Journal of Movement Disorders

The effect of Biofeedback therapy on Anxiety and Depression in Parkinson's disease: a Pilot Study: Justus Chun-Yu Chen, Tzu-Yun Tseng, Jong-Ling Fuh, Yu-Hsiang Cheng, Dai-Wei Lin, Han-Lin Chiang; Received April 14, 2025 Accepted July 12, 2025 Published online July 14, 2025; DOI: https://doi.org/10.14802/jmd.25097 [Accepted]

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Abstract PDF: Objective
This pilot study aimed to evaluate the feasibility and potential effects of biofeedback therapy (BT) on anxiety and depression in patients with Parkinson’s disease (PD).
Methods
A randomized waitlist-controlled trial was conducted involving 19 patients with PD and comorbid anxiety and/or depression. Anxiety and depression were assessed at baseline, post-treatment, and one-month follow-up.
Results
All 19 patients completed the study. Compared with the control group, significant improvements were observed immediately after BT in the Hamilton Depression Rating Scale and the anxiety subscale of the Hospital Anxiety and Depression Scale (HADS), but not in the HADS depression subscale. In the pooled analysis, the anxiolytic effect persisted at one-month follow-up, with greater improvements observed in those with more severe baseline anxiety.
Conclusion
These preliminary findings suggest that BT may help reduce anxiety symptoms in PD. Future studies with larger, more severely affected cohorts are needed to confirm these findings.

Phenotypic variability in ATP13A2 mutations-First Report of SPG78 from India: Lakshmi Priya L, Asish Vijayaraghavan, Syam Krishnan; Received April 15, 2025 Accepted June 29, 2025 Published online June 29, 2025; DOI: https://doi.org/10.14802/jmd.25100 [Accepted]

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Variability in Pull Test Performance Within a Tertiary Movement Disorders Center: Carla Silva-Batista, Lee Neilson, Hanna Whang, Jacqueline Ellison, Delaram Safarpour, Lauren Talman, Fay B. Horak, John Nutt, Marian L. Dale; Received May 22, 2025 Accepted June 20, 2025 Published online June 20, 2025; DOI: https://doi.org/10.14802/jmd.25140 [Accepted]

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The Role of handedness and extrainstrumental burdens on the course of musicians’ dystonia: J Doll-Lee, E Passarotto, Altenmüller E, Lee A; Received March 14, 2025 Accepted June 15, 2025 Published online June 15, 2025; DOI: https://doi.org/10.14802/jmd.25064 [Accepted]

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Abstract PDF: Background
This study investigates the impact of extrainstrumental workload on musician's hand dystonia (MD) and its relation to playing ability by testing two hypotheses: 1) the dominant hand is more severely affected at dystonia-onset; 2) improvement during treatment depends on whether the dominant or non-dominant hand is affected.
Methods
151 patients with dominant-hand MD and 92 with non-dominant hand MD were assessed regarding their playing ability at dystonia-onset (T0) and after treatment (T1).
Results
There was no significant difference in playing-ability at onset between groups. Significant improvement and a greater change in playing-ability was observed in the dominant-hand group. We found no difference in the proportional frequency of right-handed and left-handed individuals in the group of patients affected on the right or left side respectively.
Conclusion
These findings suggest that handedness does not influence MD localization, but the prognosis is more favorable for those with dominant hand dystonia, potentially due to metaplasticity effects.

Longitudinal Multimodal Functional Imaging: An Essential Tool for Visualizing Pathologic Progression in Parkinson’s disease: Antonio Martín-Bastida, María Cruz Rodríguez-Oroz; Received December 14, 2024 Accepted June 8, 2025 Published online June 8, 2025; DOI: https://doi.org/10.14802/jmd.24257 [Accepted]

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Abstract PDF: The study of pathophysiology of Parkinson´s disease (PD) has been traditionally performed with functional magnetic resonance imaging (fMRI), however only a few studies have been set in longitudinal cohorts. In the present literature review, we aim to summarize the most recent progress in functional fMRI studies in prospective cohorts and more specifically in combination with other biomarkers, in order to track the disease progression of PD. This review focusses in the potential application of the multimodal longitudinal functional approaches based in the current evidence for the purpose to understand disease progression and monitoring future therapeutic interventions.

MRI-Guided Focused Ultrasound (MRgFUS) in Parkinson's Disease and Essential Tremor: Incisionless but Invasive! - A Narrative Review: Vinod Metta, Hani T.S. Benamer, Dr Georgios Kapsas, Rukmini Mridula, Rajesh Alugolu, Hasna Hussain, Afsal Nalarakettil, Sampath Kumar N S, Mohamed Elmahdy, Rupam Borgohain, K Ray Chaudhuri; Received February 15, 2025 Accepted June 13, 2025 Published online June 4, 2025; DOI: https://doi.org/10.14802/jmd.25042 [Accepted]

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Abstract PDF: Magnetic resonance-guided focused ultrasound (MRgFUS) is an emerging and promising technology for treating movement disorders, such as essential tremor and tremor-dominant Parkinson’s disease. It utilises advanced ultrasound transducer emitters to condense sound waves at a precisely defined point able to target various brain areas, such as the pallidothalamic tract, thalamus, and pallidum that ameliorates some of the symptoms of Parkinson’s disease and other movement disorders like dystonic and action induced tremors. we review the current status of preclinical and clinical trials clinical use, treatment outcomes and indications of Magnetic resonance-guided focused ultrasound (MRgFUS)

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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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.

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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Efficacy of Levodopa/Benserazide Dispersible Tablets on “Delayed ON ” to the First Morning Dose in Patients With Parkinson’s Disease With Motor Fluctuations: A Multicenter, Randomized, Open-Label, Crossover Trial: Hee Jin Chang, Jongkyu Park, Sohee Oh, Chaewon 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 [Epub ahead of print]

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Abstract PDF: Objective
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 ability of various oral levodopa regimens to overcome this problem has been poorly investigated. To evaluate the efficacy of levodopa/benserazide dispersible tablets in PD patients with delayed ON to the first morning dose.
Methods
This multicenter, randomized, crossover trial involved 40 eligible PD patients with delayed ON. The participants were randomized to receive either levodopa/benserazide 100 mg dispersible or regular tablets for 4 weeks, followed by a one-week wash-out interval and an alternate drug for another 4 weeks. Participants took the investigational drug with the first morning dose of their antiparkinsonian medications. Other medications were not changed 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 the Unified Dyskinesia Rating Scale. Finally, we investigated whether efficacy was affected by Helicobacter pylori status via 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.

Diagnostic Spectrum in an “Atypical” Atypical Parkinsonism Syndrome Cohort: A Single Center Experience: Pavankumar Katragadda, 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 [Epub ahead of print]

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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 [Epub ahead of print]

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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.

Factors Associated With the Decline in Daytime Bed Mobility Independence in Patients With 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 [Epub ahead of print]

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Abstract PDF: Objective
People with Parkinson’s disease (PwPD) experience a gradual decline in bed mobility independence as the disease progresses. Identifying factors associated with nonindependence in daytime bed mobility is crucial for developing effective interventions to increase independence. We investigated factors associated with nonindependence in daytime bed mobility in PwPD.
Methods
This cross-sectional study included 109 PwPD (Hoehn and Yahr [HY] stage 2–4). Patients’ bed mobility ability (turning in bed, supine-to-sitting, and sitting-to-supine) was assessed during the daytime, and they were categorized into independent and nonindependent groups. Potential factors associated with bed mobility independence, 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, were evaluated.
Results
The nonindependent group presented 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 revealed that axial symptoms, upper limb rigidity, and trunk extension strength were highly discriminative for nonindependence in turning in bed (the area under the curve [AUC]=0.84). Similarly, upper limb rigidity and axial symptoms were predictive of nonindependence in supine-to-sitting and sitting-to-supine movements (AUC=0.78, 0.92). A significant difference in axial symptoms between the HY stage 4 subgroups was observed only in the sitting-to-supine movement.
Conclusion
Our findings indicate that axial symptoms and upper limb rigidity are key factors contributing to nonindependence in daytime bed mobility tasks among PwPD. Targeting these factors in rehabilitation may help mitigate the decline in bed mobility independence in PwPD.

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

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