- Email: [email protected]
Positional nystagmus from BPPV in polysomnography of PD patients
e48
Abstracts / Parkinsonism and Related Disorders 22 (2016) e29ee75
Chaudhuri 1. 1 NPF Parkinsons Centre of Excellence, King's College London and The Maurice Wohl Clinical Neuroscience Institute, King's College London, London, United Kingdom; 2 Department of Neurology, Lithuanian University of Health Sciences, Academy of Medicine, Kaunas, Lithuania, Kaunas, Lithuania; 3 Department of Neurology, Faculty of Medicine, Transilvania University, County Emergency Clinic Hospital, Brasov, Romania, Brasov, Romania; 4 Speech and Language therapy Department, Kings College Hospital, London, London, United Kingdom; 5 3rd Dept. of Neurology, University of Thessaloniki, Greece, Thessaloniki, Greece Objectives: Dysphagia in Parkinson's disease (PD) is a risk factor of aspiration pneumonia (AP). Literature indicates that AP can lead to hospital admission and mortality. We investigated whether there is a high rate of AP and hospitalisation in PD using the the Non-Motor Symptoms Questionnaire (NMSQuest) as a screening tool. Methods: Consecutive patients from 5 European centres completed the NMSQuest and those marking “yes” to Q3 (“Difficulty swallowing food or drink or problems with choking?”) were interviewed about any pneumonia-related event 5 years prior to NMSQuest completion. Additionally, dysphagia was evaluated by speech and language specialists and by a water swallow test when appropriate. Results: In this ongoing study, 98 patients have been evaluated and 34 (34,7%) reported dysphagia on NMSQ Q3 [mean (±SD) age 68.6 ±11,86 y, mean duration of disease 10,06 ±6,88 y, median H&Y stage 3 (range 2-5), NMSQ median burden score 4 (range 1-4)]. 17,65% of dysphagic PD had at least one incident of AP during the last 5 years, 50% requiring hospital admission. Among the patients who did not report swallowing difficulties, 9,4% had history of pneumonia. Conclusions: The preliminary results of this study suggest that PD patients reporting swallowing difficulties are at a higher risk of developing aspiration pneumonia compared to those who do not. Dysphagia could be flagged up by PD patients using the NMSQuest and this study emphasises the importance of using NMSQuest as a routine screening tool in clinics. P 1.075. SPEECH DISORDERS AND PARKINSON'S DISEASE 2. 1 University of Massimo Pettorino 1, Elisa Pellegrino 1, Maria Grazia Busa Naples L'Orientale, Naples, Italy; 2 University of Padua, Padua, Italy Objectives: Recent studies have shown that two acoustic parameters - percentage of vocalic portions of the utterance (%V) and interval between two consecutive Vowel Onset Points (VtoV) considerably increase with aging. Spectro-acoustic analysis of Woitiła's public speeches before and after he was affected by Parkinson's Disease (PD) have demonstrated that these two parameters link with the insurgence and progression of PD. The objective of this study is thus to confirm whether neurogenetic disorders connected with PD determine abnormal variation in %V and VtoV in Italian PD patients. Methods: Through the software Praat, we segmented in consonantal and vocalic portions the read speech of 11 patients with mild PD and 11 healthy speakers. The durations of all segments were automatically extracted and %V and mean VtoV were calculated. Results: %V shows significantly different values in PD patients, as compared to controls, already in the initial stages of PD. For Italian, %V spans between 44% and 50% for healthy subjects and between 51% and 58% for PD subjects. With regard to VtoV, PD subjects do not speak at a significantly slower rate than the healthy subjects, though a trend in this direction was found. This may be due to the fact that all patients had a mild form of PD. Conclusions: A possible application of these results is a speech test, based on the automatic detection of the variations of %V and VtoV, which could be used for easily detecting and monitoring the disease development.
Objective: Patients with PD have an increased risk of falls due to postural instability, orthostatic dysregulation, or BPPV. BPPV is common in PD, and BPPV often occurs during changes of head position in bed. We recently demonstrated that positional nystagmus can be discerned from other electrooculography (EOG) patterns. Since polysomnography is a commonly performed diagnostic test in PD, we aimed at elucidating the frequency of so-far undetected BPPV by analysis of EOG recordings. Methods: Retrospective analysis of whole-night polysomnography recordings of 30 PD patients. EOG recordings were manually inspected and screened for nystagmus-like patterns. Patient characterization included disease duration, UPDRS III, and disease type. In addition, the impact of polysomnography variables on BPPV frequency was assessed. Results: Twelve patients (40%) exhibited one or more nystagmus-like EOG episodes. Patients with and without nystagmus-like EOG episodes did not differ with respect to age (64±11y vs. 61±8y, p¼0.32), UPDRS III (25±9 vs. 23±12, p¼0.27), or disease duration (9±7y vs. 7±6y, p¼0.42). Sleep efficiency was similar between PD patients with and without nystagmus-like EOG episodes (77±14% vs. 80±15%, p¼0.53). Conclusions: Our preliminary findings indicate that BPPV may be more common in PD than appreciated so far, although the impact of nocturnal BPPV attacks on sleep quality remains unclear. The search for BPPV in polysomnography may be particularly meaningful in PD, as it has become a routine diagnostic tool in many specialized movement disorder units. P 1.077. AN ALTERNATIVE PERSPECTIVE ON INTERPRETATION SECONDARY MOTOR SYMPTOMS OF PARKINSON'S DISEASE
OF
THE
Ludmila Vucolova. Hackensack, United States Objectives: Secondary motor symptoms of Parkinson disease, including slurred speech, swallowing dysfunction, masked face, reduced eye movement and micrographia, which observed in distal motor repertories (hands, fingers, jaw, mouth and feet), manifest an alteration of patterns of mechanical structure-function relationships of the system with the disrupted tensegrity equilibrium. Secondary motor symptoms indicate rigidity of minor parts of the body, decreased speed and amplitude. We propose that both cardinal and secondary motor symptoms, that find its manifestation in the different parts of the body and different levels of hierarchical organization, can be unified under the umbrella of rigidity. Tremor, which observed in distal motor repertories (hands, fingers, jaw, mouth and feet) indicate a disruption of tensegrity equilibrium, that may began in the lower level of hierarchy (autonomic organs) with a continuing progression to the higher levels of hierarchy. Methods: Various methods and techniques, originated in diverse disciplines (telemechanics, mathematics, biology, neuroscience and healthrelated fields), are applied to restore tensegrity equilibrium. To impose changes throughout the entire fascia envelope, the structural members of major and peripheral parts of the body were targeted simultaneously. Results: A significant improvement of a broad spectrum of motor symptoms of 80% observed: decrease of rigidity in the minor parts of the body; improved speech, swallowing function, unmasked face, and micrographia. Conclusions: Preliminary findings support an alternative interpretation of the secondary motor symptoms. Thus, indicating an upgraded pattern of mechanical structure-function relationship.
P 1.076. POSITIONAL NYSTAGMUS FROM BPPV IN POLYSOMNOGRAPHY OF PD PATIENTS Yulia Valko 1, Esther Werth 1, Christian Baumann 1, Dominik Straumann 1, Philipp Valko 1, Konrad Weber 2. 1 Department of Neurology, University Hospital Zurich, University of Zurich, Zurich, Switzerland; 2 Departments of Ophthalmology and Neurology, University Hospital Zurich, University of Zurich, Zurich, Switzerland Ă
Abstracts / Parkinsonism and Related Disorders 22 (2016) e29ee75
Chaudhuri 1. 1 NPF Parkinsons Centre of Excellence, King's College London and The Maurice Wohl Clinical Neuroscience Institute, King's College London, London, United Kingdom; 2 Department of Neurology, Lithuanian University of Health Sciences, Academy of Medicine, Kaunas, Lithuania, Kaunas, Lithuania; 3 Department of Neurology, Faculty of Medicine, Transilvania University, County Emergency Clinic Hospital, Brasov, Romania, Brasov, Romania; 4 Speech and Language therapy Department, Kings College Hospital, London, London, United Kingdom; 5 3rd Dept. of Neurology, University of Thessaloniki, Greece, Thessaloniki, Greece Objectives: Dysphagia in Parkinson's disease (PD) is a risk factor of aspiration pneumonia (AP). Literature indicates that AP can lead to hospital admission and mortality. We investigated whether there is a high rate of AP and hospitalisation in PD using the the Non-Motor Symptoms Questionnaire (NMSQuest) as a screening tool. Methods: Consecutive patients from 5 European centres completed the NMSQuest and those marking “yes” to Q3 (“Difficulty swallowing food or drink or problems with choking?”) were interviewed about any pneumonia-related event 5 years prior to NMSQuest completion. Additionally, dysphagia was evaluated by speech and language specialists and by a water swallow test when appropriate. Results: In this ongoing study, 98 patients have been evaluated and 34 (34,7%) reported dysphagia on NMSQ Q3 [mean (±SD) age 68.6 ±11,86 y, mean duration of disease 10,06 ±6,88 y, median H&Y stage 3 (range 2-5), NMSQ median burden score 4 (range 1-4)]. 17,65% of dysphagic PD had at least one incident of AP during the last 5 years, 50% requiring hospital admission. Among the patients who did not report swallowing difficulties, 9,4% had history of pneumonia. Conclusions: The preliminary results of this study suggest that PD patients reporting swallowing difficulties are at a higher risk of developing aspiration pneumonia compared to those who do not. Dysphagia could be flagged up by PD patients using the NMSQuest and this study emphasises the importance of using NMSQuest as a routine screening tool in clinics. P 1.075. SPEECH DISORDERS AND PARKINSON'S DISEASE 2. 1 University of Massimo Pettorino 1, Elisa Pellegrino 1, Maria Grazia Busa Naples L'Orientale, Naples, Italy; 2 University of Padua, Padua, Italy Objectives: Recent studies have shown that two acoustic parameters - percentage of vocalic portions of the utterance (%V) and interval between two consecutive Vowel Onset Points (VtoV) considerably increase with aging. Spectro-acoustic analysis of Woitiła's public speeches before and after he was affected by Parkinson's Disease (PD) have demonstrated that these two parameters link with the insurgence and progression of PD. The objective of this study is thus to confirm whether neurogenetic disorders connected with PD determine abnormal variation in %V and VtoV in Italian PD patients. Methods: Through the software Praat, we segmented in consonantal and vocalic portions the read speech of 11 patients with mild PD and 11 healthy speakers. The durations of all segments were automatically extracted and %V and mean VtoV were calculated. Results: %V shows significantly different values in PD patients, as compared to controls, already in the initial stages of PD. For Italian, %V spans between 44% and 50% for healthy subjects and between 51% and 58% for PD subjects. With regard to VtoV, PD subjects do not speak at a significantly slower rate than the healthy subjects, though a trend in this direction was found. This may be due to the fact that all patients had a mild form of PD. Conclusions: A possible application of these results is a speech test, based on the automatic detection of the variations of %V and VtoV, which could be used for easily detecting and monitoring the disease development.
Objective: Patients with PD have an increased risk of falls due to postural instability, orthostatic dysregulation, or BPPV. BPPV is common in PD, and BPPV often occurs during changes of head position in bed. We recently demonstrated that positional nystagmus can be discerned from other electrooculography (EOG) patterns. Since polysomnography is a commonly performed diagnostic test in PD, we aimed at elucidating the frequency of so-far undetected BPPV by analysis of EOG recordings. Methods: Retrospective analysis of whole-night polysomnography recordings of 30 PD patients. EOG recordings were manually inspected and screened for nystagmus-like patterns. Patient characterization included disease duration, UPDRS III, and disease type. In addition, the impact of polysomnography variables on BPPV frequency was assessed. Results: Twelve patients (40%) exhibited one or more nystagmus-like EOG episodes. Patients with and without nystagmus-like EOG episodes did not differ with respect to age (64±11y vs. 61±8y, p¼0.32), UPDRS III (25±9 vs. 23±12, p¼0.27), or disease duration (9±7y vs. 7±6y, p¼0.42). Sleep efficiency was similar between PD patients with and without nystagmus-like EOG episodes (77±14% vs. 80±15%, p¼0.53). Conclusions: Our preliminary findings indicate that BPPV may be more common in PD than appreciated so far, although the impact of nocturnal BPPV attacks on sleep quality remains unclear. The search for BPPV in polysomnography may be particularly meaningful in PD, as it has become a routine diagnostic tool in many specialized movement disorder units. P 1.077. AN ALTERNATIVE PERSPECTIVE ON INTERPRETATION SECONDARY MOTOR SYMPTOMS OF PARKINSON'S DISEASE
OF
THE
Ludmila Vucolova. Hackensack, United States Objectives: Secondary motor symptoms of Parkinson disease, including slurred speech, swallowing dysfunction, masked face, reduced eye movement and micrographia, which observed in distal motor repertories (hands, fingers, jaw, mouth and feet), manifest an alteration of patterns of mechanical structure-function relationships of the system with the disrupted tensegrity equilibrium. Secondary motor symptoms indicate rigidity of minor parts of the body, decreased speed and amplitude. We propose that both cardinal and secondary motor symptoms, that find its manifestation in the different parts of the body and different levels of hierarchical organization, can be unified under the umbrella of rigidity. Tremor, which observed in distal motor repertories (hands, fingers, jaw, mouth and feet) indicate a disruption of tensegrity equilibrium, that may began in the lower level of hierarchy (autonomic organs) with a continuing progression to the higher levels of hierarchy. Methods: Various methods and techniques, originated in diverse disciplines (telemechanics, mathematics, biology, neuroscience and healthrelated fields), are applied to restore tensegrity equilibrium. To impose changes throughout the entire fascia envelope, the structural members of major and peripheral parts of the body were targeted simultaneously. Results: A significant improvement of a broad spectrum of motor symptoms of 80% observed: decrease of rigidity in the minor parts of the body; improved speech, swallowing function, unmasked face, and micrographia. Conclusions: Preliminary findings support an alternative interpretation of the secondary motor symptoms. Thus, indicating an upgraded pattern of mechanical structure-function relationship.
P 1.076. POSITIONAL NYSTAGMUS FROM BPPV IN POLYSOMNOGRAPHY OF PD PATIENTS Yulia Valko 1, Esther Werth 1, Christian Baumann 1, Dominik Straumann 1, Philipp Valko 1, Konrad Weber 2. 1 Department of Neurology, University Hospital Zurich, University of Zurich, Zurich, Switzerland; 2 Departments of Ophthalmology and Neurology, University Hospital Zurich, University of Zurich, Zurich, Switzerland Ă