sleep satisfaction scale, and patient global satisfaction scale. BoNT-A was injected intradermally and subcutaneously, five units/site into the allodynic area (total dose 40-200 units).

Results: None of the patients with allodynia showed a significant response after treatment. The treatment was painful and poorly tolerated.

Conclusion: Intrademal and subcutaneous administration of BoNT-A into the allodynic skin of the patients with complex regional pain syndrome (CRPS) failed to improve pain and was poorly tolerated.
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http://dx.doi.org/10.1111/j.1526-4637.2010.00897.xDOI Listing
September 2010