1·8 billion people of diverse ethnicities and cultures live in the Western Pacific Region. The increasing longevity of populations in this region is a major contributor to the exponential increase in Parkinson's disease prevalence worldwide. Differences exist between Parkinson's disease in the Western Pacific Region and in Europe and North America that might provide important insights into our understanding of the disease and approaches to management. For example, some genetic factors (such as LRRK2 mutations or variants) differ, environmental exposures might play differential roles in modulating the risk of Parkinson's disease, and fewer dyskinesias are reported, with some differences in the profile of non-motor symptoms and comorbidities. Gaps in awareness of the disease and inequitable access to treatments pose challenges. Further improvements in infrastructure, clinical governance, and services, and concerted collaborative efforts in training and research, including greater representation of the Western Pacific Region in clinical trials, will improve care of patients with Parkinson's disease in this region and beyond.

Parkinson's disease in the Western Pacific Region

In the article “Zonisamide improves motor function in Parkinson disease: A randomized, double-blind study” by …

https://n.neurology.org/content/neurology/69/1/120.2.full.pdf

Zonisamide improves motor function in Parkinson disease: A randomized, double-blind study

Prosodic analysis of neutral, stress-modified and rhymed speech in patients with Parkinson's disease

Hypokinetic dysarthria in Parkinson's disease (PD) can be characterized by monotony of pitch and loudness, reduced stress, variable rate, imprecise consonants, and a breathy and harsh voice Using acoustic analysis, we studied the effects of high-frequency repetitive transcranial magnetic stimulation (rTMS) applied over the primary orofacial sensorimotor area (SM1) and the left dorsolateral prefrontal cortex (DLPFC) on motor aspects of voiced speech in PD Twelve non-depressed and non-demented men with PD (mean age 6458 ± 804 years, mean PD duration 1075 ± 748 years) and 21 healthy age-matched men (a control group, mean age 64 ± 855 years) participated in the speech study The PD patients underwent two sessions of 10 Hz rTMS over the dominant hemisphere with 2,250 stimuli/day in a random order: (1) over the SM1; (2) over the left DLPFC in the "on" motor state Speech examination comprised the perceptual rating of global speech performance and an acoustic analysis based upon a standardized speech task The Mann-Whitney U test was used to compare acoustic speech variables between controls and PD patients The Wilcoxon test was used to compare data prior to and after each stimulation in the PD group rTMS applied over the left SM1 was associated with a significant increase in harmonic-to-noise ratio and net speech rate in the sentence tasks With respect to the vowel task results, increased median values and range of Teager-Kaiser energy operator, increased vowel space area, and significant jitter decrease were observed after the left SM1 stimulation rTMS over the left DLPFC did not induce any significant effects The positive results of acoustic analysis were not reflected in a subjective rating of speech performance quality as assessed by a speech therapist Our pilot results indicate that one session of rTMS applied over the SM1 may lead to measurable improvement in voice quality and intensity and an increase in speech rate and tongue movements Nevertheless, these changes were not accompanied by changes in a perceptual evaluation of speech performance by a speech therapist Future placebo-controlled studies in larger patient cohorts should verify if rTMS would be clinically useful for treating hypokinetic dysarthria in PD

Acoustic evaluation of short-term effects of repetitive transcranial magnetic stimulation on motor aspects of speech in Parkinson’s disease

In this letter, making use of real gait force profiles of healthy and patient groups with Parkinson disease which have different disease severity in terms of Hoehn-Yahr stage, we calculate various heuristic complexity measures of the recurrence quantification analysis (RQA). Using this technique, we are able to evince that entropy, determinism and average diagonal line length (divergence) measures decrease (increases) with increasing disease severity. We also explain these tendencies using a theoretical model (based on the sine-circle map), so that we clearly relate them to decreasing degree of irrationality of the system as a course of gait's nature. This enables us to interpret the dynamics of normal/pathological gait and is expected to increase further applications of this technique on gait timings, gait force profiles and combinations of them with various physiological signals.

/pdf/recurrence-quantification-analysis-at-work-quasi-periodicity-930smxysty.pdf

Recurrence Quantification Analysis at work: Quasi-periodicity based interpretation of gait force profiles for patients with Parkinson disease.

Background Immune-evading severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants are emerging continuously. The clinical effectiveness of monoclonal antibody agents that exhibit decreased in vitro activity against SARS-CoV-2 variants needs to be elucidated. Methods A nationwide, multicenter, retrospective cohort study was designed to evaluate the effectiveness of regdanvimab, an anti-SARS-CoV-2 monoclonal antibody agent. Regdanvimab was prescribed in South Korea before and after the emergence of the delta variant, against which the in vitro activity of regdanvimab was decreased but present. Mild to moderate coronavirus 2019 (COVID-19) patients with risk factors for disease progression who were admitted within seven days of symptom onset were screened in four designated hospitals between December 2020 and September 2021. The primary outcomes, O2 requirements and progression to severe disease within 21 days of admission, were compared between the regdanvimab and supportive care groups, with a subgroup analysis of delta variant–confirmed patients. Results A total of 2,214 mild to moderate COVID-19 patients were included, of whom 1,095 (49.5%) received regdanvimab treatment. In the analysis of the total cohort, significantly fewer patients in the regdanvimab group than the supportive care group required O2 support (18.4% vs. 27.1%, P < 0.001) and progressed to severe disease (4.0% vs. 8.0%, P < 0.001). In the multivariable analysis, regdanvimab was significantly associated with a decreased risk for O2 support (HR 0.677, 95% CI 0.561–0.816) and progression to severe disease (HR 0.489, 95% CI 0.337–0.709). Among the 939 delta-confirmed patients, O2 support (21.5% vs. 23.5%, P = 0.526) and progression to severe disease (4.2% vs. 7.3%, P = 0.055) did not differ significantly between the regdanvimab and supportive care groups. In the multivariable analyses, regdanvimab treatment was not significantly associated with a decreased risk for O2 support (HR 0.963, 95% CI 0.697–1.329) or progression to severe disease (HR 0.665, 95% CI 0.349–1.268) in delta-confirmed group. Conclusions Regdanvimab treatment effectively reduced progression to severe disease in the overall study population, but did not show significant effectiveness in the delta-confirmed patients. The effectiveness of dose increment of monoclonal antibody agents should be evaluated for variant strains exhibiting reduced susceptibility.

/pdf/effectiveness-of-regdanvimab-treatment-for-sars-cov-2-delta-3dizfyww.pdf

Effectiveness of regdanvimab treatment for SARS-CoV-2 delta variant, which exhibited decreased in vitro activity: a nationwide real-world multicenter cohort study

Objectives: To survey daily doses of dopaminergic medications and to draw a posteriori equation of the dose in relation to the various clinical variables in Korean patients with Parkinson disease. Methods: A multi-center cross-sectional survey was conducted over a defi ned period. Information on patient demographics and clinical features including age at Parkinson disease onset, disease duration, treatment duration and Hoehn and Yahr stage, and daily doses of anti-parkinsonian drugs was obtained from the patients’ medical records. Results: A total of 1,762 patients with Parkinson disease were recruited from 6 referral centers. The mean L-dopa equivalent daily dose (LEDD) in the whole population was 608.9 mg/day, which tended to increase linearly depending on the duration of disease and Hoehn and Yahr stage. LEDD was also signifi cantly affected by age and gender. We performed multiple linear regression analyses and devised a posteriori equation of LEDD with clinical variables. Conclusions: This survey provides systematic data for mean LEDD in Korean Parkinson disease patients. In spite of profound individual variations in LEDD, our linear regression model provides an insight about the relationship between daily doses of dopaminergic medications and various clinical features of Parkinson disease.

/pdf/daily-dose-of-dopaminergic-medications-in-parkinson-disease-1nwt4wp72a.pdf

Daily dose of dopaminergic medications in Parkinson disease: Clinical correlates and a posteriori equation

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Effectiveness of regdanvimab treatment for SARS-CoV-2 delta variant, which exhibited decreased in vitro activity: a nationwide real-world multicenter cohort study

Daily dose of dopaminergic medications in Parkinson disease: Clinical correlates and a posteriori equation