Journal of Movement Disorders

Letter to the editor

Atypical imaging findings in corticobasal syndrome: a case report: Hyunji Kim, Seo Young Kang, Ji Young Yun, Jee Hyang Jeong; Received February 7, 2025 Accepted May 22, 2025 Published online May 22, 2025; DOI: https://doi.org/10.14802/jmd.25034 [Accepted]

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Original Article

Factors associated with response to exercise in patients with Parkinson's disease: Myung Jun Lee, Jinse Park, Dong-Woo Ryu, Dallah Yoo, Sang-Myung Cheon; Received March 17, 2025 Accepted May 16, 2025 Published online May 16, 2025; DOI: https://doi.org/10.14802/jmd.25068 [Accepted]

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Abstract PDF: Introduction
Exercises have been proposed as adjuvants for the treatment of Parkinson's disease (PD); however, responses to exercise interventions have shown inconsistent results. We investigated clinical factors associated with improvements in motor deficits after exercise.
Methods
85 PD patients were enrolled from five tertiary hospitals and classified into four exercise groups: home exercises, strength training, Tai Chi, and yoga. Clinical measurements of the motor and non-motor features of PD were assessed at baseline and 12 weeks after the exercise intervention. We employed principal component analysis (PCA) to reduce variables into ten factors and then examined associations of baseline characteristics with percentage improvement in the Movement Disorder Society Unified Parkinson's Disease Rating Scale part III (MDS-UPDRS III) using the Bayesian regression model.
Results
In the multivariate Bayesian regression model including ten PCA-driven factors, the percentage improvement of the MDS-UPDRS III was associated with factors including prominent motor deficits (posterior interval; mean ± SD, – 3.9 ± 1.7) and non-motor symptoms such as depression, anxiety, and subjective memory impairment (2.5 ± 1.5). Another factor related to functional impairments in gait and postural control was associated with less improvement after the exercise intervention (3.3 ± 1.7). In the subgroup analyses, motor features were associated with improvement in the home exercise and strength training groups, whereas mood disturbance, fatigue, and subjective cognitive impairment were related to changes in the home exercise and Tai Chi groups.
Conclusions
Our results suggest that individual phenotypes of PD patients may be associated with clinical improvement following exercise.

Letter to the editor

Optimizing Device-Aided Therapies in Advanced Parkinson’s Disease: A Case Series on Continuous Subcutaneous Apomorphine Infusion in Challenging Scenarios: Adrian Paul R De Leon, Roongroj Bhidayasiri, Onanong Phokaewvarangkul; Received February 25, 2025 Accepted May 12, 2025 Published online May 14, 2025; DOI: https://doi.org/10.14802/jmd.25045 [Accepted]

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Original Article

Efficacy of levodopa/benserazide dispersible tablet on the ‘Delayed-ON’ to first morning dose in patients with Parkinson’s disease with motor fluctuations: a multicenter, randomized, open-label, cross-over trial: Hee Jin Chang, Jongkyu Park, Sohee Oh, Chae Won Shin, Ji Won Kim, Jin Whan Cho, Jee-Young Lee; Received February 5, 2025 Accepted May 3, 2025 Published online May 7, 2025; DOI: https://doi.org/10.14802/jmd.25031 [Accepted]

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Abstract PDF: Background
Delayed ON is a condition in which Parkinson's disease (PD) patients do not experience the effect of levodopa in time after taking the dosage. The efficacy of various oral levodopa regimens to overcome this problem has been investigated limitedly.
Objective
To evaluate the efficacy of levodopa/benserazide dispersible tablet in PD patients with delayed ON to first morning dose.
Methods
This multicenter, randomized, cross-over trial involved 40 eligible PD patients with delayed ON. Participants were randomized to receive either levodopa/benserazide 100mg dispersible or regular tablets for 4 weeks, thereafter one week wash-out interval, followed by an alternate drug for another 4-week. Participants took the investigational drug with the first-morning dose of their antiparkinsonian medications. Other medications were unchanged during the trial. The primary outcome was changes in time-to-ON after the first-morning dose recorded in a special diary before and after each therapy. We also evaluated changes in parkinsonism, motor fluctuations, and dyskinesia using the Unified PD Rating Scale and Unified Dyskinesia Rating Scale. Finally, we investigated whether the efficacy wase affected by Helicobacter pylori status using baseline serum samples from every participant.
Results
Nine patients dropped out during the trial. The time-to-ON was significantly reduced by the dispersible tablet compared with the regular tablet (-34.72 vs -23.81 minutes, p=0.014). There were no significant changes in parkinsonian severity or dyskinesia with either drug. The dispersible formulation was beneficial for both Helicobacter pylori-positive and -negative groups.
Conclusion
Levodopa/benserazide dispersible formulations can improve time-to-ON without exacerbating dyskinesia in PD patients suffering from delayed ON.

Viewpoint

Diagnostic spectrum in a cohort of “Atypical” Atypical Parkinsonism Syndromes: A single center experience: Pavankumar Katragadde, Vikram V Holla, Nitish Kamble, Rohan R Mahale, Ravi Yadav, Pramod Kumar Pal; Received January 27, 2025 Accepted May 2, 2025 Published online May 7, 2025; DOI: https://doi.org/10.14802/jmd.25021 [Accepted]

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Letter to the editor

An uncommon cause of progressive rest, postural and kinetic tremor with ataxia in a middle-aged man: a rare case of Klinefelter’s syndrome: Malghalara Naeem, Shakya Bhattacharjee; Received March 28, 2025 Accepted April 30, 2025 Published online May 1, 2025; DOI: https://doi.org/10.14802/jmd.25081 [Accepted]

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Brief communication

Safety and efficacy of istradefylline in Parkinson’s disease patients with and without pre-existing dyskinesia: Pooled analysis of 8 randomized controlled trials: Nobutaka Hattori, Lawrence Elmer, Stuart H. Isaacson, Rajesh Pahwa, Olivier Rascol, Kapil Sethi, Fabrizio Stocchi, Yu Nakajima, Hannah Cummings, Lia Kostiuk; Received February 27, 2025 Accepted April 25, 2025 Published online April 25, 2025; DOI: https://doi.org/10.14802/jmd.25047 [Accepted]

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Abstract PDF: Objectives
Evaluate the efficacy of istradefylline in people with Parkinson’s disease with motor fluctuations, with and without dyskinesia, and characterize potential predictors for treatment-emergent dyskinesia with istradefylline.
Methods
Pooled analysis of 8 phase 2b/3 trials of istradefylline (20 or 40mg/day) versus placebo.
Results
Data from 2719 patients, including 56% with baseline dyskinesia, were analyzed post-hoc. The presence of baseline dyskinesia did not affect mean reductions in OFF-time, increases in ON-time without troublesome dyskinesia, or improvements in Unified Parkinson’s Disease Rating Scale motor scores associated with istradefylline treatment. Dyskinesia was reported by 17% of istradefylline-treated patients, with higher rates for women (21%), patients with BMI <18.5 kg/m2 (22%), and patients treated with COMT inhibitors plus dopamine agonists (22%) and MAO-B inhibitors (25%).
Conclusion
Istradefylline treatment resulted in greater reductions in total OFF hours/day and increases in ON-time without troublesome dyskinesia versus placebo regardless of the presence or absence of pre-existing dyskinesia.

Original Article

Factors associated with the decline of daytime bed-mobility independence in Parkinson's disease: A cross-sectional study: Masaru Narita, Kosuke Sakano, Yuichi Nakashiro, Fumio Moriwaka, Shinsuke Hamada, Yohei Okada; Received February 9, 2025 Accepted April 25, 2025 Published online April 25, 2025; DOI: https://doi.org/10.14802/jmd.25035 [Accepted]

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Abstract PDF: Objective
People with Parkinson's disease (PwPD) experience a gradual decline in independence in bed mobility as the disease progresses. Identifying factors associated with non-independence in daytime bed mobility is crucial for developing effective interventions to enhance independence. We investigated factors associated with non-independence in daytime bed mobility in PwPD.
Methods
This cross-sectional study included 109 PwPD (Hoehn & Yahr [HY] stage 2–4) . Patients' bed mobility ability (turning in bed, supine-to-sitting, and sitting-to-supine) was assessed during daytime and categorized into independent and non-independent groups. Potential factors associated with bed-mobility independence were evaluated, including components of the Movement Disorders Society-Unified Parkinson's Disease Rating Scale (rigidity, bradykinesia, tremor, axial symptoms), neck/trunk/hip strength, the Mini-Mental State Examination, and the Trail Making Test-A and B.
Results
The non-independent group showed significantly increased axial symptoms, increased rigidity in the upper and lower limbs and neck, increased upper limb bradykinesia, and decreased trunk flexion/extension strength in all bed-mobility tasks (p<0.05). Multivariate regression analyses showed that axial symptoms, upper limb rigidity, and trunk extension strength were highly discriminative for non-independence in turning in bed (AUC = 0.84). Similarly, upper limb rigidity and axial symptoms were predictive of non-independence in supine-to-sitting and sitting-to-supine movements (AUC = 0.78, 0.92). A significant difference in axial symptoms between HY4 subgroups was observed only in the sitting-to-supine movement.
Conclusions
Our findings indicate that axial symptoms and upper limb rigidity are key factors contributing to non-independence in daytime bed-mobility tasks among PwPD. Targeting these factors in rehabilitation may help mitigate the decline in bed-mobility independence in PwPD.

Letters to the editor

Dopamine Transporter Deficiency Syndrome: A Rare Case of Infantile-Onset Dystonia-Parkinsonism: Bhavani Madduluri, Garapati Divyateja, Sireesha Yareeda; Received March 8, 2025 Accepted April 22, 2025 Published online April 22, 2025; DOI: https://doi.org/10.14802/jmd.25057 [Accepted]

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Rare Yet Real: Rheumatic Chorea’s Burden in the Modern Era- Case series from a Tertiary Health Care Centre in South India: M K Farsana, Vikram V Holla, Nitish Kamble, Rohan R Mahale, Faheem Arshad, Pramod Kumar Pal, Ravi Yadav; Received January 25, 2025 Accepted April 21, 2025 Published online April 22, 2025; DOI: https://doi.org/10.14802/jmd.25018 [Accepted]

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Brief communication

Clinical and Genetic Characterization of Woodhouse-Sakati Syndrome in Iranian Patients: A Case Series: Sepehr Khosravi, Toktam Moosavian, Shadab Salehpour, Seyed Amir Hassan Habibi, Afagh Alavi, Mohammad Rohani; Received February 17, 2025 Accepted April 15, 2025 Published online April 16, 2025; DOI: https://doi.org/10.14802/jmd.25043 [Accepted]

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Abstract PDF: Objective
Woodhouse-Sakati syndrome (WSS) is a rare autosomal recessive neuroendocrine disorder characterized by a variety of endocrine and neurological involvement, including extrapyramidal symptoms and intellectual disability.
Methods
This report presents five Iranian patients with WSS with their genetic characterizations, also reporting the first Iranian patient to undergo Deep Brain Stimulation (DBS).
Result
We highlight five Iranian patients with mutations in DCAF17 gene presenting with variable features of WSS, with symptom onset in early adolescence. Whole exome sequencing identified four homozygous variants (c.436delC, c.982-2A>G, c.580C>T, and c.838+1G>A) within the DCAF17 gene in the probands. Patients had variable responses to common therapies, and one patient achieved significant improvement following DBS.
Conclusion
We expand the clinical and genetic heterogeneity among Iranian patients and suggest the c.436delC variant as a founder mutation in the region. We highlight the importance of considering WSS in patients with both neurological and endocrine symptoms and suggest DBS as a potential treatment option.

Original Article

Comparison of Impact of Various Exercise Modalities on Parkinson’s Disease: Jinse Park, Sang-Myung Cheon, Myung Jun Lee, Dong-Woo Rhu, Dallah Yoo; Received February 13, 2025 Accepted April 15, 2025 Published online April 15, 2025; DOI: https://doi.org/10.14802/jmd.25038 [Accepted]

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Abstract PDF: Background and Purpose
Exercise is a critical non-pharmacological intervention for Parkinson’s disease (PD); however, comparative evidence on the efficacy of different exercise modalities is limited. This study aimed to compare the effects of tai chi, strength training, yoga, and home-based exercises on motor in patients with Parkinson’s disease (PD).
Subject and Methods
In this multicenter, open-label, randomized clinical trial, 99 patients with PD were allocated to one of four exercise interventions: tai chi, strength training, yoga, or home-based exercises. Each intervention consisted of 12 weeks of supervised sessions, followed by 12 weeks of independent practice. The primary outcomes included the MDS-UPDRS Part III and timed up-and-go (TUG) test parameters. The secondary outcomes assessed included physical activity (SPPB and 6 MWT), balance (Mini-BEST), and freezing of gait (NFOGQ).
Results
Home exercise and tai chi demonstrated significant improvements in the MDS-UPDRS Part III scores over 24 weeks. 6 minutes walking test was improved by home exercises, tai chi, and MiniBest was enhanced by strength exercises and yoga. The total duration and forward movement of TUG and turning duration measuring by wearable sensor were markedly improved in yoga group.
Conclusion
Our results support that various in adherence and outcomes of exercise have been observed in real-world setting even though effectiveness of exercise is well established. These findings highlighted the importance of tailoring exercise regimens considering individual patients in PD management

Letter to the editor

Late-onset Ataxia, Chorea, Cognitive impairment, and Insomnia: Expanding the phenotype of IRF2BPL-related disease: Salhin Alatrash, Mary O’Driscoll, Amrit-Deep Samra; Received February 5, 2025 Accepted April 15, 2025 Published online April 15, 2025; DOI: https://doi.org/10.14802/jmd.25030 [Accepted]

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Brief communication

Current status of pelvic lateral shift in patients with Parkinson’s disease and its relation to lateral trunk flexion: Kyohei Mikami, Makoto Shiraishi, Akika Yoshimoto, Tsutomu Kamo; Received January 25, 2025 Accepted April 15, 2025 Published online April 15, 2025; DOI: https://doi.org/10.14802/jmd.25017 [Accepted]

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Abstract PDF: Objectives
A lack of standardized methods for evaluating postural abnormalities hinders treatment progress. The role of pelvic lateral shift (PLS) in patients with Parkinson’s disease (PwP) exhibiting lateral trunk flexion (LTF) remains unclear. We hypothesized that PLS is related to LTF and investigated its characteristics and relationship to LTF angle.
Methods
PwP attending outpatient rehabilitation (March 2018–March 2023) were assessed using still images. PLS direction, its relationship with LTF angle, and LTF angle by PLS side were analysed.
Results
Among 158 patients, PLS was contralateral in 80 (50.6%), ipsilateral in 43 (27.2%), and absent in 35 (22.2%). In contralateral PLS, but not ipsilateral, PLS angle correlated with LTF angle (r=0.48, p<0.001). LTF angle was greater in contralateral (8.5±9.6°) than ipsilateral shift (2.8±4.2°, p<0.001).
Conclusions
Because of the positive relationship between LTF angle and contralateral shift angle, evaluation criteria that include PLS are needed for PwP with LTF.

Original Article

Shoulder Dysfunction in Parkinson's Disease: Implications of Motor Subtypes, Disease Severity, and Spinopelvic Alignment: Sieh Yang Lee, Lay San Lim, Yun-Ru Lai, Cheng-Hsien Lu; Received February 6, 2025 Accepted April 8, 2025 Published online April 8, 2025; DOI: https://doi.org/10.14802/jmd.25032 [Accepted]

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Abstract PDF: Purpose
To investigate shoulder function and muscle alterations in patients with Parkinson’s disease (PD) and to determine their association with spinopelvic parameters and clinical status.
Methods
This prospective cohort study included 62 PD patients (divided into PIGD [n=30] and non-PIGD [n=32] groups) and 35 controls. The American Shoulder and Elbow Surgeons score (ASES), range of motion (ROM), and shoulder muscle stiffness were assessed for each group. Data on clinical demographics, PD disease severity, and shoulder parameters were extracted and analyzed.
Results
The PIGD group had significantly lower ASES total and sub-scores (all p < 0.05) compared to the controls. Both PIGD and non-PIGD groups demonstrated reduced abduction and forward flexion (all p < 0.05) compared to controls. The PIGD group also had decreased external rotation compared to the non-PIGD group and controls (all p < 0.05). Infraspinatus muscle stiffness was higher in the PIGD group than in controls (p = 0.012). Correlation analysis revealed that shoulder condition was significantly associated with PD disease severity and PIGD score, while muscle stiffness was linked to spinopelvic alignment and PIGD score. Various clinical factors, including PD disease severity, PIGD score, tremor score, and spinopelvic alignment, significantly correlated with shoulder ROM.
Conclusion
PD patients experienced shoulder dysfunction in various ways, including decreased ASES scores, limited ROM, and increased shoulder muscle stiffness. Our study highlighted the impact of PD motor subtype, disease severity, and spinopelvic alignment on the development of shoulder dysfunction, offering deeper insights into the pathophysiological basis of shoulder disorders in PD.

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