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Non-Motor Symptoms in Movement Disorders

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Clinical Neurology".

Deadline for manuscript submissions: closed (20 February 2025) | Viewed by 9918

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Prof. Dr. Francesca Morgante

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Guest Editor

Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George’s University of London, London SW17 0RE, UK
Interests: Parkinson’s disease; dystonia; tremor; deep brain stimulation; device-aided therapies; rare movement disorders

Dr. Lucia Ricciardi

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Guest Editor

Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St. George's University of London, London SW17 0RE, UK
Interests: cognitive, psychiatric and emotional dysfunction in patients with movement disorders, especially those with Parkinson’s disease
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Special Issue Information

Dear Colleagues,

People with movement disorders present a plethora of non-motor symptoms (NMS), which are very disabling and impact patients’ and their families’ quality of life.

The research on NMS in people with Parkinson’s disease has enormously expanded in the last decade, underlining the importance of the proper diagnosis of these symptoms and the need for multidisciplinary management. Less is known about this topic in patients with atypical Parkinsonian disorders, with dystonia and with tremor, although NMS such as anxiety, depression, excessive daytime sleepiness, cognitive disturbances, and poor sleep are commonly associated with these disorders.

Finally, Huntington’s disease and tic disorders have core features of NMS, especially in the neuropsychiatric and cognitive domains. Recently, functional movement disorders have gained great attention from clinicians and researchers, and in these patients, pain, fatigue, cognitive complaints and psychiatric comorbidities have a detrimental impact on quality of life.

There are several knowledge gaps to be addressed regarding the pathological basis, diagnosis and management of NMS in movement disorders. This topic requires dedicated knowledge and multidisciplinary management. For all these reasons, it seemed necessary to create a Special Issue on this topic. With this Special Issue, we hope to encourage submissions that discuss the current state of the art, address ongoing knowledge gaps, and focus on ongoing controversies and management related to NMS in movement disorders.

Prof. Dr. Francesca Morgante
Dr. Lucia Ricciardi
Guest Editors

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Keywords

movement disorders
Parkinson’s disease
dystonia
tremor
non-motor symptoms
sleep
neuropsychiatric symptoms

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Published Papers (8 papers)

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9 pages, 504 KiB

Open AccessArticle

Cognitive Rehabilitation as a Possible Therapeutic Approach in Patients with Blepharospasm

by Francesco Marchet, Daniele Belvisi, Giorgio Leodori, Flavia Aiello, Matteo Costanzo, Federica Satriano, Antonella Di Vita, Antonella Conte, Giovanni Fabbrini and Gina Ferrazzano

J. Clin. Med. 2025, 14(8), 2574; https://doi.org/10.3390/jcm14082574 - 9 Apr 2025

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Abstract

Background/Objectives: Blepharospasm (BSP) is a focal dystonia characterized by involuntary, bilateral spasms of the orbicularis oculi muscle. While botulinum toxin (BoNT) is the standard treatment, cognitive tasks such as reading and writing may exert transient modulatory effects on spontaneous blinking and dystonic spasms. This study investigates the potential of cognitive training, including reading and writing tasks, as a complementary therapeutic approach to BoNT in BSP patients. Methods: A total of 16 BSP patients were randomly assigned to two groups: Group A (n = 6) received cognitive training alongside BoNT, while Group B (n = 10) received only BoNT. Cognitive training included structured reading and writing exercises over three months. Blink rate (BR) and dystonic spasms were assessed at baseline (T0), one month (T1), and three months (T2) post-treatment. Results: Both groups exhibited a significant reduction in BR at T1 (p = 0.001), but Group A exhibited a greater improvement in BR (45.4%) compared to that of Group B (12.6%, p = 0.04). Reading and writing tasks were the most effective in reducing BR and dystonic spasms (p < 0.001). No significant correlation was found between the clinical and demographic features (p > 0.05). Conclusions: Cognitive training significantly enhances the therapeutic effects of BoNT on BR in BSP patients, suggesting its potential as a non-invasive complementary intervention. These preliminary findings warrant further investigation using larger cohorts and employing neurophysiological assessments. Full article

(This article belongs to the Special Issue Non-Motor Symptoms in Movement Disorders)

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14 pages, 1311 KiB

Open AccessArticle

Determinants of Sexual Dysfunction in Parkinson’s Disease Patients: A Secondary Analysis of a Multicenter Cross-Sectional Study

by Alfredo Manuli, Maria Grazia Maggio, Paolo De Pasquale, Loredana Raciti, Serena Filoni, Simona Portaro, Gianluca Pucciarelli and Rocco Salvatore Calabrò

J. Clin. Med. 2025, 14(1), 152; https://doi.org/10.3390/jcm14010152 - 30 Dec 2024

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Abstract

Background: Sexual dysfunction (SD) in Parkinson’s Disease (PD) patients is a common and distressing concern, although it remains an underdiagnosed and undertreated condition. Indeed, the prevalence of SD in PD ranges from 42.6% to 79% in men and from 36% to 87.5% in women. PD-related SD etiology is multifactorial and includes biological, psychological, and socio-relational factors. In a previous multicenter study on 203 PD patients, we found that there was no gender difference in dysfunction severity, although men were significantly more affected by SD than women. Methods: This paper is a secondary analysis of this previous multicenter study, and aims to investigate the potential risk factors that contribute to SD. The relationship between dysfunction and the experimental factors was assessed using Generalized Linear Mixed-Effects (GLME) model. Results: The final analysis was conducted on a sample of 177 patients (76 women), after excluding individuals with incomplete data, non-compliance with inclusion criteria, or delays in assessment tool administration. The analysis, performed using the GLME model (R² = 0.68), revealed that gender (p = 0.01), age (p = 0.02), and depression status (HAMD) (p = 0.01) were significant predictors of SD. In contrast, other factors considered in the model, such as diabetes, and autonomic symptoms, did not significantly influence SD. Conclusions: This study demonstrates that age, gender, and depression are important predictors of SD in patients with PD. Although SD is a common NMS in PD patients, it is often neglected in clinical practice and the research on this hot topic is still poor. Then, a multidisciplinary approach, including nursing and coaching, is mandatory in order to improve sexual health in this patient population. Full article

(This article belongs to the Special Issue Non-Motor Symptoms in Movement Disorders)

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10 pages, 215 KiB

Open AccessArticle

Non-Obscene Socially Inappropriate Behavior in Patients with Gilles de la Tourette Syndrome

by Mateusz Grycz and Piotr Janik

J. Clin. Med. 2024, 13(19), 5926; https://doi.org/10.3390/jcm13195926 - 4 Oct 2024

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Abstract

Background/Objectives: Behavioral disturbances are a common phenomenon associated with Gilles de la Tourette syndrome (GTS), which can manifest as non-obscene socially inappropriate behaviors (NOSIBs). The classification of NOSIB has not yet been clearly established. The objective of this study was to determine the frequency, age of onset, and clinical correlation of NOSIB with tic severity and the prevalence of comorbid psychiatric disorders in individuals with GTS. Methods: A total of 365 participants (272 male, 74.5%) with GTS were included in the study. Of these, 278 (76.2%) were children and adolescents. The mean age of the participants at evaluation was 14.4 ± 9.8 years, with a range of 4 to 64 years. The clinical data of NOSIB were collected during a routine, ambulatory examination using half-structured questionnaires developed by the authors. Results: NOSIB was observed in 86 patients with GTS, representing a prevalence of 23.6%. NOSIB commenced at a mean age of 6.6 ± 4.1 years (range 2–19). The mean age at onset of NOSIB was 1.4 ± 3.7 years after the onset of tics, with 18 cases (26.1%) preceding tics and 13 cases (18.8%) starting at the same age as tics. The results of the multivariate analysis confirmed the associations between NOSIB and YGTSS (p = 0.02) and coprophenomena (p < 0.01), as well as ADHD (p < 0.01), ODD (p = 0.01), ASD (p < 0.01), and anxiety disorders (p = 0.02). Conclusions: NOSIB is an early symptom of GTS that typically manifests in childhood and occurs in approximately a quarter of patients. Tic severity and the presence of psychiatric comorbidities, which indicate a more severe disease course, may serve as risk factors for NOSIB. Full article

(This article belongs to the Special Issue Non-Motor Symptoms in Movement Disorders)

13 pages, 585 KiB

Open AccessArticle

Cognition in Patients with Spinocerebellar Ataxia 1 (SCA1) and 2 (SCA2): A Neurophysiological and Neuropsychological Approach

by Fabiana Colucci, Sara Stefanelli, Elena Contaldi, Andrea Gozzi, Alessia Marchetti, Maura Pugliatti, Michele Laudisi, Pietro Antenucci, Jay Guido Capone, Daniela Gragnaniello and Mariachiara Sensi

J. Clin. Med. 2024, 13(16), 4880; https://doi.org/10.3390/jcm13164880 - 19 Aug 2024

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Background/Objectives: Cognitive impairment in spinocerebellar ataxia patients has been reported since the early-disease stage. We aimed to assess cognitive differences in SCA1 and SCA2 patients. Methods: We performed neuropsychological (NPS) and neurophysiological (auditory event-related potentials, aERPs) assessments in 16 SCA1 and 18 SCA2 consecutive patients. Furthermore, clinical information (age at onset, disease duration, motor disability) was collected. Results: NPS tests yielded scores in the normal range in both groups but with lower scores in the Frontal Assessment Battery (p < 0.05) and Visual Analogue Test for Anosognosia for motor impairment (p < 0.05) in SCA1, and the Trail Making Test (p < 0.01), Raven’s progressive matrices (p < 0.01), Stroop (p < 0.05), and emotion attribution tests (p < 0.05) in SCA2. aERPs showed lower N100 amplitude (p < 0.01) and prolonged N200 latency (p < 0.01) in SCA1 compared with SCA2. Clinically, SCA2 had more severe motor disability than SCA1 in the Assessment and Rating of Ataxia Scale. Conclusions: SCA2 showed more significant difficulties in attentional, visuospatial, and emotional function, and greater motor impairment. In contrast, SCA1 showed less cognitive flexibility/phasic ability, probably affected by a more severe degree of dysarthria. The same group revealed less neural activity during nonconscious attentional processing (N100-N200 data), suggesting greater involvement of sensory pathways in discriminating auditory stimuli. NFS did not correlate with NPS findings, implying an independent relationship. However, the specific role of the cerebellum and cerebellar symptoms in NPS test results deserves more focus. Full article

(This article belongs to the Special Issue Non-Motor Symptoms in Movement Disorders)

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15 pages, 733 KiB

Open AccessArticle

Survey on Parkinson’s Disease Diagnosis Impact: Patients, Caregivers and Health Care Professionals’ Perspectives

by Stela Dodaj, Margherita Fabbri, Anne Doe de Maindreville, Alexandra Foubert-Samier, Marie-Claire Toussaint, Nicolas Carriere, Jeanne Lopez, Marine Giroud, Virginie Sattler, Angélique Gerdelat, Guillaume Baille, Jean Denis Turc, Christel Barthelemy, Charlotte Scotto d Apollonia, Marie Helene Fabre, Elina Eytier, Claire Thiriez, Frederique Fluchère and Fabienne Ory-Magne

J. Clin. Med. 2024, 13(14), 4118; https://doi.org/10.3390/jcm13144118 - 14 Jul 2024

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Abstract

Background: The announcement of Parkinson’s disease (PD) diagnosis may provoke negative feelings that impact the ability to cope with the disease and all life changes related to this new condition. There are scarce data on how to improve communication about PD diagnosis and which factors may influence this outcome. Methods: We performed a national French survey, investigating the diagnosis announcement impact on a large population of people living with PD (PwPD), who recently received the diagnosis (≤1 year since PD diagnosis), and on related caregivers and health care professionals (HCPs), from tertiary and community-based hospitals. Results: A total of 397 PwPD (45% female and 82% > 50 years old), 192 caregivers and 120 HCPs (69% neurologists) completed the questionnaire. The diagnosis was not expected by about 60% of PwPD and induced negative feelings in the majority (82%) of them. Negative feelings that PwPD experience in the moment of the diagnosis announcement were related with male gender [OR = 2.034, CI 95% 1.09–3.78; p = 0.025] and older age [OR = 1.05, CI 95% 1.01–1.08; p = 0.004], while tremor as the first symptom had a threshold significance [OR = 1.78, CI 95% 0.994–3.187; p = 0.052]. Half of the PwPD and caregivers considered that they did not receive enough information and one third had a short-term appointment to rediscuss the diagnosis. A total of 82% of PwPD expressed the willingness to have a multidisciplinary follow-up (PD nurse, psychologists). Only 24% of the HCPs had been trained for PD announcement. Conclusions: The way a PD diagnosis is delivered represents a pivotal moment in the journey of PwPD and caregivers. This process requires improvement in addressing the gaps expressed by PwPD, caregivers, and HCPs through a participatory approach. Full article

(This article belongs to the Special Issue Non-Motor Symptoms in Movement Disorders)

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11 pages, 811 KiB

Open AccessArticle

The Effects of Multidisciplinary Intensive Rehabilitation on Cognitive and Executive Functions in Parkinson’s Disease: A Clinical Database Analysis

by Ivana Baldassarre, Rossella Rotondo, Laura Piccardi, Lorenza Leonardi, Danilo Lanni, Maria Gaglione, Fabrizio Stocchi, Massimo Fini, Michela Goffredo, Elvira Padua and Maria Francesca De Pandis

J. Clin. Med. 2024, 13(13), 3884; https://doi.org/10.3390/jcm13133884 - 2 Jul 2024

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Abstract

Background/Objectives: This study is based on data collected from a medical health record review to assess whether multidisciplinary intensive rehabilitation treatment in Parkinson’s disease (PD) patients can improve global cognitive functioning and executive functions. Methods: The data related to PD patients were extrapolated from a clinical database called “NeuroRehab”. A total of 104 PD patients (51 males; 53 females) performed 6 weeks of multidisciplinary intensive rehabilitation treatment in clinical practice from January 2019 to May 2023. This training program was characterized by three daily sessions of 60 min of activities (muscle relaxation and stretching exercises, moderate physical aerobic exercise, and occupational therapy). The patients were classified and stratified according to disease severity (according to the Hoehn and Yahr scale), postural instability and gait difficulty (PIGD) or tremor-dominant (TD) subtypes, disease duration (DD), and the presence of dyskinesias. The effect of multidisciplinary intensive rehabilitation treatment on cognitive and executive functions was evaluated through the administration of cognitive tests, such as the Mini–Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), and Frontal Assessment Battery (FAB). All the parameters were evaluated at the baseline (T0) and at the end of the rehabilitation program (T1). Results: The multidisciplinary intensive rehabilitation treatment significantly improved cognitive performance. The MMSE, MoCA, and FAB test scores after the rehabilitation program (T1) were significantly higher compared to the scores obtained at the baseline (T0). Moreover, further analyses on subgroups of the patients who scored below the cut-off in the MMSE showed that at least 50% of patients overcame the cut-off score. Interestingly, the same analyses performed for the MoCA and FAB revealed a higher rate of improvement in cognitive functions, with normal scores in both tests after 6 weeks of multidisciplinary intensive rehabilitation treatment. Conclusions: This study revealed the potential effects of a 6-week multidisciplinary rehabilitation program in improving cognitive status in a PD inpatient cohort. Full article

(This article belongs to the Special Issue Non-Motor Symptoms in Movement Disorders)

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12 pages, 230 KiB

Open AccessArticle

Non-Motor Symptoms in Primary Familial Brain Calcification

by Giulia Bonato, Paola Cimino, Francesca Pistonesi, Leonardo Salviati, Cinzia Bertolin and Miryam Carecchio

J. Clin. Med. 2024, 13(13), 3873; https://doi.org/10.3390/jcm13133873 - 30 Jun 2024

Viewed by 1429

Abstract

Background/Objectives: Primary Familial Brain Calcification is a rare neurodegenerative disorder of adulthood characterized by calcium deposition in the basal ganglia and other brain areas; the main clinical manifestations include movement disorders, mainly parkinsonism. Non-motor symptoms are not well defined in PFBC. This work aims at defining the burden of non-motor symptoms in PFBC. Methods: A clinical, genetic and neuropsychological evaluation of a cohort of PFBC patients, COMPASS-31 scale administration. Results: A total of 50 PFBC patients were recruited; in 25, the genetic test was negative; 10 carried mutations in SLC20A2 gene, 8 in MYORG, 3 in PDGFB, 1 in PDGFRB, 2 in JAM2 (single mutations), and one test is still ongoing. The main motor manifestation was parkinsonism. Headache was reported in 26% of subjects (especially in PDGFB mutation carriers), anxiety or depression in 62%, psychosis or hallucinations in 10–12%, sleep disturbances in 34%; 14% of patients reported hyposmia, 32% constipation, and 34% urinary disturbances. A neuropsychological assessment revealed cognitive involvement in 56% (sparing memory functions, to some extent). The COMPASS-31 mean score was 20.6, with higher sub-scores in orthostatic intolerance and gastrointestinal problems. MYORG patients and subjects with cognitive decline tended to have higher scores and bladder involvement compared to other groups. Conclusions: The presence of non-motor symptoms is frequent in PFBC and should be systematically assessed to better meet patients’ needs. Full article

(This article belongs to the Special Issue Non-Motor Symptoms in Movement Disorders)

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17 pages, 286 KiB

Open AccessReview

The Role of MAO-B Inhibitors in Fatigue in Parkinson’s Disease: A Narrative Review

by Silvia Galli, Pierre Pacilio, Edoardo Bianchini, Marika Alborghetti, Lanfranco De Carolis, Pietro Lombardo, Francesco Garramone, Marco Salvetti and Domiziana Rinaldi

J. Clin. Med. 2025, 14(8), 2598; https://doi.org/10.3390/jcm14082598 - 10 Apr 2025

Viewed by 363

Abstract

Background: Fatigue is a common and debilitating non-motor symptom (NMS) in Parkinson’s disease (PD), significantly affecting patients’ quality of life. MAO-B inhibitors are effective therapy for motor symptoms and fluctuations and may also play a role in fatigue management. Methods: We searched PubMed for English-language articles (January 1978–August 2024) using keywords including “selegiline”, “rasagiline”, “safinamide”, “MAO-B”, “fatigue”, and “Parkinson’s disease”. Clinical trials, observational, and preclinical studies were included. Results: While the role of MAO-B inhibitors in fatigue remains unclear, evidence suggests potential benefits. Selegiline has shown effectiveness in improving fatigue in animal models, supporting its potential utility in treating fatigue and motivational impairments in PD patients. Rasagiline has been associated with reduced fatigue progression in early PD, with some studies showing significant improvements compared to placebo. Safinamide, with its dual action as an MAO-B inhibitor and glutamate modulator, may further enhance fatigue management. Its ability to reduce glutamate release is particularly relevant, given the role of glutamate overactivity in PD-related fatigue. Studies indicate safinamide can significantly reduce fatigue levels. Conclusions: Fatigue in PD is a complex symptom with multiple contributing factors. While MAO-B inhibitors may support fatigue management, their precise role and optimal use require further investigation. Full article

(This article belongs to the Special Issue Non-Motor Symptoms in Movement Disorders)

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