Monica Kurtis - Academia.edu (original) (raw)

Papers by Monica Kurtis

Movement disorders of the face are frequent; they can be hypokinetic or hyperkinetic, primary or ... more Movement disorders of the face are frequent; they can be hypokinetic or hyperkinetic, primary or secondary, and be manifestations of an isolated condition or part of a generalized disorder. Hypokinetic movements such as hypomimia are characteristic of parkinsonian syndromes, while facial hyperkinetic movements are very common in certain forms of dystonia, dyskinesias, chorea, myoclonus, tremor, tics, and psychogenic movement disorders. Since these topics are covered extensively in other parts of the text, this chapter focuses on the clinical characteristics of movement disorders (centering on primary etiologies) when they affect the facial muscles and covers other entities that fall into the differential diagnosis. Emphasis is made on phenomenology with careful description of clinical signs and distinguishing features that may aid the diagnosis.

BMC Neurology, Mar 12, 2022

Background: Optimisation of dopaminergic therapy may alleviate fluctuation-related pain in Parkin... more Background: Optimisation of dopaminergic therapy may alleviate fluctuation-related pain in Parkinson's disease (PD). Opicapone (OPC) is a third-generation, once-daily catechol-O-methyltransferase inhibitor shown to be generally well tolerated and efficacious in reducing OFF-time in two pivotal trials in patients with PD and end-of-dose motor fluctuations. The OpiCapone Effect on motor fluctuations and pAiN (OCEAN) trial aims to investigate the efficacy of OPC 50 mg in PD patients with end-of-dose motor fluctuations and associated pain, when administered as adjunctive therapy to existing treatment with levodopa/dopa decarboxylase inhibitor (DDCi). Methods: OCEAN is a Phase IV, international, multicentre, randomised, double-blind, placebo-controlled, parallelgroup, interventional trial in PD patients with end-of-dose motor fluctuations and associated pain. It consists of a 1-week screening period, 24-week double-blind treatment period and 2-week follow-up period. Eligible patients will be randomised 1:1 to OPC 50 mg or placebo once daily while continuing current treatment with levodopa/DDCi and other chronic, stable anti-PD and/or analgesic treatments. The primary efficacy endpoint is change from baseline in Domain 3 (fluctuation-related pain) of the King's Parkinson's disease Pain Scale (KPPS). The key secondary efficacy endpoint is change from baseline in Domain B (anxiety) of the Movement Disorder Society-sponsored Non-Motor rating Scale (MDS-NMS). Additional secondary efficacy assessments include other domains and total scores of the KPPS and MDS-NMS, the Parkinson's Disease Questionnaire (PDQ-8), the MDS-sponsored Unified Parkinson's Disease Rating Scale (MDS-UPDRS) Parts III and IV, Clinical and Patient's Global Impressions of Change, and change in functional status via Hauser's diary. Safety assessments include the incidence of treatment-emergent adverse events. The study

Oxford University Press eBooks, Jun 1, 2020

Parkinson disease (PD) patients who have undergone surgery and develop festinating gait and postu... more Parkinson disease (PD) patients who have undergone surgery and develop festinating gait and postural instability are challenging to diagnose and treat. This chapter describes the case of an early-onset PD patient who underwent deep brain stimulation (DBS) 4 years after disease onset due to motor and nonmotor fluctuations and medication side effects (impulse control disorder). A year after surgery, the patient developed gait and balance problems in the on-medication/on-stimulation states that resolved after turning stimulation off or withdrawing medication for 12 hours. However, other symptoms, including as bradykinesia, rigidity, and tremor, reappeared. Troubleshooting involved magnetic resonance imaging to evaluate electrode placement and complete screening of all contacts with successful reprogramming and medication adjustments. The pathophysiology of balance problems is discussed, including the synergistic effects of subthalamic nucleus DBS and dopaminergic treatment, which may lead to increased postural sway and lower limb dystonia.

European Journal of Neurology, 2021

Neurologia, 2021

Epilepsia; Educación; Tratamiento; En vías de desarrollo; Embarazo Resumen Introducción: La epile... more Epilepsia; Educación; Tratamiento; En vías de desarrollo; Embarazo Resumen Introducción: La epilepsia es una enfermedad prevalente en países en vías de desarrollo debido al mayor número de causas que pueden producirla, al menos duplicándose tanto incidencia como prevalencia en comparación con nuestro medio. Además, existe una gran estigmatización y los medios para su manejo son limitados. Material y métodos: Estudio observacional descriptivo mediante la realización de un cuestionario a profesionales sanitarios de 3 hospitales de Camerún, interrogando sobre factores relacionados con el manejo de la epilepsia, en diciembre de 2016. Se presentan los datos como media o porcentaje. Resultados: Participaron 38 profesionales sanitarios, de los cuales el 42,1% eran mujeres, con una edad media de 40,1 años (rango 22-62). Respecto a la causa de la enfermedad un 68,4% la considera psiquiátrica, 34,2% degenerativa, 28,9% hereditaria y 21,1% secundaria a una infección. En cuanto al manejo un 23,7% consideraba suficiente la anamnesis para llegar al diagnóstico. Solo un 60,5% consideraba la historia importante en el diagnóstico, 52,6% consideraba necesario un EEG, un 28,9% creía importantes las pruebas de laboratorio y un 13,2%

npj Parkinson's Disease, 2021

Quality of life (QOL) plays an important role in independent living in Parkinson’s disease (PD) p... more Quality of life (QOL) plays an important role in independent living in Parkinson’s disease (PD) patients, being crucial to know what factors impact QoL throughout the course of the disease. Here we identified predictors of QoL impairment in PD patients from a Spanish cohort. PD patients recruited from 35 centers of Spain from the COPPADIS cohort from January 2016, to November 2017, were followed up during 2 years. Health-related QoL (HRQoL) and global QoL (GQoL) were assessed with the 39-item Parkinson’s disease Questionnaire (PDQ-39) and the EUROHIS-QOL 8-item index (EUROHIS-QOL8), respectively, at baseline (V0) and at 24 months ± 1 month (V2). Clinically significant QoL impairment was defined as presenting an increase (PDQ-39SI) or decrement (EUROHIS-QOL8) at V2 ≥ 10% of the score at baseline (V0). A comparison with a control group was conducted for GQoL. GQoL did not change significantly in PD patients (N = 507; p = 0.686) or in the control group (N = 119; p = 0.192). The mean PD...

Journal of Parkinson's Disease, 2020

Background: Little information is available on the official postgraduate and subspecialty trainin... more 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 countr...

Neurología, 2020

INTRODUCTION Unilateral Gamma Knife™ stereotactic radiosurgery on the ventral-intermediate nucleu... more INTRODUCTION Unilateral Gamma Knife™ stereotactic radiosurgery on the ventral-intermediate nucleus of the thalamus is a minimally invasive neurosurgical option for refractory tremor. We describe the experience of Gamma Knife™ thalamotomy (GKT) in patients with essential tremor (ET) and tremor-dominant Parkinson's disease (PD) at our specialised stereotactic neurosurgery unit. METHODS We reviewed the cases of patients treated with GKT between January 2014 and February 2018 with a minimum of 12 months' follow-up. We analysed clinical and demographic variables, indication, radiation dose, effectiveness (based on subscales of the Fahn-Tolosa-Marin [FTM] scale and the Movement Disorders Society-Unified Parkinson's Disease Rating Scale [MDS-UPDRS] motor score), and adverse events. RESULTS Thirteen patients were registered, 6 with a diagnosis of tremor-dominant PD, four with refractory ET, and three with ET and PD. Median age was 78 years (range, 62-83), with seven patients aged over 75 years. Four patients were receiving anticoagulants and two had history of stroke. The maximum radiation dose administered was 130 Gy. Mean (standard deviation) follow-up duration was 30.0 (14.5) months. Significant tremor improvement was observed on the FTM subscales: 63.6% at 12 months and 63.5% at the end of follow-up; MDS-UPDRS tremor items showed improvements of 71.3% at 12 months and 60.3% at the end of follow up. Eleven patients reported significant improvements in quality of life, and 3 reported mild and transient adverse effects. CONCLUSIONS This is the largest series of patients with essential and parkinsonian tremor treated with GKT and followed up in the long term in Spain. GKT can be safe and effective in the long term in patients with refractory tremor, including in elderly patients and those receiving anticoagulants.

Neurología, 2019

International Journal of Geriatric Psychiatry, 2020

BackgroundAlthough depression is known to be frequent in Parkinson's disease (PD), it is uncl... more BackgroundAlthough depression is known to be frequent in Parkinson's disease (PD), it is unclear how mood can change and/or impact on patient's quality of life (QoL) over time. Our aim was to analyze the frequency of depression, mood related factors and the contribution of mood to a patient's QoL perception in regard to disease duration.MethodsPD patients recruited from the COPPADIS cohort from January 2016 to November 2017 were included in this cross‐sectional study. Three groups were defined: <5 years (Group A); from 5 to <10 years (Group B); ≥10 years (Group C). Analysis with well‐planned linear regression models was conducted to determine how different factors contribute to mood (Beck Depression Inventory‐II [BDI‐II] as dependent variable), to health‐related QoL (39‐item Parkinson's Disease Questionnaire [PDQ‐39SI] as dependent variable) and to global QoL (European Health Interview Survey – Quality of Life Eight‐Item Index [EUROHIS‐QOL8] as dependent variab...

npj Parkinson's disease, Jun 8, 2021

To identify predictors of 36-month follow-up quality of life (QoL) outcome after bilateral subtha... more To identify predictors of 36-month follow-up quality of life (QoL) outcome after bilateral subthalamic nucleus deep brain stimulation (STN-DBS) in Parkinson's disease (PD). In this ongoing, prospective, multicenter international study (Cologne, Manchester, London) including 73 patients undergoing STN-DBS, we assessed the following scales preoperatively and at 6-month and 36-month follow-up: PD Questionnaire-8 (PDQ-8), NMSScale (NMSS), Scales for Outcomes in PD (SCOPA)-motor examination,-activities of daily living, and-complications, and levodopa equivalent daily dose (LEDD). We analyzed factors associated with QoL improvement at 36-month follow-up based on (1) correlations between baseline test scores and QoL improvement, (2) step-wise linear regressions with baseline test scores as independent and QoL improvement as dependent variables, (3) logistic regressions and receiver operating characteristic curves using a dichotomized variable "QoL responders"/"non-responders". At both follow-ups, NMSS total score, SCOPA-motor examination, and-complications improved and LEDD was reduced significantly. PDQ-8 improved at 6-month follow-up with subsequent decrements in gains at 36-month follow-up when 61.6% of patients were categorized as "QoL non-responders". Correlations, linear, and logistic regression analyses found greater PDQ-8 improvements in patients with younger age, worse PDQ-8, and worse specific NMS at baseline, such as 'difficulties experiencing pleasure' and 'problems sustaining concentration'. Baseline SCOPA scores were not associated with PDQ-8 changes. Our results provide evidence that 36-month QoL changes depend on baseline neuropsychological and neuropsychiatric non-motor symptoms burden. These findings highlight the need for an assessment of a wide range of non-motor and motor symptoms when advising and selecting individuals for DBS therapy.

European Journal of Neurology, Jan 21, 2014

Background and purpose: The Movement Disorder Society sponsored version of the Unified Parkinson'... more Background and purpose: The Movement Disorder Society sponsored version of the Unified Parkinson's Disease Rating Scale (MDS-UPDRS) is a comprehensive instrument for assessing Parkinson's disease (PD). The present study was aimed at determining the relationships between MDS-UPDRS components and health-related quality of life (HRQoL) evaluations in PD patients. Methods: An international, multicenter, cross-sectional study was carried out of 435 PD patients assessed with the MDS-UPDRS, Hoehn and Yahr (HY), Clinical Impression Severity for PD, EQ-5D and PD Questionnaire À eight items (PDQ-8). Spearman's rank correlation coefficients, exploratory factor analysis and multiple linear regression models (dependent variables EQ-5D and PDQ-8) were performed. Results: The participants' age was 66.71 AE 10.32 years (51.5% men). PD duration was 8.52 AE 6.14, and median HY was 2 (range 1-5). The correlation between the EQ-5D index and the MDS-UPDRS ranged from À0.46 (Part IV) to À0.72 (Part II) and for the PDQ-8 index from 0.47 (Part III) to 0.74 (Part II). In multiple regression models with the MDS-UPDRS domains as independent variables, the main determinant for both the EQ-5D index and the PDQ-8 was Part II followed by Part I. After factorial grouping of the cardinal PD manifestations embedded in the MDS-UPDRS Parts III and IV for inclusion into multiple regression models, a factor formed by M-EDL, nM-EDL and fluctuations was the main determinant for both the EQ-5D and PDQ-8 indexes. Conclusions: The MDS-UPDRS component most tightly related with the HRQoL measures was a combination of motor and non-motor experiences of daily living.

European Journal of Neurology, Apr 22, 2013

Journal of Neurology, Aug 5, 2012

Your article is protected by copyright and all rights are held exclusively by Springer-Verlag. Th... more Your article is protected by copyright and all rights are held exclusively by Springer-Verlag. This e-offprint is for personal use only and shall not be self-archived in electronic repositories. If you wish to self-archive your work, please use the accepted author's version for posting to your own website or your institution's repository. You may further deposit the accepted author's version on a funder's repository at a funder's request, provided it is not made publicly available until 12 months after publication.

Parkinsonism & Related Disorders, Dec 1, 2013

This article appeared in a journal published by Elsevier. The attached copy is furnished to the a... more This article appeared in a journal published by Elsevier. The attached copy is furnished to the author for internal non-commercial research and education use, including for instruction at the authors institution and sharing with colleagues. Other uses, including reproduction and distribution, or selling or licensing copies, or posting to personal, institutional or third party websites are prohibited. In most cases authors are permitted to post their version of the article (e.g. in Word or Tex form) to their personal website or institutional repository. Authors requiring further information regarding Elsevier's archiving and manuscript policies are encouraged to visit: http://www.elsevier.com/authorsrights

CNS Drugs, May 1, 2015

Quality of life (QoL) is a patient-reported outcome frequently included in Parkinson&amp;... more Quality of life (QoL) is a patient-reported outcome frequently included in Parkinson&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s disease (PD) clinical trials as a secondary or tertiary endpoint. However, QoL is an important variable that reflects the impact of disease and treatment from the patients&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; perspective. In a chronic, neurodegenerative disease such as PD, with a wide range of complex symptoms, QoL provides valuable and comprehensive information on the patients&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; health status. This narrative review aims to evaluate the effect of specific PD treatments currently in use on patients&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; QoL measured with the Parkinson&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s Disease Questionnaire, 39-item (PDQ-39) or 8-item (PDQ-8) version. A quantification of this effect is provided by calculation of the relative change and effect size. These two parameters allow an intuitive standardized approach to the importance of change based on its magnitude. Some high-quality studies (Level I) were found for levodopa (immediate- or extended-release formulations), levodopa with added-on catechol-O-methyltransferase (COMT) inhibitors, levodopa/carbidopa gel for intestinal infusion, some dopamine agonists (ropinirole, cabergoline, pergolide), and the monoamine oxidase B (MAO-B) inhibitor safinamide. As a whole, these studies found a beneficial effect of variable magnitude, weak to moderate, on patients&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; QoL. Studies with a lower level of evidence or not providing enough data to estimate relative change and effect size, including those for the apomorphine subcutaneous pump, also reported improvement of QoL, but the evidence was insufficient to confirm the effect. More high-quality studies focused on QoL are needed to determine the real impact of PD drug treatments for this important outcome.

Parkinsonism & Related Disorders, Jul 1, 2018

Background The relationship between Health-Related Quality of Life (HRQoL) and MDS-UPDRS has not ... more Background The relationship between Health-Related Quality of Life (HRQoL) and MDS-UPDRS has not been fully studied so far. The aim of this study was to evaluate the relationship between all MDS-UPDRS components and HRQoL in a representative international cohort of PD patients. Methods We collected demographic and disease-related data as well as MDS-UPDRS and PDQ8 scales. Data were analyzed using two hierarchical multiple regressions, first between the MDS-UPDRS Parts scores and PDQ8 and second between individual items from those Parts demonstrating significant relationship to PDQ8 in the first regression. LASSO regression analyses were performed to evaluate the relationship between PDQ8 and all individual MDS-UPDRS items.

Parkinson's Disease, Apr 6, 2023

Introduction. Drooling in Parkinson's disease (PD) is frequent but often goes underrecognized. Ou... more Introduction. Drooling in Parkinson's disease (PD) is frequent but often goes underrecognized. Our aim was to examine the prevalence of drooling in a PD cohort and compare it with a control group. Specifcally, we identifed factors associated with drooling and conducted subanalyses in a subgroup of very early PD patients. Patients and Methods. PD patients who were recruited from January 2016 to November 2017 (baseline visit; V0) and evaluated again at a 2-year ± 30-day follow-up (V2) from 35 centers in Spain from the COPPADIS cohort were included in this longitudinal prospective study. Subjects were classifed as with or without drooling according to item 19 of the NMSS (Nonmotor Symptoms Scale) at V0, V1 (1-year ± 15 days), and V2 for patients and at V0 and V2 for controls. Results. Te frequency of drooling in PD patients was 40.1% (277/691) at V0 (2.4% (5/201) in controls; p < 0.0001), 43.7% (264/604) at V1, and 48.2% (242/502) at V2 (3.2% (4/124) in controls; p < 0.0001), with a period prevalence of 63.6% (306/481). Being older (OR � 1.032; p � 0.012), being male (OR � 2.333; p < 0.0001), having greater nonmotor symptom (NMS) burden at the baseline (NMSS total score at V0; OR � 1.020; p < 0.0001), and having a greater increase in the NMS burden from V0 to V2 (change in the NMSS total score from V0 to V2; OR � 1.012; p < 0.0001) were identifed as independent predictors of drooling after the 2-year follow-up. Similar results were observed in the group of patients with ≤2 years since symptom onset, with a cumulative prevalence of 64.6% and a higher score on the UPDRS-III at V0 (OR � 1.121; p � 0.007) as a predictor of drooling at V2. Conclusion. Drooling is frequent in PD patients even at the initial onset of the disease and is associated with a greater motor severity and NMS burden.