Ihtsham Haq | Wake Forest University (original) (raw)

Papers by Ihtsham Haq

Research paper thumbnail of Antibody Mediated Movement Disorders and Their Differential Response to Immunomodulatory Therapy (P4.051)

Research paper thumbnail of Mitochondrial Encephalopathy with Lactic Acidosis and Stroke (MELAS) presenting as an apparent neoplastic process (P5.015)

Research paper thumbnail of A Novel Familial Mutation in the CACNA1A Gene Associated with an Episodic Ataxia Type 2 Phenotype (S47.005)

Research paper thumbnail of Association Between Subthalamic Nucleus Deep Brain Stimulation and Weight Gain: Results of a Case-Control Study

Clinical Neurology and Neurosurgery, 2015

To evaluate whether weight change in patients with Parkinson's disease (PD) is di... more To evaluate whether weight change in patients with Parkinson's disease (PD) is different in those undergoing deep brain stimulation (DBS) of the subthalamic nucleus (STN) compared to those not undergoing DBS. A retrospective case-control study was performed in PD patients who had undergone STN DBS (cases) compared to matched PD patients without DBS (controls). Demographic and clinical data including Unified Parkinson's Disease Rating Scale (UPDRS) motor scores were collected. Repeated measures mixed model regression was used to identify variables associated with weight gain. Thirty-five cases and 34 controls were identified. Baseline age, gender, diagnosis and weight were similar. Duration of diagnosis was longer in cases (6.3 vs 4.9 years, p=0.0015). At 21.3 months, cases gained 2.9kg (+4.65%) while controls lost 1.8kg (-3.05%, p<0.02). Postoperative UPDRS motor scores improved by 49% indicating surgical efficacy. Only younger age (p=0.0002) and DBS (p=0.008) were significantly associated with weight gain. In this case-control study, PD patients undergoing STN DBS experienced post-operative weight gain that was significantly different from the weight loss observed in non-DBS PD controls. Patients, especially overweight individuals, should be informed that STN DBS can result in weight gain.

Research paper thumbnail of Memantine for the treatment of levodopa induced dyskinesias in demented and non-demented patients with Parkinson's disease

Research paper thumbnail of Memantine improves" off periods" in patients with advanced Parkinson's disease

Research paper thumbnail of Increased Pain Sensitivity and Impulsivity Appear Related: Pain-Related fMRI in Parkinson's Disease

Research paper thumbnail of Mismatch of non-motor symptoms among DBS-candidate Parkinson patients and their carepartners may be scale driven

Research paper thumbnail of A comparison of prevalence of non-motor symptoms in movement disorders

Research paper thumbnail of Value of" hot cross bun sign" in multiple system atrophy-C (MSA-C)

Research paper thumbnail of Antibody Mediated Movement Disorders and Their Differential Response to Immunomodulatory Therapy (P4. 051)

Research paper thumbnail of A Novel Familial Mutation in the CACNA1A Gene Associated with an Episodic Ataxia Type 2 Phenotype (S47. 005)

Research paper thumbnail of A novel familial mutation in the CACNA1A gene associated with an episodic ataxia type 2 phenotype

Research paper thumbnail of Rapid-onset dystonia-parkinsonism associated with the I758S mutation of the ATP1A3 gene: a neuropathologic and neuroanatomical study of four siblings

Acta Neuropathologica, 2014

disease and Alzheimer disease, were evident in all subjects. We evaluated areas that may be relev... more disease and Alzheimer disease, were evident in all subjects. We evaluated areas that may be relevant to rDP separately from those affected by the comorbid conditions. Anatomical areas identified as potential targets of I758S mutation were globus pallidus, subthalamic nucleus, red nucleus, inferior olivary nucleus, cerebellar Purkinje and granule cell layers, and dentate nucleus. Involvement of subcortical white matter tracts was also evident. Furthermore, in the spinal cord, a loss of dorsal column fibers was noted. This study has identified rDP-associated pathology in neuronal populations, which are part of complex motor and sensory loops. Their involvement would cause an interruption of cerebral and cerebellar connections which are essential for maintenance of motor control.

Research paper thumbnail of An unusual aetiology for internuclear ophthalmoplegia

Case Reports, 2013

Typical causes of internuclear ophthalmoplegia (INO) include arterial infarcts, demyelinating con... more Typical causes of internuclear ophthalmoplegia (INO) include arterial infarcts, demyelinating conditions, inflammation and trauma. We here report the unique case of a 33-year-old man with INO of the right eye caused by infarction of the right midbrain, confirmed by diffusion-weighted MRI. At presentation he displayed impaired adduction of the right eye with normal movement of the left. CT angiogram revealed an underlying developmental venous anomaly (DVA), raising the concern of venous infarction. His symptoms improved with aggressive management of blood pressure and risk factors. The patient had vascular risk factors-smoking, hypertension and dyslipidaemia-and we theorise that the hyalinised and inelastic walls of our patient's DVA were more vulnerable to the thrombogenic effects of his risk factors, predisposing him to this event. Venous infarcts owing to DVA are rare. To our knowledge INO secondary to venous infarct has not been reported, and should be considered in the differential of such cases.

Research paper thumbnail of Diagnostic challenges in movement disorders: Sensory Ataxia Neuropathy Dysarthria and Ophthalmoplegia (SANDO) syndrome

Research paper thumbnail of Cognitive impairment in rapid-onset dystonia-parkinsonism

Movement Disorders, 2014

Rapid-onset dystonia-parkinsonism (RDP) is caused by mutations in the ATP1A3 gene. This observati... more Rapid-onset dystonia-parkinsonism (RDP) is caused by mutations in the ATP1A3 gene. This observational study sought to determine if cognitive performance is decreased in patients with RDP compared with mutation-negative controls. We studied 22 familial RDP patients, 3 non-motor-manifesting mutation-positive family members, 29 mutation-negative family member controls in 9 families, and 4 unrelated RDP patients, totaling 58 individuals. We administered a movement disorder assessment, including the Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS) and the Unified Parkinson's Disease Rating Scale (UPDRS) and a cognitive battery of memory and learning, psychomotor speed, attention, and executive function. The cognitive battery was designed to evaluate a wide range of functions; recognition memory instruments were selected to be relatively pure measures of delayed memory, devoid of significant motor or vocal production limitations. Comparisons of standardized cognitive scores were assessed both with and without controlling for psychomotor speed and similarly for severity of depressive symptoms. A majority of RDP patients had onset of motor symptoms by age 25 and had initial symptom presentation in the upper body (face, mouth, or arm). Among patients, the BFMDRS (mean ± SD, 52.1 ± 29.5) and UPDRS motor subscore (29.8 ± 12.7) confirmed dystonia-parkinsonism. The affected RDP patients performed more poorly, on average, than mutation-negative controls for all memory and learning, psychomotor speed, attention, and executive function scores (all P ≤ 0.01). These differences persisted after controlling for psychomotor speed and severity of depressive symptoms. Impaired cognitive function may be a manifestation of ATP1A3 mutation and RDP.

Research paper thumbnail of The Frequency of Nonmotor Symptoms among Advanced Parkinson Patients May Depend on Instrument Used for Assessment

Parkinson's Disease, 2011

Background. Nonmotor symptoms (NMS) of Parkinson's disease (PD) may be more debilitating than mot... more Background. Nonmotor symptoms (NMS) of Parkinson's disease (PD) may be more debilitating than motor symptoms. The purpose of this study was to determine the frequency and corecognition of NMS among our advanced PD cohort (patients considered for deep brain stimulation (DBS)) and caregivers. Methods. NMS-Questionnaire (NMS-Q), a self-administered screening questionnaire, and NMS Assessment-Scale (NMS-S), a clinician-administered scale, were administered to PD patients and caregivers. Results. We enrolled 33 PD patients (23 males, 10 females) and caregivers. The most frequent NMS among patients using NMS-Q were gastrointestinal (87.9%), sleep (84.9%), and urinary (72.7%), while the most frequent symptoms using NMS-S were sleep (90.9%), gastrointestinal (75.8%), and mood (75.8%). Patient/caregiver scoring correlations for NMS-Q and NMS-S were 0.670 (P < 0.0001) and 0.527 (P = 0.0016), respectively. Conclusion The frequency of NMS among advanced PD patients and correlation between patients and caregivers varied with the instrument used. The overall correlation between patient and caregiver was greater with NMS-Q than NMS-S.

Research paper thumbnail of Person-Centered Care in the Home Setting for Parkinson’s Disease: Operation House Call Quality of Care Pilot Study

Parkinson's Disease, 2015

Research paper thumbnail of Selective use of low frequency stimulation in Parkinson's disease based on absence of tremor

NeuroRehabilitation, 2013

High frequency stimulation (HFS) of the subthalamic nucleus is one of the most effective treatmen... more High frequency stimulation (HFS) of the subthalamic nucleus is one of the most effective treatments for advanced Parkinson's disease (PD). HFS has provided beneficial improvements in the cardinal features of PD, but has not been proven as effective for addressing the axial predominant levodopa resistant symptoms, such as speech disturbances, gait disturbances, and postural instability. Recent studies have suggested that changes in stimulation parameters may influence differing PD symptoms. The purpose of this study was to compare the effects of low frequency stimulation (LFS) versus HFS on the Unified Parkinson's Disease Rating Scale (UPDRS), gait, balance, and verbal fluency. Eight tremor dominant and nine non-tremor dominant participants with bilateral deep brain stimulation of the subthalamic nucleus were tested off stimulation, during LFS, and during HFS. Results revealed that HFS significantly reduced UPDRS tremor score in the tremor dominant group; however no differenc...

Research paper thumbnail of Antibody Mediated Movement Disorders and Their Differential Response to Immunomodulatory Therapy (P4.051)

Research paper thumbnail of Mitochondrial Encephalopathy with Lactic Acidosis and Stroke (MELAS) presenting as an apparent neoplastic process (P5.015)

Research paper thumbnail of A Novel Familial Mutation in the CACNA1A Gene Associated with an Episodic Ataxia Type 2 Phenotype (S47.005)

Research paper thumbnail of Association Between Subthalamic Nucleus Deep Brain Stimulation and Weight Gain: Results of a Case-Control Study

Clinical Neurology and Neurosurgery, 2015

To evaluate whether weight change in patients with Parkinson&amp;amp;#39;s disease (PD) is di... more To evaluate whether weight change in patients with Parkinson&amp;amp;#39;s disease (PD) is different in those undergoing deep brain stimulation (DBS) of the subthalamic nucleus (STN) compared to those not undergoing DBS. A retrospective case-control study was performed in PD patients who had undergone STN DBS (cases) compared to matched PD patients without DBS (controls). Demographic and clinical data including Unified Parkinson&amp;amp;#39;s Disease Rating Scale (UPDRS) motor scores were collected. Repeated measures mixed model regression was used to identify variables associated with weight gain. Thirty-five cases and 34 controls were identified. Baseline age, gender, diagnosis and weight were similar. Duration of diagnosis was longer in cases (6.3 vs 4.9 years, p=0.0015). At 21.3 months, cases gained 2.9kg (+4.65%) while controls lost 1.8kg (-3.05%, p&amp;amp;lt;0.02). Postoperative UPDRS motor scores improved by 49% indicating surgical efficacy. Only younger age (p=0.0002) and DBS (p=0.008) were significantly associated with weight gain. In this case-control study, PD patients undergoing STN DBS experienced post-operative weight gain that was significantly different from the weight loss observed in non-DBS PD controls. Patients, especially overweight individuals, should be informed that STN DBS can result in weight gain.

Research paper thumbnail of Memantine for the treatment of levodopa induced dyskinesias in demented and non-demented patients with Parkinson's disease

Research paper thumbnail of Memantine improves" off periods" in patients with advanced Parkinson's disease

Research paper thumbnail of Increased Pain Sensitivity and Impulsivity Appear Related: Pain-Related fMRI in Parkinson's Disease

Research paper thumbnail of Mismatch of non-motor symptoms among DBS-candidate Parkinson patients and their carepartners may be scale driven

Research paper thumbnail of A comparison of prevalence of non-motor symptoms in movement disorders

Research paper thumbnail of Value of" hot cross bun sign" in multiple system atrophy-C (MSA-C)

Research paper thumbnail of Antibody Mediated Movement Disorders and Their Differential Response to Immunomodulatory Therapy (P4. 051)

Research paper thumbnail of A Novel Familial Mutation in the CACNA1A Gene Associated with an Episodic Ataxia Type 2 Phenotype (S47. 005)

Research paper thumbnail of A novel familial mutation in the CACNA1A gene associated with an episodic ataxia type 2 phenotype

Research paper thumbnail of Rapid-onset dystonia-parkinsonism associated with the I758S mutation of the ATP1A3 gene: a neuropathologic and neuroanatomical study of four siblings

Acta Neuropathologica, 2014

disease and Alzheimer disease, were evident in all subjects. We evaluated areas that may be relev... more disease and Alzheimer disease, were evident in all subjects. We evaluated areas that may be relevant to rDP separately from those affected by the comorbid conditions. Anatomical areas identified as potential targets of I758S mutation were globus pallidus, subthalamic nucleus, red nucleus, inferior olivary nucleus, cerebellar Purkinje and granule cell layers, and dentate nucleus. Involvement of subcortical white matter tracts was also evident. Furthermore, in the spinal cord, a loss of dorsal column fibers was noted. This study has identified rDP-associated pathology in neuronal populations, which are part of complex motor and sensory loops. Their involvement would cause an interruption of cerebral and cerebellar connections which are essential for maintenance of motor control.

Research paper thumbnail of An unusual aetiology for internuclear ophthalmoplegia

Case Reports, 2013

Typical causes of internuclear ophthalmoplegia (INO) include arterial infarcts, demyelinating con... more Typical causes of internuclear ophthalmoplegia (INO) include arterial infarcts, demyelinating conditions, inflammation and trauma. We here report the unique case of a 33-year-old man with INO of the right eye caused by infarction of the right midbrain, confirmed by diffusion-weighted MRI. At presentation he displayed impaired adduction of the right eye with normal movement of the left. CT angiogram revealed an underlying developmental venous anomaly (DVA), raising the concern of venous infarction. His symptoms improved with aggressive management of blood pressure and risk factors. The patient had vascular risk factors-smoking, hypertension and dyslipidaemia-and we theorise that the hyalinised and inelastic walls of our patient's DVA were more vulnerable to the thrombogenic effects of his risk factors, predisposing him to this event. Venous infarcts owing to DVA are rare. To our knowledge INO secondary to venous infarct has not been reported, and should be considered in the differential of such cases.

Research paper thumbnail of Diagnostic challenges in movement disorders: Sensory Ataxia Neuropathy Dysarthria and Ophthalmoplegia (SANDO) syndrome

Research paper thumbnail of Cognitive impairment in rapid-onset dystonia-parkinsonism

Movement Disorders, 2014

Rapid-onset dystonia-parkinsonism (RDP) is caused by mutations in the ATP1A3 gene. This observati... more Rapid-onset dystonia-parkinsonism (RDP) is caused by mutations in the ATP1A3 gene. This observational study sought to determine if cognitive performance is decreased in patients with RDP compared with mutation-negative controls. We studied 22 familial RDP patients, 3 non-motor-manifesting mutation-positive family members, 29 mutation-negative family member controls in 9 families, and 4 unrelated RDP patients, totaling 58 individuals. We administered a movement disorder assessment, including the Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS) and the Unified 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;amp;amp;amp;amp;amp;amp;amp;amp;#39;s Disease Rating Scale (UPDRS) and a cognitive battery of memory and learning, psychomotor speed, attention, and executive function. The cognitive battery was designed to evaluate a wide range of functions; recognition memory instruments were selected to be relatively pure measures of delayed memory, devoid of significant motor or vocal production limitations. Comparisons of standardized cognitive scores were assessed both with and without controlling for psychomotor speed and similarly for severity of depressive symptoms. A majority of RDP patients had onset of motor symptoms by age 25 and had initial symptom presentation in the upper body (face, mouth, or arm). Among patients, the BFMDRS (mean ± SD, 52.1 ± 29.5) and UPDRS motor subscore (29.8 ± 12.7) confirmed dystonia-parkinsonism. The affected RDP patients performed more poorly, on average, than mutation-negative controls for all memory and learning, psychomotor speed, attention, and executive function scores (all P ≤ 0.01). These differences persisted after controlling for psychomotor speed and severity of depressive symptoms. Impaired cognitive function may be a manifestation of ATP1A3 mutation and RDP.

Research paper thumbnail of The Frequency of Nonmotor Symptoms among Advanced Parkinson Patients May Depend on Instrument Used for Assessment

Parkinson's Disease, 2011

Background. Nonmotor symptoms (NMS) of Parkinson's disease (PD) may be more debilitating than mot... more Background. Nonmotor symptoms (NMS) of Parkinson's disease (PD) may be more debilitating than motor symptoms. The purpose of this study was to determine the frequency and corecognition of NMS among our advanced PD cohort (patients considered for deep brain stimulation (DBS)) and caregivers. Methods. NMS-Questionnaire (NMS-Q), a self-administered screening questionnaire, and NMS Assessment-Scale (NMS-S), a clinician-administered scale, were administered to PD patients and caregivers. Results. We enrolled 33 PD patients (23 males, 10 females) and caregivers. The most frequent NMS among patients using NMS-Q were gastrointestinal (87.9%), sleep (84.9%), and urinary (72.7%), while the most frequent symptoms using NMS-S were sleep (90.9%), gastrointestinal (75.8%), and mood (75.8%). Patient/caregiver scoring correlations for NMS-Q and NMS-S were 0.670 (P < 0.0001) and 0.527 (P = 0.0016), respectively. Conclusion The frequency of NMS among advanced PD patients and correlation between patients and caregivers varied with the instrument used. The overall correlation between patient and caregiver was greater with NMS-Q than NMS-S.

Research paper thumbnail of Person-Centered Care in the Home Setting for Parkinson’s Disease: Operation House Call Quality of Care Pilot Study

Parkinson's Disease, 2015

Research paper thumbnail of Selective use of low frequency stimulation in Parkinson's disease based on absence of tremor

NeuroRehabilitation, 2013

High frequency stimulation (HFS) of the subthalamic nucleus is one of the most effective treatmen... more High frequency stimulation (HFS) of the subthalamic nucleus is one of the most effective treatments for advanced Parkinson's disease (PD). HFS has provided beneficial improvements in the cardinal features of PD, but has not been proven as effective for addressing the axial predominant levodopa resistant symptoms, such as speech disturbances, gait disturbances, and postural instability. Recent studies have suggested that changes in stimulation parameters may influence differing PD symptoms. The purpose of this study was to compare the effects of low frequency stimulation (LFS) versus HFS on the Unified Parkinson's Disease Rating Scale (UPDRS), gait, balance, and verbal fluency. Eight tremor dominant and nine non-tremor dominant participants with bilateral deep brain stimulation of the subthalamic nucleus were tested off stimulation, during LFS, and during HFS. Results revealed that HFS significantly reduced UPDRS tremor score in the tremor dominant group; however no differenc...