2021 International Parkinson's Disease and Movement Disorders (MDS) Conference​

The 2021 International Parkinson's Disease and Dyskinesia (MDS) Conference kicked off at 22:00 on September 17, Beijing time.
Affected by the global epidemic, the conference was held online
.

The conference still lived up to expectations.
It lasted for 7 days and included 64 thematic conferences.
221 colleagues from 38 countries participated in the academic feast
.

Individual venues were set up in cooperation with the European and American Neurological Societies, and more than 1,300 posters were displayed, including 36 excellent abstract speeches, for attendees to read
.

Different from last year’s meeting, this year’s MDS meeting has new attempts: "Expert Round Table Discussion", "Excellent Summary Speech in the Sub-venue", "Post-theme Discussion", "Video Challenge Live" and "Youth Representative Club", etc.
For you to choose and participate
.

Next, the Lundbeck Medical team will take you to the feast on the first day of the conference: the chairman's speech and the subject information of the Parkinson's disease (PD) keynote speech
.

01 Early PD campaign [Keywords]: early identification; disease modification; personalized treatment
.

Professor Jee-Young Lee from South Korea delivered a speech entitled "Parkinson's Disease: Early Motor Symptoms": Early identification and initiation of disease modification treatment is an ideal early treatment strategy for PD
.
Early identification of mild PD signs can be closer to early identification of PD .

Studies have shown that minor motor signs in the elderly are related to the density of substantia nigra neurons [1], and non-PD elderly people will also have minor signs of Parkinson's syndrome and about 16.
5% of substantia nigra neurons are lost [2]
.

Before the diagnosis of PD, there will be changes in language and voice, changes in writing, dry eyes, reduced facial expressions, and reduced arm swings caused by decreased blink frequency [3].
Among LRRK2 and GBA carriers who have not lost the dopamine transporter DAT, they can Early mild motor and non-motor symptoms were observed [4]
.

The goal of disease modification treatment is getting closer, but there is still a long way to go
.

By restoring dying cells, prolonging the survival of neurons, and blocking the spread of pathology, the effect of modifying the course of PD can be achieved
.

More and more clinical trials have carried out related explorations.
The potential targets of action are currently being investigated including: reducing a-synuclein aggregation [5], restoring the lysosomal function of mitochondria and autophagosomes, and cholesterol balance ( Statins, results in dispute), L-type calcium channel antagonists (Iradipine, negative results), glucagon-like peptide (GLP-1) receptor agonists and other anti-diabetic agents (exenatide, III study period), the iron chelator (nerve melanin), of LRRK2 kinase inhibitors (LRRK2 & GCase), c- Abl tyrosine kinase inhibitor (nilotinib, II of negative results) and the like
.

In addition, a good diet and moderate to high-intensity physical activity are beneficial to PD patients
.

Exercise can reduce the risk of PD, improve muscle strength, and reduce the symptoms of Parkinson's disease [6]; the Mediterranean diet can delay the onset of PD, especially in female groups [7]
.

However, the goal of disease modification has not yet been reached.
The reasons and solutions can be obtained from the C.
David Marsden Award winner-Professor Etienne Hirsch of France, in his speech on "Improvement of Neuroprotection Research".
The professor shared the team’s A study published earlier this year "7 Solutions for Neuroprotective Research"
.

In the past, from in vitro cell experiments and animal experiments, drugs with neuroprotective effects have been confirmed
.

None have been confirmed in clinical trials, from the earliest DATATOP to the latest STEADY-PD III trial
.

Seven reasons for the failure of the test were analyzed and summarized, and seven solutions were recommended accordingly [8]
.

They are: optimizing the control of motor symptoms, choosing a personalized treatment plan, and choosing a reasonable treatment plan based on the patient's disease severity, age, combined medication, and gene phenotype
.

The goal of early treatment is to restore the ability of daily living, improve the quality of life, delay the occurrence of sports complications, and reduce the impact of non-motor symptoms
.

Therefore, for dopamine receptor agonist drugs that are prone to side effects such as impulse control disorder (ICD) and hallucinations, you should pay attention.
If the symptoms are mild, you can use type B monooxygenase (MAO-B) inhibitors, once a day, and may It has potential disease modification effects
.

For patients with early-onset PD, more attention is paid to the occurrence of dyskinesias and side effects, but there are few studies specifically on patients with early-onset PD.
The results of the ADAGIO study including early PD patients show that [9], rasagiline add therapy to poorly controlled motor symptoms Patients benefit
.

For elderly patients, it is necessary to consider issues such as comorbidities and combined medications, falling risks, cognitive impairment, and depression [10]
.

Individualized treatment plans should also be adjusted for patients with different genotypes
.

02 [Keywords]: 5-2-1 principles; multidisciplinary team; equipment-assisted therapy
.

Professor Tove Henriksen from Denmark gave a speech titled "Parkinson's Disease: Late Motor Symptoms", discussing the management strategies available for advanced and complex PD
.

[5-2-1 Principles] Help define advanced PD.
Advanced PD is difficult to define in clinical practice.
Due to the continuous progression of the disease, the manifestations are diverse and there is a lack of reliable biomarkers or tests
.

Doctor's clinical perspective: According to the patient's personal situation, optimized oral treatment has been given, but motor symptoms and non-motor symptoms are still not well controlled
.

Patient perspective: Need to consider device-assisted treatment, such as: troublesome shut-off periods for several hours, unpredictable fluctuations, and high-dose drug burden
.

In short, if there is a persistent movement fluctuation problem, and the patient can benefit from device assistance, it can be considered advanced PD
.

You can refer to the 5-2-1 principle [11], that is, taking levodopa for more than 5 times a day, each time the off period occurs for more than 2 hours, and the disturbing abnormality occurs for more than 1 hour per day, which can help clinical definition Progressive PD
.

Multi-disciplinary team, equipment-assisted treatment is the focus of advanced PD management.
Maintain a good cooperative relationship with patients and nursing staff for joint decision-making, and closely follow up on effects, side effects, comorbidities and combined medications, and increase the burden of non-exercise.
Learn how to use a pump/charger stimulator, have a PD nurse, and be managed by a multidisciplinary team
.

You can refer to the review "Diagnosis and Treatment of Parkinson's Disease" published in JAMA in 2020 and the evidence-based recommendations for motor symptoms published in MDS in 2018 [12,13]
.

Device-assisted therapy, such as levodopa-carbidopa enteric-coated gel (LCIG) infusion, subthalamic nucleus deep brain stimulation (STN-DBS), continuous subcutaneous apomorphine infusion (CSAI) [11]
.

03 Non-motor symptoms [keywords]: throughout the course of the disease; non-motor symptoms fluctuations Professor Maria Cersosimo from Argentina, delivered a speech entitled "Parkinson's disease non-motor symptoms: clinical manifestations and management"
.

Describes the non-motor syndrome (NMS) spectrum of Parkinson's disease, reviews the clinical characteristics of various types of NMS, and summarizes current management strategies
.

NMS runs through the entire course of PD (from pre-exercise to late), and is a significant and disabling symptom hypoosmia, rapid eye movement sleep behavior disorder (RBD), constipation, depression, anxiety, pain, orthostatic hypotension ( OH), daytime sleepiness (EDS), and hypersexuality appear in the early stages of PD; dementia, mental symptoms, dysphagia, and weight loss appear more in the middle and late stages of PD [14]
.

NMS is easy to superimpose and becomes a decisive factor affecting the quality of life.
However, NMS management is still insufficiently evidence-based.
You can refer to the evidence-based recommendations for non-motor symptoms published by MDS [15]
.

For fatigue, consider rasagiline (effective); for salivation, consider injection of botulinum toxin A or B (effective); for constipation, consider probiotics and prebiotic fibers (effective); nocturia may consider sorinacine (may be effective); Droxidopa (effective) can be considered for OH; the incidence of insomnia is as high as 80%, and sleep fragmentation caused by motor symptoms or non-motor symptoms needs to be evaluated, eszopiclone or melatonin (may be effective) can be considered; depression Consider venlafaxine (effective) and some SSRIs
.

In addition, NMS can be aggravated by drugs, such as impulse control disorder (ICD), stereotyped behavior, and dopamine imbalance syndrome [16]
.

Therefore, it is very necessary to review the patient's medication situation
.

The awareness of non-motor symptom fluctuation (NMF) is very important.
It can be recognized at the same time as motor symptom fluctuation (MF).
; But some symptoms will be aggravated by dopaminergic treatment, such as hallucinations, dementia, EDS, constipation, OH
.

04Opening the "Pandora" box of Parkinson's syndrome Professor Oscar Gershanik from Argentina won the Stanley Fahn Award and gave a speech entitled "Opening the Pandora's Box of Parkinson's Syndrome"
.

The professor started by looking back at the people who had had a major impact on his career in the 50 years of medicine, and extended to the progress of Parkinson's syndrome in the past 50 years
.

Explains how the complex causes and manifestations of Parkinson's syndrome can be revealed a little bit of mystery
.

The patient is diagnosed with Parkinson's syndrome, which means that complex symptoms appear one after another, just like opening a Pandora's box of "the source of trouble"
.

From 1817 to 2021, with field research, Parkinson's disease slowly evolved into a pathological manifestation of Parkinson's syndrome
.

Like the Parkinson’s syndrome in the labyrinth, individual patients show atypical symptoms, and some show typical atypical symptoms.
The correct diagnosis is a big challenge
.

The detailed disease classification will help the clinical diagnosis correctly.
The article published earlier on the classification of atypical Parkinson's syndrome provides good evidence support for the clinical classification [18]
.

Then the professor enumerated the different types of Parkinson’s syndrome, including: typical Parkinson’s syndrome (primary Parkinson’s disease); "atypical classic" Parkinson’s syndrome (solitary tremor, postural balance, and gait disorders) PIGD, Lewy body dementia DLB); typical atypical Parkinson's syndrome (multiple system atrophy MSA, progressive supranuclear palsy PSP, cortical basal ganglia degeneration CBD); "atypical" typical atypical Parkinson's syndrome (MSA variant, PSP variant, CBD variant); atypical atypical Parkinson's syndrome
.

The diagnosis and identification of Parkinson’s syndrome requires detailed patient history and a comprehensive neurological examination, such as the patient’s age and onset pattern, family history, clinical stage, clinical features, imaging findings, and whether to levodopa Respond
.

The above is the information sharing on the first day of the conference
.
The Lingbei medical team will continue to bring you the essence of MDS reports (CNSM-0346) .

References 1.
Ross, GW, et al.
, Parkinsonian signs and substantia nigra neuron density in decendents elders without PD.
Ann Neurol, 2004.
56(4): p.
532-9.
2.
Buchman, AS, et al.
, Nigral pathology and parkinsonian signs in elders without Parkinson disease.
Ann Neurol, 2012.
71(2): p.
258-66.
3.
Fereshtehnejad, SM, et al.
, Evolution of prodromal Parkinson's disease and dementia with Lewy bodies: a prospective study.
Brain , 2019.
142(7): p.
2051-2067.
4.
Simuni, T.
, et al.
, Clinical and dopamine transporter imaging characteristics of non-manifest LRRK2 and GBA mutation carriers in the Parkinson's Progression Markers Initiative (PPMI): a cross -sectional study.
Lancet Neurol, 2020.
19(1): p.
71-80.
5.
Garcia-Sanz, P.
, MFGA J, and R.
Moratalla, The Role of Cholesterol in alpha-Synuclein and Lewy Body Pathology in GBA1 Parkinson's Disease.
Mov Disord, 2021.
36(5): p.
1070-1085.
6.
Schenkman, M.
, et al.
, Effect of High-Intensity Treadmill Exercise on Motor Symptoms in Patients With De Novo Parkinson Disease: A Phase 2 Randomized Clinical Trial.
JAMA Neurol, 2018.
75(2): p.
219-226.
7.
Yin, W.
, et al.
, Mediterranean Dietary Pattern at Middle Age and Risk of Parkinson's Disease: A Swedish Cohort Study.
Mov Disord, 2021.
36(1 ): p.
255-260.
8.
Devos, D.
, E.
Hirsch, and R.
Wyse, Seven Solutions for Neuroprotection in Parkinson's Disease.
Mov Disord, 2021.
36(2): p.
306-316.
9.
Olanow, CW, et al.
, A double-blind, delayed-start trial of rasagiline in Parkinson's disease.
N Engl J Med, 2009.
361(13): p.
1268-78.
10.
Greten, S.
, et al.
, Drug safety profiles in geriatric patients with Parkinson's disease using the FORTA (Fit fOR The Aged) classification:results from a mono-centric retrospective analysis.
J Neural Transm (Vienna), 2021.
128(1): p.
49-60.
11.
Antonini, A.
, et al.
, Developing consensus among movement disorder specialists on clinical indicators for identification and management of advanced Parkinson's disease: a multi-country Delphi-panel approach.
Curr Med Res Opin, 2018.
34(12): p.
2063-2073.
12.
Armstrong, MJ and MS Okun, Diagnosis and Treatment of Parkinson Disease: A Review.
JAMA, 2020.
323(6): p.
548-560.
13.
Fox, SH, et al.
, International Parkinson and movement disorder society evidence-based medicine review: Update on treatments for the motor symptoms of Parkinson's disease.
Mov Disord, 2018 .
33(8): p.
1248-1266.
14.
Schapira, AHV, KR Chaudhuri, and P.
Jenner, Non-motor features of Parkinson disease.
Nat Rev Neurosci, 2017.
18(7): p.
435-450.
15.
Seppi , K.
, et al.
,Update on treatments for nonmotor symptoms of Parkinson's disease-an evidence-based medicine review.
Mov Disord, 2019.
34(2): p.
180-198.
16.
Lim, SY and AE Lang, The nonmotor symptoms of Parkinson's disease--an overview Mov Disord, 2010.
25 Suppl 1: p.
S123-30.
17.
Kleiner, G.
, et al.
, Non-Motor Fluctuations in Parkinson's Disease: Validation of the Non-Motor Fluctuation Assessment Questionnaire.
Mov Disord, 2021.
36( 6): p.
1392-1400.
18.
Stamelou, M.
and GU Hoeglinger, Atypical parkinsonism: an update.
Curr Opin Neurol, 2013.
26(4): p.
401-5.
Kleiner, G.
, et al.
, Non-Motor Fluctuations in Parkinson's Disease: Validation of the Non-Motor Fluctuation Assessment Questionnaire.
Mov Disord, 2021.
36(6): p.
1392-1400.
18.
Stamelou, M.
and GU Hoeglinger , Atypical parkinsonism: an update.
Curr Opin Neurol, 2013.
26(4): p.
401-5.
Kleiner, G.
, et al.
, Non-Motor Fluctuations in Parkinson's Disease: Validation of the Non-Motor Fluctuation Assessment Questionnaire.
Mov Disord, 2021.
36(6): p.
1392-1400.
18.
Stamelou, M.
and GU Hoeglinger , Atypical parkinsonism: an update.
Curr Opin Neurol, 2013.
26(4): p.
401-5.