Publications by authors named "Hana Brozova"

27 Publications

  • Page 1 of 1

3D visual cueing shortens the double support phase of the gait cycle in patients with advanced Parkinson's disease treated with DBS of the STN.

PLoS One 2020 31;15(12):e0244676. Epub 2020 Dec 31.

Department of Neurology and Center of Clinical Neuroscience, 1st Faculty of Medicine and General University Hospital, Charles University, Prague, Czech Republic.

Background: Gait disturbances have emerged as some of the main therapeutic concerns in late-stage Parkinson's disease (PD) treated with dopaminergic therapy and deep brain stimulation (DBS). External cues may help to overcome freezing of gait (FOG) and improve some of the gait parameters.

Aim: To evaluate the effect of 3D visual cues and STN-DBS on gait in PD group.

Methods: We enrolled 35 PD patients treated with DBS of nucleus subthalamicus (STN-DBS). Twenty-five patients (5 females; mean age 58.9 ±6.3) and 25 sex- and age-matched controls completed the gait examination. The gait in 10 patients deteriorated in OFF state. The severity of PD was evaluated using the Unified Parkinson's Disease Rating Scale (UPDRS) and Hoehn and Yahr (HY). The PD group filled the Falls Efficacy Scale-International (FES) and Freezing of Gait Questionnaire (FOGQ). Gait was examined using the GaitRite Analysis System, placed in the middle of the 10m marked path. The PD group was tested without dopaminergic medication with and without visual cueing together with the DBS switched ON and OFF. The setting of DBS was double-blind and performed in random order.

Results: The UPDRS was 21.9 ±9.5 in DBS ON state and 41.3 ±13.7 in DBS OFF state. HY was 2.5 ±0.6, FES 12.4 ±4.1 and FOGQ 9.4 ±5.7. In the DBS OFF state, PD group walked more slowly with shorter steps, had greater step length variability and longer duration of the double support phase compared to healthy controls. The walking speed and step length increased in the DBS ON state. The double support phase was reduced with 3D visual cueing and DBS; the combination of both cueing and DBS was even more effective.

Conclusion: Cueing with 3D visual stimuli shortens the double support phase in PD patients treated with DBS-STN. The DBS is more effective in prolonging step length and increasing gait speed. We conclude that 3D visual cueing can improve walking in patients with DBS.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0244676PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7774936PMC
December 2020

Efficiency of I-ioflupane SPECT as the marker of basal ganglia damage in acute methanol poisoning: 6-year prospective study.

Clin Toxicol (Phila) 2021 Mar 7;59(3):235-245. Epub 2020 Aug 7.

Department of Occupational Medicine, First Faculty of Medicine, Charles University, Prague, Czech Republic.

Context: Investigate whether I-ioflupane SPECT (DaT SPECT) has the potential as a marker of basal ganglia damage in acute methanol poisoning.

Methods: Prospective, single-centre, cohort study of patients with confirmed methanol poisoning was conducted. DaT SPECT was performed twice with semi-quantification using DaTQUANT and MRI-based volumetry was calculated. Specific binding ratios (SBR) of striatum, caudate nucleus, and putamen were correlated with laboratory parameters of outcome, volumetric data, and retinal nerve fibres layer (RNFL) thickness measurements.

Results: Forty-two patients (mean age 46.3 ± 4.2 years; 8 females), including 15 with MRI-detected putamen lesions (group I) and 27 patients with intact putamen (group II), underwent DaT SPECT. Volumetry was calculated in 35 of the patients assessed. SBR values for the left putamen correlated with putamen volume ( = 0.665;  < 0.001). Decreased bilateral SBR values were determined for the striatum and the putamen, but not for the nucleus caudate, in group I ( < 0.05). Significant correlation was observed between the SBR of the posterior putamen and arterial blood pH ( = 0.574;  < 0.001) and other toxicological parameters of severity of poisoning/outcome including serum lactate, glucose, and creatinine concentrations ( < 0.05). The SBR of the posterior putamen positively correlated with the global RNFL thickness ( < 0.05). ROC analysis demonstrated a significant discriminatory ability of SBR of the posterior putamen with AUC = 0.753 (95%CI 0.604-0.902;  = 0.007). The multivariate regression model demonstrated that arterial blood pH, age, and gender were the most significant factors associated with SBR of the posterior putamen.

Conclusion: DaT SPECT demonstrates significant potential for the diagnosis of methanol-induced basal ganglia damage.
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http://dx.doi.org/10.1080/15563650.2020.1802033DOI Listing
March 2021

Lack of Accredited Clinical Training in Movement Disorders in Europe, Egypt, and Tunisia.

J Parkinsons Dis 2020 ;10(4):1833-1843

Instituto de Medicina Molecular, Lisbon, Portugal.

Background: Little information is available on the official postgraduate and subspecialty training programs in movement disorders (MD) in Europe and North Africa.

Objective: To survey the accessible MD clinical training in these regions.

Methods: We designed a survey on clinical training in MD in different medical fields, at postgraduate and specialized levels. We assessed the characteristics of the participants and the facilities for MD care in their respective countries. We examined whether there are structured, or even accredited postgraduate, or subspecialty MD training programs in neurology, neurosurgery, internal medicine, geriatrics, neuroradiology, neuropediatrics, and general practice. Participants also shared their suggestions and needs.

Results: The survey was completed in 31/49 countries. Structured postgraduate MD programs in neurology exist in 20 countries; structured neurology subspecialty training exists in 14 countries and is being developed in two additional countries. Certified neurology subspecialty training was reported to exist in 7 countries. Recommended reading lists, printed books, and other materials are the most popular educational tools, while courses, lectures, webinars, and case presentations are the most popular learning formats. Mandatory activities and skills to be certified were not defined in 15/31 countries. Most participants expressed their need for a mandatory postgraduate MD program and for certified MD sub-specialization programs in neurology.

Conclusion: Certified postgraduate and subspecialty training exists only in a minority of European countries and was not found in the surveyed Egypt and Tunisia. MD training should be improved in many countries.
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http://dx.doi.org/10.3233/JPD-202000DOI Listing
January 2020

Agreement between the GAITRite System and the Wearable Sensor BTS G-Walk for measurement of gait parameters in healthy adults and Parkinson's disease patients.

PeerJ 2020 22;8:e8835. Epub 2020 May 22.

Department of Neurology and Center of Clinical Neuroscience, 1st Faculty of Medicine and General University Hospital in Prague, Charles University, Prague, Czech Republic.

Background: Nowadays, the most widely used types of wearable sensors in gait analysis are inertial sensors. The aim of the study was to assess the agreement between two different systems for measuring gait parameters (inertial sensor vs. electronic walkway) on healthy control subjects (HC) and patients with Parkinson's disease (PD).

Methods: Forty healthy volunteers (26 men, 14 women, mean age 58.7 ± 7.7 years) participated in the study and 24 PD patients (19 men, five women, mean age 62.7 ± 9.8 years). Each participant walked across an electronic walkway, GAITRite, with embedded pressure sensors at their preferred walking speed. Concurrently a G-Walk sensor was attached with a semi-elastic belt to the L5 spinal segment of the subject. Walking speed, cadence, stride duration, stride length, stance, swing, single support and double support phase values were compared between both systems.

Results: The Passing-Bablock regression slope line manifested the values closest to 1.00 for cadence and stride duration (0.99 ≤ 1.00) in both groups. The slope of other parameters varied between 0.26 (double support duration in PD) and 1.74 (duration of single support for HC). The mean square error confirmed the best fit of the regression line for speed, stride duration and stride length. The y-intercepts showed higher systematic error in PD than HC for speed, stance, swing, and single support phases.

Conclusions: The final results of this study indicate that the G-Walk system can be used for evaluating the gait characteristics of the healthy subjects as well as the PD patients. However, the duration of the gait cycle phases should be used with caution due to the presence of a systematic error.
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http://dx.doi.org/10.7717/peerj.8835DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7247524PMC
May 2020

Validation of the Freezing of Gait Questionnaire in patients with Parkinson's disease treated with deep brain stimulation.

Neurol Sci 2020 May 2;41(5):1133-1138. Epub 2020 Jan 2.

Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital in Prague, Katerinska 30, 128 21, Prague, Czech Republic.

Background: The Freezing of Gait Questionnaire (FoG-Q) is a fast and sensitive assessment tool for freezing (FoG).

Objective: The objective of the study is for validation of a Czech version of FoG-Q. A further, explorative aim was to examine what FoG-Q indicates about the presence and severity of gait impairment in patients treated with DBS in their full OFF state.

Design: The study was a cross-sectional validation study.

Methods: We translated FoG-Q following standardized validation protocol. We assessed 35 patients with PD and STN DBS using history taking, UPDRS, Hoehn and Yahr staging, Mini Mental State Examination, Frontal Assessment Battery, FoG-Q, Short Falls Efficacy Scale International, and Beck Depression Inventory, Second Edition. UPDRS III, clinical and instrumental gait assessment, was repeated OFF MED/DBS OFF and OFF MED/DBS ON.

Results: Internal consistency of FoG-Q was excellent (α = 0.91) as well as convergent (significant correlations with UPDRS II item 14, UPDRS III item 29, several TUG parameters, and FoG Score) and divergent validity (no association with UPDRS I). OFF MED/DBS OFF, the total FoG-Q score correlated with UPDRS III items 29, 30, and PIGD subscore, step time variability, and negatively with step length and velocity.

Limitations: Limitation of the study is a relatively small sample size.

Conclusions: In conclusion, the Czech translation of FoG-Q is valid. With respect to gait and balance, FoG-Q does, to a certain extent, reflect the native state of the disease in patients treated with high frequency STN DBS.
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http://dx.doi.org/10.1007/s10072-019-04209-3DOI Listing
May 2020

Pavement patterns can be designed to improve gait in Parkinson's disease patients.

Mov Disord 2019 12 23;34(12):1831-1838. Epub 2019 Aug 23.

Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine and General University Hospital, Charles University, Prague, Czech Republic.

Background: Public spaces are usually designed with respect to various patient populations, but not Parkinson's disease. The objective of this study was to explore what type of easily applicable visual cueing might be used in public spaces and some interiors to improve gait in people with Parkinson's disease.

Methods: Thirty-two patients with freezing of gait walked an 8-meter track on 6 different floor patterns in single- and dual-task conditions in random sequence. The reference pattern was a virtual large transverse chessboard, and the other patterns differed either in size (small floor stones), orientation (diagonal), nature (real paving), regularity (irregular), or no pattern. Time, number of steps, velocity, step length, cadence, and dual-task effect were calculated. The number and total duration of freezing episodes were analyzed.

Results: Virtual, large, transverse floor stones improve time (P = 0.0101), velocity (P = 0.0029), number of steps (P = 0.0291), and step length (P = 0.0254) in Parkinson's disease patients compared with walking on no pattern. Virtual floor stones were superior in time and velocity to the real ones. Transverse floor stones were better than diagonal, whereas regular pattern stones were superior to irregular in some gait parameters. Subjectively, the reference pattern was preferred to the irregular one and to no pattern. No direct effect on freezing of gait was observed.

Conclusions: Parkinson's disease patients may benefit from floor patterns incorporating transverse oriented large rectangular visual cues. Because public space can be regulated with respect to people with medical conditions, the relevant legislative documents should be extended to allow for parkinsonian gait disorder. © 2019 International Parkinson and Movement Disorder Society.
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http://dx.doi.org/10.1002/mds.27831DOI Listing
December 2019

Methanol Poisoning as an Acute Toxicological Basal Ganglia Lesion Model: Evidence from Brain Volumetry and Cognition.

Alcohol Clin Exp Res 2019 07 28;43(7):1486-1497. Epub 2019 May 28.

Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine and General University Hospital, Charles University, Prague, Czech Republic.

Background: Acute methanol poisoning leads to optic neuropathy and necrotic lesions of basal ganglia (BG) and subcortical white matter. Survivors of methanol poisoning exhibit long-term executive and memory deficits. Associations between brain volumetry parameters and cognitive sequelae of methanol poisoning are not known. The aim of our study was to identify long-term associations between the cognitive performance of survivors of methanol poisoning and the volume of the brain structures that are selectively vulnerable to methanol.

Methods: We conducted a cross-sectional follow-up study on a sample of patients (n = 33, age 50 ± 14 years, 82% males) who survived acute methanol poisoning during methanol mass poisoning outbreak from September 2012 till January 2013 in the Czech Republic. A battery of neuropsychological tests and brain magnetic resonance imaging were included in the clinical examination protocol. Specific brain structures (putamen, globus pallidus, nucleus caudatus, and frontal white matter) were selected as regions of interest, and their volumes were estimated using the MorphoBox prototype software.

Results: In robust multiple regression models, sustained visual attention performance (as assessed by Trail Making Test and Prague Stroop Test) was positively associated with BG structures and frontal white matter volumes (Wald = 9.03 to 85.50, p < 0.01), sensitivity to interference (as assessed by Frontal Battery Assessment) was negatively associated with frontal white matter volume (Wald = 35.44 to 42.25, p < 0.001), and motor performance (as assessed by Finger Tapping Test) was positively associated with globus pallidus and frontal white matter volumes (Wald = 9.66 to 13.29, p < 0.01).

Conclusions: Our results demonstrate that smaller volumes of elements of BG-thalamocortical circuitry, namely the BG and frontal white matter, relate to attention and motor performance in methanol poisoning from a long-term perspective. Disruption of those functional circuits may underlie specific cognitive deficits observed in methanol poisoning.
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http://dx.doi.org/10.1111/acer.14077DOI Listing
July 2019

Axial motor clues to identify atypical parkinsonism: A multicentre European cohort study.

Parkinsonism Relat Disord 2018 11 8;56:33-40. Epub 2018 Jun 8.

Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Parkinson Centre Nijmegen (ParC) Nijmegen, The Netherlands. Electronic address:

Objective: Differentiating Parkinson's disease (PD) from atypical parkinsonian disorders (APD) such as Multiple System Atrophy, parkinsonian type (MSA-p) or Progressive Supranuclear Palsy (PSP-RS) can be challenging. Early signs of postural Instability and gait disability (PIGD) are considered clues that may signal presence of APD. However, it remains unknown which PIGD test - or combination of tests - can best distinguish PD from APD. We evaluated the discriminative value of several widely-used PIGD tests, and aimed to develop a short PIGD evaluation that can discriminate parkinsonian disorders.

Methods: In this multicentre cohort study patients were recruited by 11 European MSA Study sites. Patients were diagnosed using standardized criteria. Postural instability and gait disability was evaluated using interviews and several clinical tests.

Results: Nineteen PD, 21 MSA-p and 25 PSP-RS patients were recruited. PIGD was more common in APD compared to PD. There was no significant difference in axial symptoms between PSP-RS and MSA-p, except for self-reported falls (more frequent in PSP-RS patients). The test with the greatest discriminative power to distinguish APD from PD was the ability to perform tandem gait (AUC 0.83; 95% CI 71-94; p < 0.001), followed by the retropulsion test (AUC 0.8; 95% CI 0.69-0.91; p < 0.001) and timed-up-and-go test (TUG) (AUC 0.77; 95% CI 0.64-0.9; p = 0.001). The combination of these three tests yielded highest diagnostic accuracy (AUC 0.96; 95% CI 0.92-1.0; p < 0.001).

Conclusions: Our study suggests that simple "bedside" PIGD tests - particularly the combination of tandem gait performance, TUG and retropulsion test - can discriminate APD from PD.
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http://dx.doi.org/10.1016/j.parkreldis.2018.06.015DOI Listing
November 2018

Gait and Balance Impairment after Acute Methanol Poisoning.

Basic Clin Pharmacol Toxicol 2018 Jan 6;122(1):176-182. Epub 2017 Sep 6.

Department of Neurology, Charles University, First Faculty of Medicine and General University Hospital, Prague, Czech Republic.

Neurological sequelae including gait impairment were reported in survivors after methanol intoxication; however, no systematic study has been published so far. We aimed to analyse gait and balance impairment in a group of Czech methanol poisoning survivors. We examined 43 patients (age 46 ± 13 years) 2-8 months after methanol poisoning and 43 healthy controls. Investigations contained a shortened version of Falls Efficacy Scale (FES), clinical tests of gait and balance including Timed Up and Go test (TUG) and gait analysis using GaitRite system, neurological and neuropsychological examination, brain imaging, EMG and tests of alcohol consumption. Nineteen patients admitted balance and gait impairment according to FES. Mild to moderate parkinsonian signs showed seven patients. Patients were slower (8.8 versus 5.7 s, p < 0.001) and performed more steps (11.1 versus 7.9, p < 0.001) in TUG compared with the controls. Gait analysis revealed shorter step length (76.5 versus 88.7 cm, p < 0.001), increased double support phase (18.8 versus 15.5%, p < 0.001) and wider base of support (11.3 versus 9.6 cm, p = 0.006) in patients. Eleven patients had deficit of executive function and performed higher cadence compared to the patients with normal execution (122.7 versus 115.0 step/min., p = 0.025). Lower limb polyneuropathy was verified in nine patients, without relation with gait or balance parameters. Neuroimaging revealed lesions mainly in the basal ganglia. Methanol poisoning survivors presented slower wide-based gait with shortened steps corresponding with frontal gait disorder. Higher stepping cadence associated with executive deficit supported the evidence of frontal lobe dysfunction related to impairment of basal ganglia and connections in frontal cortico-basal ganglia loops.
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http://dx.doi.org/10.1111/bcpt.12853DOI Listing
January 2018

Diffusion tensor imaging in the characterization of multiple system atrophy.

Neuropsychiatr Dis Treat 2016 26;12:2181-7. Epub 2016 Aug 26.

Department of Radiology, Na Homolce Hospital, Prague, Czech Republic.

Purpose: Multiple system atrophy (MSA) is a rare neurodegenerative disease that remains poorly understood, and the diagnosis of MSA continues to be challenging. We endeavored to improve the diagnostic process and understanding of in vivo characteristics of MSA by diffusion tensor imaging (DTI).

Materials And Methods: Twenty MSA subjects, ten parkinsonian dominant (MSA-P), ten cerebellar dominant (MSA-C), and 20 healthy volunteer subjects were recruited. Fractional anisotropy, mean diffusivity, radial diffusivity, and axial diffusivity maps were processed using tract-based spatial statistics. Diffusion data were additionally evaluated in the basal ganglia. A support vector machine was used to assess diagnostic utility, leave-one-out cross-validation in the evaluation of classification schemes, and receiver operating characteristic analyses to determine cutoff values.

Results: We detected widespread changes in the brain white matter of MSA subjects; however, no group-wise differences were found between MSA-C and MSA-P subgroups. Altered DTI metrics in the putamen and middle cerebellar peduncles were associated with a positive parkinsonian and cerebellar phenotype, respectively. Concerning clinical applicability, we achieved high classification performance on mean diffusivity data in the combined bilateral putamen and middle cerebellar peduncle (accuracy 90.3%±9%, sensitivity 86.5%±11%, and specificity 99.3%±4%).

Conclusion: DTI in the middle cerebellar peduncle and putamen may be used in the diagnosis of MSA with a high degree of accuracy.
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http://dx.doi.org/10.2147/NDT.S109094DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5008640PMC
September 2016

Imaging findings after methanol intoxication (cohort of 46 patients).

Neuro Endocrinol Lett 2015 ;36(8):737-44

MR Unit, Department of Diagnostic and Interventional Radiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.

Objectives: Our goal is to demonstrate the variability of imaging findings, primarily in the MRI, in 46 patients who survived acute methanol poisoning. This cohort of patients is the largest such sample group examined by MRI.

Methods: Patients were examined by means of imaging methods (42 patients by MRI and 4 by CT). All had an identical protocol of MR examination (T2WI, FLAIR, T1WI with or without application of contrast medium and T2WI/FFE, DWI in the transversal plane of the scan, and with focus on the optic nerves in the coronal plane of the scan in T2WI-SPIR).

Results: Imaging methods revealed a positive finding associated with methanol intoxication in 21 patients (46%). These consisted of symmetrical lesions in the putamen--13 patients (28%), haemorrhage--13 cases (28%), deposits in white matter with localization primarily subcortically--4 cases (9%), lesions in the region of the globus pallidus--7 cases (15%) (in 6 cases without combination with the lesions in the putamen), lesions in the brainstem afflicted 6 patients (13%), and lesion in the cerebellum was found in one case. A pathological finding was found only in the patients examined by MRI.

Conclusion: Almost half of the patients who survived acute methanol poisoning had pathological findings by MRI. The most common finding concerned an affliction of the putamen, which is a predilection area. An interesting finding was the relatively frequent occurrence of selective lesion of the globus pallidus, which is more usually associated with other types of intoxication.
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July 2016

Predicting Falls in Parkinson Disease: What Is the Value of Instrumented Testing in OFF Medication State?

PLoS One 2015 7;10(10):e0139849. Epub 2015 Oct 7.

Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine and General University Hospital in Prague, Charles University in Prague, Prague, Czech Republic.

Background: Falls are a common complication of advancing Parkinson's disease (PD). Although numerous risk factors are known, reliable predictors of future falls are still lacking. The objective of this prospective study was to investigate clinical and instrumented tests of balance and gait in both OFF and ON medication states and to verify their utility in the prediction of future falls in PD patients.

Methods: Forty-five patients with idiopathic PD were examined in defined OFF and ON medication states within one examination day including PD-specific clinical tests, instrumented Timed Up and Go test (iTUG) and computerized dynamic posturography. The same gait and balance tests were performed in 22 control subjects of comparable age and sex. Participants were then followed-up for 6 months using monthly fall diaries and phone calls.

Results: During the follow-up period, 27/45 PD patients and 4/22 control subjects fell one or more times. Previous falls, fear of falling, more severe motor impairment in the OFF state, higher PD stage, more pronounced depressive symptoms, higher daily levodopa dose and stride time variability in the OFF state were significant risk factors for future falls in PD patients. Increased stride time variability in the OFF state in combination with faster walking cadence appears to be the most significant predictor of future falls, superior to clinical predictors.

Conclusion: Incorporating instrumented gait measures into the baseline assessment battery as well as accounting for both OFF and ON medication states might improve future fall prediction in PD patients. However, instrumented testing in the OFF state is not routinely performed in clinical practice and has not been used in the development of fall prevention programs in PD. New assessment methods for daylong monitoring of gait, balance and falls are thus required to more effectively address the risk of falling in PD patients.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0139849PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4596567PMC
June 2016

Eye movements in ephedrone-induced parkinsonism.

PLoS One 2014 12;9(8):e104784. Epub 2014 Aug 12.

Department of Neurology and Centre of Clinical Neuroscience, Charles University in Prague, 1st Faculty of Medicine and General University Hospital, Prague, Czech Republic.

Patients with ephedrone parkinsonism (EP) show a complex, rapidly progressive, irreversible, and levodopa non-responsive parkinsonian and dystonic syndrome due to manganese intoxication. Eye movements may help to differentiate parkinsonian syndromes providing insights into which brain networks are affected in the underlying disease, but they have never been systematically studied in EP. Horizontal and vertical eye movements were recorded in 28 EP and compared to 21 Parkinson's disease (PD) patients, and 27 age- and gender-matched healthy subjects using standardized oculomotor tasks with infrared videooculography. EP patients showed slow and hypometric horizontal saccades, an increased occurrence of square wave jerks, long latencies of vertical antisaccades, a high error rate in the horizontal antisaccade task, and made more errors than controls when pro- and antisaccades were mixed. Based on oculomotor performance, a direct differentiation between EP and PD was possible only by the velocity of horizontal saccades. All remaining metrics were similar between both patient groups. EP patients present extensive oculomotor disturbances probably due to manganese-induced damage to the basal ganglia, reflecting their role in oculomotor system.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0104784PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4130591PMC
February 2016

Grooved pegboard predicates more of cognitive than motor involvement in Parkinson's disease.

Assessment 2014 Dec 3;21(6):723-30. Epub 2014 Mar 3.

Charles University in Prague, Prague, Czech Republic.

The Grooved Pegboard Test (GPT) was conceived as a test of manual dexterity, upper-limb motor speed, and hand-eye coordination. The aim of our study was to test the componential structure of the GPT on an archetypal model of motor impairment, Parkinson's disease (PD). A total of 45 PD patients (33 males, 12 females; age M = 67, range = 49-81; PD duration M = 10, range = 6-20 years; H/Y stage 2, range = 2-3) and 20 age- and education-matched controls (14 males, 6 females; age M = 66, range = 48-80) were included. All participants were investigated using the GPT, Short Falls Efficacy Scale-International, Frontal Assessment Battery (FAB), Montreal Cognitive Assessment (MoCA), and Non-Motor Symptom Scale. Patients were followed for 6 months, using fall diaries and monthly phone calls to define PD fallers (falls ≥ 1; n = 27) and PD nonfallers (falls = 0; n = 18). Using structural equation modeling, the GPT predicted performance on the MoCA (p < .001), but not on the FAB (p = .29). In conclusion, analysis of the structure of the GPT provided evidence about important cognitive features, in addition to the motor component of this test in PD.
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http://dx.doi.org/10.1177/1073191114524271DOI Listing
December 2014

A distinct variant of mixed dysarthria reflects parkinsonism and dystonia due to ephedrone abuse.

J Neural Transm (Vienna) 2014 Jun 21;121(6):655-64. Epub 2014 Jan 21.

Department of Circuit Theory, Faculty of Electrical Engineering, Czech Technical University in Prague, Prague, Czech Republic.

A distinctive alteration of speech has been reported in patients suffering from ephedrone-induced parkinsonism. However, an objective assessment of dysarthria has not been performed in ephedrone users. We studied 28 young Caucasian men from Georgia with a previous history of ephedrone abuse and compared them to 25 age-matched healthy controls. Speech examination, brain MRI, and NNIPPS-Parkinson plus scale were performed in all patients. The accurate differential diagnosis of dysarthria subtypes was based on the quantitative acoustic analyses of 15 speech dimensions. We revealed a distinct variant of mixed dysarthria with a combination of hyperkinetic and hypokinetic components representing the altered motor programming of dystonia and bradykinesia in ephedrone-induced parkinsonism. According to acoustic analyses, all patients presented at least one affected speech dimension, whereas dysarthria was moderate in 43% and severe in 36% of patients. Further findings indicated relationships between motor subscores of dystonia and bradykinesia and speech components of loudness (r = -0.54, p < 0.01), articulation (r = 0.40, p < 0.05), and timing (r = -0.53, p < 0.01). In ephedrone-induced parkinsonism a prominent mixed hyperkinetic-hypokinetic dysarthria occurs that appears related to marked dystonia and bradykinesia and probably reflects manganese induced toxic and neurodegenerative damage to the globus pallidus internus and substantia nigra.
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http://dx.doi.org/10.1007/s00702-014-1158-6DOI Listing
June 2014

New non-linear color look-up table for visualization of brain fractional anisotropy based on normative measurements - principals and first clinical use.

PLoS One 2013 22;8(8):e71431. Epub 2013 Aug 22.

Department of Neurology, Third Faculty of Medicine, Charles University in Prague, Prague, Czech Republic ; Department of Radiology, Na Homolce Hospital, Prague, Czech Republic.

Fractional anisotropy (FA) is the most commonly used quantitative measure of diffusion in the brain. Changes in FA have been reported in many neurological disorders, but the implementation of diffusion tensor imaging (DTI) in daily clinical practice remains challenging. We propose a novel color look-up table (LUT) based on normative data as a tool for screening FA changes. FA was calculated for 76 healthy volunteers using 12 motion-probing gradient directions (MPG), a subset of 59 subjects was additionally scanned using 30 MPG. Population means and 95% prediction intervals for FA in the corpus callosum, frontal gray matter, thalamus and basal ganglia were used to create the LUT. Unique colors were assigned to inflection points with continuous ramps between them. Clinical use was demonstrated on 17 multiple system atrophy (MSA) patients compared to 13 patients with Parkinson disease (PD) and 17 healthy subjects. Four blinded radiologists classified subjects as MSA/non-MSA. Using only the LUT, high sensitivity (80%) and specificity (84%) were achieved in differentiating MSA subjects from PD subjects and controls. The LUTs generated from 12 and 30 MPG were comparable and accentuate FA abnormalities.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0071431PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3750032PMC
April 2014

Changes of hand preference in Parkinson's disease.

J Neural Transm (Vienna) 2012 Jun 10;119(6):693-6. Epub 2012 Jan 10.

Department of Kinanthropology, Charles University in Prague, Jose Martiho 31, 162 52 Prague, Czech Republic.

This study focused on the difference between pre-morbid and current hand preference of patients with Parkinson's disease (PD). A survey instrument comprised items measuring pre-morbid and current hand preference and question related to the side of occurrence of initial symptoms. These questions were administered to 471 PD patients. The results show a significant change of pre-morbid right hand preference toward using the left when the side of PD onset was on the right hand and vice versa. Disease duration does not predict the amount of hand preference shift.
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http://dx.doi.org/10.1007/s00702-011-0759-6DOI Listing
June 2012

A sensitivity comparison of clinical tests for postural instability in patients with Huntington's disease.

Gait Posture 2011 Jun 8;34(2):245-7. Epub 2011 Jun 8.

Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine and General University Hospital, Charles University in Prague, Katerinska 30, 12000 Prague 2, Czech Republic.

Falls are a common complication in Huntington's disease (HD) and detection of postural instability (PI) may be useful for identifying patients who are at risk of falls. The aim of our study was to find the most sensitive clinical test for PI in patients with HD and to correlate PI with the other symptoms. 20 HD patients were examined using: (1) The Unified Huntington's Disease Rating Scale (UHDRS), (2) The Mini Mental State Examination (MMSE) and (3) six clinical tests for PI. Inter-scale and test correlations were inspected and uni-dimensionality, validity, and measurement precision were analyzed using a factor analysis model/latent PI score. PI was compared with information obtained from surveys completed independently by patients and caregivers, and both reports were evaluated for absolute agreement using intraclass correlations (ICCs). PI was found in 16 patients; the tests correlated better with caregivers' reports (r=0.78) than patients' responses. The validity of the patients' answers decreased with the level of MMSE scores. PI correlated with MMSE (r=0.64, p<0.01), the subscale score for voluntary movements (r=0.86, p<0.01), the overall motor subscore (r=0.73, p<0.01), and the Luria test subscore (r=0.87, p<0.01). The stance with feet close together and tandem gait correlated best with the latent PI score, and factor loadings confirmed they were the most sensitive tests for PI detection in HD.
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http://dx.doi.org/10.1016/j.gaitpost.2011.05.006DOI Listing
June 2011

Fear of falling has greater influence than other aspects of gait disorders on quality of life in patients with Parkinson's disease.

Neuro Endocrinol Lett 2009 ;30(4):453-7

Department of Neurology, 1st Medical Faculty and General Teaching Hospital, Charles University, Prague, Czech Republic.

We assessed the influence of gait disorders (GD) on quality of life (QOL) in Parkinson's disease (PD). In a survey including the PDQ-39 and a new 8-item questionnaire of GD (8-QGD), 491 PD patients estimated their gait at the worst state, the effect of their GD on activities of daily living, compared the severity of GD with the other PD symptoms, evaluated the occurrence of freezing of gait (FOG), levodopa-resistant FOG, falls, activity limitation due to fear of falling (FOF), and the occurrence of injuries. Significant differences in PDQ-39 scores were found between three groups of patients divided with respect to the severity of GD. Linear multiple regression analysis showed that FOF had the highest impact on PDQ-39 scores (r=0.32, p<0.001). These results confirm that GD have a substantial impact upon the QOL in PD and suggest that FOF plays a major role in QOL deterioration.
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March 2010

Costs of Parkinson's disease in eastern Europe: a Czech cohort study.

Parkinsonism Relat Disord 2010 Jan 8;16(1):51-6. Epub 2009 Aug 8.

Dept. of Neurology, Philipps University, Marburg, Germany.

Life expectancy is increasing worldwide and the burden of Parkinson's disease (PD) is growing. There are several cost-of-illness studies for PD from Western Europe and the USA, however, data about the costs associated with PD in Eastern Europe are still lacking. The objective of this study was to evaluate direct and indirect costs in a cohort of Czech patients with idiopathic PD and to identify cost-driving factors. Study participants (n=100) were recruited from the neurological department of the Charles University in Prague. Health-economic data were collected using a "bottom-up" approach. Costs were calculated from the societal perspective and the human capital approach was used to estimate indirect costs. Czech currency was converted into 2004 Euros (EUR) and inflated to 2008 prices. Independent cost-driving factors were identified in multivariate regression analysis. Total semi-annual costs of PD were EUR 5510 (95% CI: 4470-7090) per patient. Direct costs accounted for 60% of the total costs and indirect costs for 40%. Patients' expenditures accounted for 40% of their income. Independent cost-driving factors included disease severity, motor complications, psychosis and age. In conclusion, our study demonstrates a considerable economic burden of PD in the Czech Republic. Total costs are generally lower than in Western Europe but the proportion of costs that fall on patients is higher because of lower incomes. More intensive government support for patients with chronic diseases such as PD and the development of disease-management programs that incorporate both the clinical and economic effects of PD treatment are needed.
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http://dx.doi.org/10.1016/j.parkreldis.2009.07.005DOI Listing
January 2010

Handedness does not predict side of onset of motor symptoms in Parkinson's disease.

Mov Disord 2009 Sep;24(12):1836-9

Department of Kinanthropology, Charles University in Prague, Czech Republic.

This study focused on the relationship between the asymmetry of initial motor symptoms of Parkinson's disease (PD) and premorbid handedness of patients. Structural equation modeling has been used for this purpose. The survey consisting of validated items measuring handedness and questions related to side of occurrence of initial symptoms was administered to 472 patients with PD [277 men, 195 women, mean age 66.5 (9.3), mean duration of the disease 10 (6.1) years]. The unidimensional model of handedness fits the data well (chi(2) = 37.86, df = 20, P = 0.009, Root Mean Square Error of Approximation = 0.044, Comparative Fit Index = 1.00, Standardized Root Mean Square Residual = 0.042) and side of initial motor symptoms is not significantly related to the factor of handedness (r =0.11, SE = 0.07, P = 0.14). In contrast to several other studies, the results indicate that the side of first occurrence of PD signs cannot be predicted from premorbid handedness of patients.
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http://dx.doi.org/10.1002/mds.22653DOI Listing
September 2009

Push-and-release test predicts Parkinson fallers and nonfallers better than the pull test: comparison in OFF and ON medication states.

Mov Disord 2008 Jul;23(10):1453-7

2nd Department of Neurology, School of Medicine, Comenius University, Bratislava, Slovak Republic.

The aim of this study was to compare the Pull Test--Retropulsion Test and the Push and Release Test (P&R) as regards their ability to predict Parkinson (PD) fallers and nonfallers in relation to their medication state. Eighty-two PD patients participated in the study. Fallers (N = 36) and nonfallers (N = 46) were grouped on the basis of their fall history. Fallers were those who had fallen at least once within the last 6 months. The two groups were compared on the basis of the patients' performance in the Pull and the P&R tests, both in their "OFF" and "ON" medication state. The overall accuracy of the classification of PD patients as fallers and nonfallers was determined by means of binomial logistic regression (BLR) and the analysis of the "area under the receiver operating characteristics curve" (AUC). In the OFF medication state, the statistical analysis revealed that the Pull Test was accurate (methods BLR (AUC)) in 85.4% (0.87) of cases and the P&R Test in 86.6% (0.90). In the ON medication state, the Pull Test was only 76.8% (0.78) accurate, while the P&R Test was 87.8% (0.87) accurate. Both clinical tests are valid and relatively equivalent when assessing patients in their OFF medication state; however, the P&R Test is more accurate than the Pull Test in the ON state. This indicates that it is more widely applicable in clinical practice.
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http://dx.doi.org/10.1002/mds.22131DOI Listing
July 2008

On the structure of motor symptoms of Parkinson's disease.

Mov Disord 2008 Jul;23(9):1307-12

Department of Kinanthropology, Charles University, Prague, Czech Republic.

This study aims to investigate the structure of the motor symptoms of Parkinson's disease (PD), as measured by the Motor Section of the Unified Parkinson's Disease Rating Scale (UPDRS). The dimensionality of the Motor Section of the UPDRS was studied using structural equation modeling. The UPDRS measures were obtained from 405 patients with PD [237 men (39 "off", 170 "on", 28 unknown) and 168 women (21 "off", 140 "on", 7 unknown)]. The ordinal character of UPDRS scores and sample size substantiated the use of robust diagonally weighted least squares model estimation. It was shown that the Motor Section of the UPDRS incorporates five main latent symptom factors (rigidity, tremor, bradykinesia of the extremities, axial/gait bradykinesia, speech/hypomimia) plus two additional factors for laterality, which account for asymmetry of tremor, rigidity and bradykinesia of the extremities. Tremor seems to be an independent symptom factor of PD. Other latent variables are substantially correlated.
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http://dx.doi.org/10.1002/mds.22029DOI Listing
July 2008

Mokken scale analysis of the UPDRS: dimensionality of the Motor Section revisited.

Neuro Endocrinol Lett 2008 Feb;29(1):151-8

Department of Kinanthropology, Charles University, Czech Republic.

The dimensionality and reliability of the Motor Section of the Unified Parkinson Disease Rating Scale (UPDRS III) was studied with non-parametric Mokken scale analysis. UPDRS measures were obtained on 147 patients with PD (96 men, 51 women, mean age 61, range 35-80 yrs). Mokken scale analysis revealed a four-dimensional structure of the UPDRS III. Left-sided bradykinesia and rigidity appeared to co-occur with axial signs, gait disturbance, and speech/hypomimia, whereas right-sided bradykinesia and rigidity formed a second scale. Two further small scales were found consisting of right- and left-sided tremor. Results from the scale analysis reveal that all four subscales are strong. The reliability of the two tremor scales is low because they only contain three and four items, respectively.
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February 2008

Caudate nucleus atrophy in Huntington's disease and its relationship with clinical and genetic parameters.

Funct Neurol 2005 Jul-Sep;20(3):127-30

Department of Neurology, 1st Medical Faculty, Charles University, Prague, Czech Republic.

We analysed clinical data in 80 genetically confirmed Huntington?s disease (HD) patients and measured the severity of the head of the caudate nucleus (HCN) atrophy using computed tomography-guided planimetry. The results were compared with measurements obtained in 43 age-matched healthy subjects. Mean planimetric measurements of the HCN differed significantly between the HD patients and healthy controls (p<0.001). We observed a significant inverse correlation between duration of HD and HCN planimetric values (p<0.001). Physiological atrophy of the HCN with age was also present in healthy controls, but did not overlap with values obtained in HD patients (p<0.01). Furthermore, we found in our patients a statistically significant inverse correlation between the number of CAG triplet repeats and the age at onset of HD (p<0.001). Neither the number of CAG triplet repeats, nor the age at onset of HD was found to be related to the character of the initial clinical symptoms (motor vs mental). Similarly, no relationship emerged between maternal or paternal inheritance and the number of CAG triplet repeats. Moreover, the type of inheritance did not influence the age at onset of HD in our patients. Planimetric measurement of the HCN appears to be a simple and useful paraclinical tool for the diagnosis of HD.
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March 2006