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Article ; Online: Unraveling the threads of stability: A review of the neurophysiology of postural control in Parkinson's disease.

Bath, Jessica E / Wang, Doris D

Neurotherapeutics : the journal of the American Society for Experimental NeuroTherapeutics

2024 Volume 21, Issue 3, Page(s) e00354

Abstract: Postural instability is a detrimental and often treatment-refractory symptom of Parkinson's disease. While many existing studies quantify the biomechanical deficits among various postural domains (static, anticipatory, and reactive) in this population, ... ...

Abstract	Postural instability is a detrimental and often treatment-refractory symptom of Parkinson's disease. While many existing studies quantify the biomechanical deficits among various postural domains (static, anticipatory, and reactive) in this population, less is known regarding the neural network dysfunctions underlying these phenomena. This review will summarize current studies on the cortical and subcortical neural activities during postural responses in healthy subjects and those with Parkinson's disease. We will also review the effects of current therapies, including neuromodulation and feedback-based wearable devices, on postural instability symptoms. With recent advances in implantable devices that allow chronic, ambulatory neural data collection from patients with Parkinson's disease, combined with sensors that can quantify biomechanical measurements of postural responses, future work using these devices will enable better understanding of the neural mechanisms of postural control. Bridging this knowledge gap will be the critical first step towards developing novel neuromodulatory interventions to enhance the treatment of postural instability in Parkinson's disease.
MeSH term(s)	Humans ; Parkinson Disease/physiopathology ; Parkinson Disease/therapy ; Postural Balance/physiology
Language	English
Publishing date	2024-04-04
Publishing country	United States
Document type	Journal Article ; Review ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ZDB-ID	2316693-9
ISSN	1878-7479 ; 1933-7213
ISSN (online)	1878-7479
ISSN	1933-7213
DOI	10.1016/j.neurot.2024.e00354
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Article ; Online: Focused Ultrasound for Treatment of Movement Disorders: A Review of Non-Food and Drug Administration Approved Indications.

Cummins, Daniel D / Bernabei, John M / Wang, Doris D

Stereotactic and functional neurosurgery

2024 Volume 102, Issue 2, Page(s) 93–108

Abstract: Introduction: MRI-guided focused ultrasound (FUS) is an incisionless thermo-ablative procedure that may be used to treat medication-refractory movement disorders, with a growing number of potential anatomic targets and clinical applications. As of this ... ...

Abstract	Introduction: MRI-guided focused ultrasound (FUS) is an incisionless thermo-ablative procedure that may be used to treat medication-refractory movement disorders, with a growing number of potential anatomic targets and clinical applications. As of this article's publication, the only US Food and Drug Administration (FDA)-approved uses of FUS for movement disorders are thalamotomy for essential tremor (ET) and tremor-dominant Parkinson's Disease (PD), and pallidotomy for other cardinal symptoms of PD. We present a state-of-the-art review on all non-FDA approved indications of FUS for movement disorders, beyond the most well-described indications of ET and PD. Our objective was to summarize the safety and efficacy of FUS in this setting and provide a roadmap for future directions of FUS for movement disorders. Methods: A state-of-the-art review was conducted on use of FUS for non-FDA approved movement disorders. All movement disorders excluding FDA-approved uses for ET and PD were included. Results: A total of 25 studies on 172 patients were included. In patients with tremor plus dystonia syndromes (n = 6), ventralis intermediate nucleus of the thalamus (VIM)-FUS gave >50% tremor reduction, with no improvement in dystonia and worsened dystonia in 2/6 patients. Ventral-oralis complex (VO)-FUS gave >50% improvement for focal hand dystonia (n = 6) and 100% return to musical performance in musician's dystonia (n = 6). In patients with multiple sclerosis (MS) and tremor (n = 3), improvement in tremor was seen in 2 patients with a favorable skull density ratio; no MS disease change was noted after VIM-FUS. In patients with tremor and comorbid ataxia syndromes (n = 3), none were found to have worsened ataxia after VIM-FUS; all had clinically significant tremor improvement. Subthalamic nucleus (STN)-FUS for PD (n = 49) gave approximately 50% improvement in PD motor symptoms, with dystonia and mild dyskinesias as possible adverse effects. Cerebellothalamic tract (CTT-FUS) for ET (n = 42) gave 55-90% tremor improvement, with gait dysfunction as a rare persistent adverse effect. Pallidothalamic tract (PTT-FUS) for PD (n = 50) gave approximately 50% improvement in motor symptoms, with mild speech dysfunction as a possible adverse effect. Conclusion: VIM-FUS appeared safe and effective for heterogenous tremor etiologies, and VO-FUS appeared most effective for isolated segmental dystonia. STN-FUS was effective for PD symptom reduction; postoperative dystonia and mild on-medication dyskinesias required medical management. Tractography-based targeting with CTT-FUS for ET and PTT-FUS for PD demonstrated promising early results. Larger prospective trials with long-term follow-up are needed to the evaluate the safety and efficacy non-FDA approved indications for FUS.
MeSH term(s)	United States ; Humans ; Tremor/surgery ; Dystonia ; Prospective Studies ; United States Food and Drug Administration ; Thalamus/surgery ; Essential Tremor/surgery ; Parkinson Disease/diagnostic imaging ; Parkinson Disease/therapy ; Ataxia ; Dyskinesias ; Treatment Outcome ; Dystonic Disorders
Language	English
Publishing date	2024-02-16
Publishing country	Switzerland
Document type	Systematic Review
ZDB-ID	645069-6
ISSN	1423-0372 ; 1011-6125
ISSN (online)	1423-0372
ISSN	1011-6125
DOI	10.1159/000535621
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Article ; Online: Kounis Syndrome, an Unrecognized Presentation of Perioperative Anaphylaxis in a Transplant Candidate.

Hong, Andrew D / Fleissner, Zachary J / Campos-Cuellar, Cesar / Gonzalez-Estrada, Alexei / Mao, Shennen A / Doris Wang, R / Pai, Sher-Lu

Progress in transplantation (Aliso Viejo, Calif.)

2023 Volume 33, Issue 3, Page(s) 270–271

MeSH term(s)	Humans ; Anaphylaxis/diagnosis ; Anaphylaxis/etiology ; Kounis Syndrome/diagnosis ; Kounis Syndrome/etiology ; Transplants
Language	English
Publishing date	2023-08-02
Publishing country	United States
Document type	Journal Article
ZDB-ID	2864264-8
ISSN	2164-6708 ; 1526-9248
ISSN (online)	2164-6708
ISSN	1526-9248
DOI	10.1177/15269248231191485
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Article ; Online: A Systematic Review Comparing Focused Ultrasound Surgery With Radiosurgery for Essential Tremor.

Kondapavulur, Sravani / Silva, Alexander B / Molinaro, Annette M / Wang, Doris D

Neurosurgery

2023 Volume 93, Issue 3, Page(s) 524–538

Abstract: Background: Focused ultrasound (FUS-T) and stereotactic radiosurgery thalamotomy (SRS-T) targeting the ventral intermediate nucleus are effective incisionless surgeries for essential tremor (ET). However, their efficacy for tremor reduction and, ... ...

Abstract	Background: Focused ultrasound (FUS-T) and stereotactic radiosurgery thalamotomy (SRS-T) targeting the ventral intermediate nucleus are effective incisionless surgeries for essential tremor (ET). However, their efficacy for tremor reduction and, importantly, adverse event incidence have not been directly compared. Objective: To present a comprehensive systematic review with network meta-analysis examining both efficacy and adverse events (AEs) of FUS-T vs SRS-T for treating medically refractory ET. Methods: We conducted a systematic review and network meta-analysis according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, using the PubMed and Embase databases. We included all primary FUS-T/SRS-T studies with approximately 1-year follow-up, with unilateral Fahn-Tolosa-Marin Tremor Rating Scale or Clinical Rating Scale for Tremor scores prethalamotomy/post-thalamotomy and/or AEs. The primary efficacy outcome was Fahn-Tolosa-Marin Tremor Rating Scale A+B score reduction. AEs were reported as an estimated incidence. Results: Fifteen studies of 464 patients and 3 studies of 62 patients met inclusion criteria for FUS-T/SRS-T efficacy comparison, respectively. Network meta-analysis demonstrated similar tremor reduction between modalities (absolute tremor reduction: FUS-T: -11.6 (95% CI: -13.3, -9.9); SRS-T: -10.3 (95% CI: -14.2, -6.0). FUS-T had a greater 1-year adverse event rate, particularly imbalance and gait disturbances (10.5%) and sensory disturbances (8.3%). Contralateral hemiparesis (2.7%) often accompanied by speech impairment (2.4%) were most common after SRS-T. There was no correlation between efficacy and lesion volume. Conclusion: Our systematic review found similar efficacy between FUS-T and SRS-T for ET, with trend toward higher efficacy yet greater adverse event incidence with FUS-T. Smaller lesion volumes could mitigate FUS-T off-target effects for greater safety.
MeSH term(s)	Humans ; Essential Tremor/surgery ; Magnetic Resonance Imaging ; Radiosurgery/adverse effects ; Thalamus/surgery ; Treatment Outcome ; Tremor/surgery ; Ultrasonic Surgical Procedures ; Network Meta-Analysis
Language	English
Publishing date	2023-04-03
Publishing country	United States
Document type	Systematic Review ; Meta-Analysis ; Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	135446-2
ISSN	1524-4040 ; 0148-396X
ISSN (online)	1524-4040
ISSN	0148-396X
DOI	10.1227/neu.0000000000002462
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Article: Training Medical Student Counselors for the Rochester Model, a Hospital Tobacco Treatment Program.

Grable, John C / Shan, Kevin / Wang, Matthew / Han, Daniel D / Sportiello, Kristen / Chang, Melissa / Sysol, Justin R / Bugbee, Doris / Peltzer, Kenneth

Journal of multidisciplinary healthcare

2024 Volume 17, Page(s) 601–607

Abstract: Purpose: Providing effective tobacco dependence treatments to hospitalized patients remains a challenge. Prior to 2021, the Rochester Model program used staff nurses for both bedside and post-discharge counseling necessary to maintain abstinence. When ... ...

Abstract	Purpose: Providing effective tobacco dependence treatments to hospitalized patients remains a challenge. Prior to 2021, the Rochester Model program used staff nurses for both bedside and post-discharge counseling necessary to maintain abstinence. When nurse shortages and elevated job stress occurred during the COVID Pandemic, we proposed that medical students learn to counsel patients at the bedside and after discharge. Patients and methods: Due to COVID restrictions, first- and second-year medical students trained using remote Zoom sessions. The total training time was 2.5 hr without role-play or additional evaluations. A survey measured the students' satisfaction, confidence, and counseling barriers. A smoking patient on a participating hospital unit can enroll in the program. Students delivered bedside counseling, then provided follow-up treatment and outcome calls along with New York State Quitline counselors. Results: The survey demonstrated that 89% of the students were satisfied with the training. The bedside counseling confidence was greater than the phone counseling confidence. All students felt the program experience has value to them as future physicians. 124 smoking patients enrolled, and outcomes followed out to 6 months. The 7-day point prevalence quit rates using the as-treated (patients contacted) analysis were 57% at 4 weeks, 48% at 3 months, and 43% at 6 months. The 7-day point prevalence quit rates using the intent-to-treat (all patients) analysis were 31% at 4 weeks, 16% at 3 months and 14% at 6 months. Conclusion: Medical students given minimal training are effective tobacco cessation counselors at no cost to the hospital system. The Rochester Model program using student counseling benefits patients, the students, and the health-care system.
Language	English
Publishing date	2024-02-07
Publishing country	New Zealand
Document type	Journal Article
ZDB-ID	2453343-9
ISSN	1178-2390
ISSN	1178-2390
DOI	10.2147/JMDH.S447462
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Article ; Online: Ventral Intermediate Nucleus of the Thalamus versus Posterior Subthalamic Area: Network Meta-Analysis of DBS Target Site Efficacy for Essential Tremor.

Kondapavulur, Sravani / Silva, Alexander B / Wang, Doris D

Stereotactic and functional neurosurgery

2022 Volume 100, Issue 4, Page(s) 224–235

Abstract: Background: Deep brain stimulation (DBS) targeting the ventral intermediate nucleus (Vim) of the thalamus or the posterior subthalamic area (PSA) are effective treatments for essential tremor (ET). However, their relative efficacy is unknown.: ... ...

Abstract	Background: Deep brain stimulation (DBS) targeting the ventral intermediate nucleus (Vim) of the thalamus or the posterior subthalamic area (PSA) are effective treatments for essential tremor (ET). However, their relative efficacy is unknown. Objective: Here, we present the first systematic review and network meta-analysis, examining the efficacy of Vim versus PSA DBS for treating medically refractory ET. Methods: We included all primary studies that reported validated Fahn-Tolosa-Marin Tremor Rating Scale (FTM-TRS) scores pre-/postimplantation or on-/off-stimulation postimplantation, for patients receiving either Vim or PSA DBS. The primary outcome was FTM-TRS score reduction; the secondary outcome was percent reduction in score. We categorized all outcomes as short-term (≤12 months) or long-term (>12 months). Results: For pre-/postimplantation comparisons, 19 and 11 studies met inclusion criteria for short- and long-term follow-ups, respectively. For on-/off-stimulation tremor score comparisons, 8 studies met inclusion criteria for short-term follow-up. Network meta-analysis of pre-/postimplantation tremor scores showed greater tremor reduction with PSA implantation short-term (absolute tremor reduction: PSA: -30.94 [95% confidence interval (CI): -34.93, -26.95]; Vim: -26.26 [95% CI: -33.39, -19.12]; relative tremor reduction: PSA: 63.3% [95% CI: 61.8%-64.8%]; Vim: 57.8% [95% CI: 56.5%-59.0%]). However, there was no difference in efficacy between PSA and Vim DBS when comparing tremor on-versus off-stimulation at short-term follow-up or pre- versus postimplantation tremor reduction long-term. Conclusion: Our systematic review highlighted both heterogeneity in scoring systems used and lack of transparency in reporting total scores, limiting direct comparison across studies. We found a modestly superior efficacy with PSA stimulation in the short term, but no difference in tremor reduction long-term.
MeSH term(s)	Deep Brain Stimulation ; Essential Tremor/therapy ; Humans ; Network Meta-Analysis ; Thalamus/surgery ; Treatment Outcome ; Tremor/therapy ; Ventral Thalamic Nuclei/physiology
Language	English
Publishing date	2022-03-29
Publishing country	Switzerland
Document type	Meta-Analysis ; Systematic Review ; Research Support, N.I.H., Extramural
ZDB-ID	645069-6
ISSN	1423-0372 ; 1011-6125
ISSN (online)	1423-0372
ISSN	1011-6125
DOI	10.1159/000522573
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Article: Brain Network Oscillations During Gait in Parkinson's Disease.

Wang, Doris D / Choi, Julia T

Frontiers in human neuroscience

2020 Volume 14, Page(s) 568703

Abstract: Human bipedal walking is a complex motor task that requires supraspinal control for balance and flexible coordination of timing and scaling of many muscles in different environment. Gait impairments are a hallmark of Parkinson's disease (PD), reflecting ... ...

Abstract	Human bipedal walking is a complex motor task that requires supraspinal control for balance and flexible coordination of timing and scaling of many muscles in different environment. Gait impairments are a hallmark of Parkinson's disease (PD), reflecting dysfunction of cortico-basal ganglia-brainstem circuits. Recent studies using implanted electrodes and surface electroencephalography have demonstrated gait-related brain oscillations in the basal ganglia and cerebral cortex. Here, we review the physiological and pathophysiological roles of (1) basal ganglia oscillations, (2) cortical oscillations, and (3) basal ganglia-cortical interactions during walking. These studies extend a novel framework for movement of disorders where specific patterns of abnormal oscillatory synchronization in the basal ganglia thalamocortical network are associated with specific signs and symptoms. Therefore, we propose that many gait dysfunctions in PD arise from derangements in brain network, and discuss potential therapies aimed at restoring gait impairments through modulation of brain network in PD.
Language	English
Publishing date	2020-10-23
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2425477-0
ISSN	1662-5161
ISSN	1662-5161
DOI	10.3389/fnhum.2020.568703
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Article ; Online: Relevance of antinuclear antibody in diagnosis and characteristics of multiple sclerosis.

Koshorek, Jacqueline / Hu, Chen / Wang, Yujie / Grkovski, Risto / Lin, Doris / Fitzgerald, Kathryn / Newsome, Scott D / Mowry, Ellen M

Multiple sclerosis and related disorders

2024 Volume 87, Page(s) 105639

Abstract: Background: Criteria for multiple sclerosis (MS) diagnosis rely upon clinical and paraclinical data that are supportive of MS in the absence of a better explanation. Patients referred for consideration of a MS diagnosis often undergo an extensive ... ...

Abstract	Background: Criteria for multiple sclerosis (MS) diagnosis rely upon clinical and paraclinical data that are supportive of MS in the absence of a better explanation. Patients referred for consideration of a MS diagnosis often undergo an extensive serologic workup including antinuclear antibody (ANA) testing, even when an individual already meets diagnostic criteria for MS. It is unclear whether ANA serostatus is associated with clinical outcomes in MS. The present study aims to determine if ANA seropositivity in those referred with concern for MS differs in those who meet 2017 revised McDonald criteria compared to those who did not receive a diagnosis of MS. Associations between ANA seropositivity and clinical or radiological phenotype of MS patients are also explored. Methods: The cohort included people at least 18 years old, referred to our tertiary care MS center with concern for MS (regardless of prior diagnosis) who had an ANA test with known titer completed within one year of first evaluation. Electronic health record (EHR) charts were manually reviewed, and MRIs underwent blinded review by a radiologist with training in neuroradiology. Diagnosis of MS was determined by a neuroimmunologist and was based on 2017 revised McDonald Criteria. Results are reported as odds ratios from multivariable logistic regression analyses adjusted for age, sex at birth, race, smoking history, personal history of comorbid autoimmune conditions, and family history of autoimmunity. Within the MS cohort, similar analytical models were performed to assess association between ANA and clinical and radiological characteristics. Results: A final cohort of 258 patients was analyzed (out of 542 referrals): 106 nonMS and 152 with MS. There was no association between MS (vs. nonMS) diagnosis and ANA status (ANA positive n = 74) in the multivariable models (OR 1.5, 95 % CI 0.82, 2.72, p = 0.20). Among those with MS, there was no association of ANA seropositivity with the odds of atypical brain MRI features, number of cardinal MRI areas involved, location of MRI lesions, or of having an atypical presentation of first demyelinating event. Black race (OR 2.8, 95 % CI 1.27, 6.26, p = 0.01) and family history of autoimmunity (OR 2.1, 95 % CI 1.09, 3.98, p = 0.03) were independently associated with increased odds of ANA positivity. Within the MS cohort analysis, progressive MS (PMS; vs relapsing-remitting MS), a covariate in the model, appeared to be at higher odds of being ANA positive (OR 3.6, 95 % CI 1.03, 13.05, p = 0.046) but only when assessing mean area of cardinal MS locations. Conclusions: While ANA testing does not appear to be useful in distinguishing MS from non-MS, it remains less clear as to whether it may be associated with differences in the clinical course of MS (relapsing-remitting vs progressive). Future studies should aim to systematically evaluate whether those who are ANA positive are more likely, in well-designed and representative prospective cohorts, to be diagnosed with or develop progressive MS. Whether a positive ANA early in MS is associated with increased risk over time of developing or diagnosing another systemic autoimmune disease would also be of interest.
Language	English
Publishing date	2024-05-04
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	2645330-7
ISSN	2211-0356 ; 2211-0348
ISSN (online)	2211-0356
ISSN	2211-0348
DOI	10.1016/j.msard.2024.105639
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Article ; Online: Temporal Changes in Coronary

Daghem, Marwa / Adamson, Philip D / Wang, Kang-Ling / Doris, Mhairi / Bing, Rong / van Beek, Edwin J R / Forsyth, Laura / Williams, Michelle C / Tzolos, Evangelos / Dey, Damini / Slomka, Piotr J / Dweck, Marc R / Newby, David E / Moss, Alastair J

Journal of nuclear medicine : official publication, Society of Nuclear Medicine

2023 Volume 64, Issue 9, Page(s) 1478–1486

Abstract: ... ...

Abstract	Coronary
MeSH term(s)	Humans ; Male ; Aged ; Female ; Coronary Artery Disease/diagnostic imaging ; Fluorides ; Calcium ; Heart ; Myocardial Ischemia ; Myocardial Infarction/diagnostic imaging ; Calcinosis
Chemical Substances	Fluorides (Q80VPU408O) ; Calcium (SY7Q814VUP)
Language	English
Publishing date	2023-08-17
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	80272-4
ISSN	1535-5667 ; 0097-9058 ; 0161-5505 ; 0022-3123
ISSN (online)	1535-5667
ISSN	0097-9058 ; 0161-5505 ; 0022-3123
DOI	10.2967/jnumed.122.264331
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Article ; Online: Improved psychotic symptoms following resection of amygdalar low-grade glioma: illustrative case.

Andrews, John P / Wozny, Thomas A / Yue, John K / Wang, Doris D

Journal of neurosurgery. Case lessons

2022 Volume 4, Issue 22

Abstract: Background: Epilepsy-associated psychoses are poorly understood, and management is focused on treating epilepsy. Chronic, interictal psychosis that persists despite seizure control is typically treated with antipsychotics. Whether resection of a mesial ... ...

Abstract	Background: Epilepsy-associated psychoses are poorly understood, and management is focused on treating epilepsy. Chronic, interictal psychosis that persists despite seizure control is typically treated with antipsychotics. Whether resection of a mesial temporal lobe lesion may improve interictal psychotic symptoms that persist despite seizure control remains unknown. Observations: In a 52-year-old man with well-controlled epilepsy and persistent comorbid psychosis, brain magnetic resonance imaging (MRI) revealed an infiltrative, intraaxial, T2 fluid-attenuated inversion recovery intense mass of the left amygdala. The patient received an amygdalectomy for oncological diagnosis and surgical treatment of a presumed low-grade glioma. Pathology was ganglioglioma, World Health Organization grade I. Postoperatively, the patient reported immediate resolution of auditory hallucinations. Patient has remained seizure-free on 2 antiepileptic drugs and no antipsychotic pharmacotherapy and reported lasting improvement in his psychotic symptoms. Lessons: This report discusses improvement of psychosis symptoms after resection of an amygdalar glioma, independent of seizure outcome. This case supports a role of the amygdala in psychopathology and suggests that low-grade gliomas of the limbic system may represent, at minimum, partially reversible etiology of psychotic symptoms.
Language	English
Publishing date	2022-11-28
Publishing country	United States
Document type	Journal Article
ISSN	2694-1902
ISSN (online)	2694-1902
DOI	10.3171/CASE22362
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