Nonmotor symptoms are independently associated with impaired health‐related quality of life in Chinese patients with Parkinson's disease

We performed a cross‐sectional study of 82 Chinese patients with Parkinson's disease (PD) enrolled during an 18‐month period using a clinical interview to assess the prevalence of nonmotor symptoms (NMS), the association with disease severity and motor status, and the impact on patients' health‐related quality of life (Hr‐QoL). The patients' NMS, Hr‐QoL, disease severity, and motor status were assessed by the Nonmotor Symptoms Scale (NMSS), the 39‐item Parkinson's Disease Questionnaire (PDQ‐39), the modified Hoehn and Yahr staging scale (H&Y) and the Unified Parkinson's Disease Rating Scale part III (UPDRS III), respectively. We found that 100% of patients with PD presented with NMS. The NMSS significantly correlated with disease duration (Spearman's r_S = 0.276, P = 0.012), H&Y (r_S = 0.230, P = 0.038), and UPDRS III (r_S = 0.350, P = 0.001). Similarly, the PDQ‐39 SI significantly associated with the disease duration (r_S = 0.258, P = 0.019), H&Y (r_S = 0.340, P = 0.002), and UPDRS III (r_S = 0.453, P < 0.001). NMS domains that influenced the PDQ‐39 SI were sleep/fatigue, mood, gastrointestinal, urinary, and miscellaneous symptoms. This strongly suggested that the five domains played a key role in the manifestation of Hr‐QoL. NMSS explains more of the variability in Hr‐QoL than UPDRS III, when both are the model (stepwise multiple linear regression analysis R² change, 47.8% vs. 5.87%, respectively). Therefore, these findings demonstrate that NMS are independently and negatively associated with Hr‐QoL in PD and that improving NMS should be viewed as an important part in the management of PD. © 2010 Movement Disorder Society     

Association of social support with quality of life in patients with polyneuropathy

The aim of this study was to examine the impact of social support on quality of life (QoL) in patients with polyneuropathy. One hundred and fifty‐four patients with polyneuropathy were enrolled from a neuromuscular clinic. The QoL Instrument and the Medical Outcome Study‐Social Support Survey (MOS‐SSS) were used to assess QoL and social support, respectively. Disease severity and clinical factors were also assessed. Neuropathy patients had a lower QoL compared to a previously published normative sample (p < 0.0001) and an MOS‐SSS comparable to other patients with chronic disease. Social support correlated weakly with the self esteem and emotional well being mental health dimensions (r_s:0.20–0.38) but not the physical health QoL (PH‐QoL) domains. Physical and mental QoL also correlated significantly with presence of pain (r_s: ?0.39 and ?0.42, respectively) and number of autonomic symptoms (r_s: ?0.39 and ?0.30, respectively). Social support independently predicts MH‐QoL when controlling for age, gender, pain, and the Toronto Clinical Neuropathy Score (TCNS; p < 0.0001). TCNS and gender are independently related to PH‐QoL (p < 0.05). This study demonstrates that improved social support serves as an independent predictor of MH‐QoL when controlling for age, gender, pain, and severity of neuropathy. Future studies examining the effects of improving social support on QoL in patients with polyneuropathy are recommended.     

Health‐related quality‐of‐life and treatment targets in myasthenia gravis

Introduction: The aim of this study was to determine factors affecting health‐related quality of life (HRQOL) and to propose appropriate treatment targets for patients with myasthenia gravis (MG). Methods: We evaluated 640 consecutive patients with MG seen at 11 neurological centers. Two‐year follow‐up data were obtained for 282 patients. Correlations between detailed clinical factors and the Japanese version of the 15‐item MG‐specific QOL scale score were analyzed. Results: In a cross‐sectional analysis of 640 MG patients, multivariate regression revealed that disease severity, as evaluated by the MG Composite (P < 0.0001), total dose of oral prednisolone during the last year (P = 0.002), and Cushingoid appearance index (P = 0.0004), showed significant negative effects on HRQOL, but the quantitative MG score and current prednisolone dose did not. Conclusions: Achieving minimal manifestations (MM) status or better with prednisolone ≤5 mg/day was found to exert a major positive impact on HRQOL in both the cross‐sectional and 2‐year follow‐up patient samples and can be recommended as a treatment target. Muscle Nerve 50: 493–500, 2014     

Interleukin-2 gene expression in different phases of episodic cluster headache--a pilot study

Kummer A, Scalzo P, Cardoso F, Teixeira AL. Evaluation of fatigue in Parkinson’s disease using the Brazilian version of Parkinson’s Fatigue Scale.
Acta Neurol Scand: 2011: 123: 130–136.
© 2010 The Authors Journal compilation © 2010 Blackwell Munksgaard. Objective – Fatigue is common in Parkinson’s disease (PD). However, factors associated with fatigue in PD are still controversial. This study aimed to translate the Parkinson’s Fatigue Scale (PFS) into Brazilian‐Portuguese, to test its psychometric properties, and to assess the severity of fatigue in PD as well as its relation to demographic and clinical features, depression, anxiety, excessive daytime sleepiness and cognitive performance. Methods – We translated and assessed the internal consistency of the Brazilian version of the PFS. After, we assessed 87 PD patients with several neurological and psychopathological instruments. Results – The Brazilian version of PFS had good internal consistency (Cronbach’s alpha = 0.939). Clinical significant fatigue was present in 36 patients (41.4%). A logistic regression analysis showed that fatigue was better explained by dysthymia (P = 0.006), more severe symptoms of depression as assessed by the Hamilton Depression Rating Scale (P = 0.027), daytime sleepiness (P = 0.022) and female gender (P = 0.031). Conclusions – Fatigue is a common non‐motor symptom in PD and seems to be associated with female gender, dysthymia, severity of depression and daily somnolence.     

MRI and motor evoked potential findings in nondisabled multiple sclerosis patients with and without symptoms of fatique

Fatique is a common symptom of multiple sclerosis (MS) even in the early phases of the disease, when neurological disability is usually still not present. To investigate the pathophysiology of fatigue we compared neurophysiological (motor evoked potentials of the four limbs, MEPs) and brain magnetic resonance imaging (MRI) findings in two groups of nondisabled MS patients, those with (n=15) and those without (n=15) fatigue. Fatigue was assessed by an interview and scored by the Fatigue Severity Scale. The two groups were matched for sex, age, disease duration, Expanded Disability Status Scale score, pyramidal Functional System (FS) score, and depression score. MEPs were abnormal in five patients with fatigue and in one patient without fatigue. A significant association was found between the patient scores on the Fatigue Severity Scale, and the burden of MRI lesions (r=0.5; P<0.005). Significantly higher parietal lobe (P<0.05), internal capsule (P<0.05), and periventricular trigone (P<0.05) lesion loads were found in patients with fatigue than in those without. Our results agree with a central nervous system origin of fatigue in MS patients. This symptom might be a consequence either of a functional deafferentation of the cortex due to cortico-subcortical interconnection damage or of a demyelination in critical sites of the CNS, such as the cortico-spinal tract. Received: 15 December 1999, Received in revised form: 15 February 2000, Accepted: 26 February 2000     

Single fiber EMG as a prognostic tool in myasthenia gravis

Introduction: Single fiber electromyography (SFEMG) is the most sensitive diagnostic tool for diagnosis of myasthenia gravis (MG). Its prognostic value is not known. Methods: We retrospectively analyzed the clinical course of 232 MG patients who presented with only mild symptoms and had SFEMG of the orbicularis oculi muscle. We correlated their SFEMG results with the severity of their later clinical course. Results: During the observation period 39 patients (17%) developed severe disease exacerbations, and 193 (83%) remained stable. Patients with severe disease exacerbation had a significantly higher mean jitter value (P < 0.0001), a greater percentage of fibers with increased jitter (P < 0.0001), and/or impulse blocking (P < 0.0001) on SFEMG. Conclusions: The extent of the SFEMG abnormalities in this study correlated with the later clinical course of MG. Muscle Nerve 54 : 1034–1040, 2016     

Translation and validation of the arabic version of the revised 15‐item myasthenia gravis quality‐of‐life questionnaire

Introduction: We sought to translate, culturally adapt, and assess the Arabic version of the 15‐item myasthenia gravis quality‐of‐life revised scale (MGQOL15R). Methods: We assessed reliability with Cronbach α; reproducibility with intraclass correlation coefficient (ICC); validity with Spearman correlations for myasthenia gravis (MG)‐specific activities of daily living (MG‐ADL), MG composite (MGC) score, and MG manual muscle test (MG‐MMT) and with MGQOL15R in patients with different disease severity through the Kruskal–Wallis test; and sensitivity to change with Wilcoxon signed‐rank test. Results: In 65 enrolled patients, the mean MGQOL15R score was 10.84 ± 8.11 (α = 0.94, ICC = 0.95). The correlation coefficients between MGQOL15R and MGC, MG‐ADL, and MG‐MMT scores were 0.75, 0.75, and 0.74, respectively (P < 0.001). MGQOL15R scores were significantly higher (worse) in patients with more severe disease at baseline and significantly lower (better) in improved patients at follow‐up. Discussion: The Arabic version of MGQOL15R is valid, reliable, stable, and sensitive to changes. Muscle Nerve 57 : 581–585, 2018     

European neuroborreliosis: quality of life 30 months after treatment

Eikeland R, Mygland Å, Herlofson K, Ljøstad U. European neuroborreliosis: quality of life 30 months after treatment.
Acta Neurol Scand: 2011: 124: 349–354.
© 2011 John Wiley & Sons A/S. Objectives – The prognosis after Lyme neuroborreliosis (LNB) is debated. The aim of this study was to assess health‐related Quality of Life (QoL) and neurological symptoms 30 months after treatment in European patients with LNB. Materials and methods – In a prospective case–control designed study, we investigated 50 well‐characterized patients with LNB who had participated in a treatment trial for LNB 30 months earlier and 50 matched control persons with the health QoL questionnaire Short‐Form 36 (SF‐36), the Fatigue Severity Scale (FSS), the Montgomery and Åsberg Depression Rating Scale (MADRS), the Starkstein Apathy Scale (SAS), and the Mini Mental State (MMS). Clinical and demographic data were collected by semi‐structured interviews and clinical neurological examination. Results – Lyme neuroborreliosis‐treated patients scored lower than control persons in the SF‐36 domains physical component summary (PCS) (44 vs 51 P < 0.001) and mental component summary (MCS) (49 vs 54 P = 0.010). They also scored lower than control persons in all the SF‐36 subscales, except for bodily pain, and on FSS (3.5 vs 2.1 P < 0.001), but not on MMS (28 vs 29 P = 0.106). There was a difference in MADRS (3.1 vs 0. 8 P = 0.003) and SAS (13 vs 11 P = 0.016), but the scores were low in both groups. Fatigue was the most frequently reported symptom among LNB‐treated patients (50%). Patients who reported complete recovery (56%) after LNB had similar QoL scores as the controls. Conclusion – European persons treated for LNB have poorer health‐related QoL and have more fatigue than persons without LNB.     

Quality of life in adult patients with limb–girdle muscular dystrophies

Although limb–girdle muscular dystrophies (LGMD) can cause permanent disability, to date there are no studies that examined quality of life (QoL) in these patients. Our aim was to evaluate QoL in patients with LGMD, and to identify the most significant predictors of QoL. The study comprised 46 patients with diagnosis of limb–girdle muscular weakness. QoL in patients was evaluated using two scales—SF-36 questionnaire and the Individualized Neuromuscular Quality of Life questionnaire (INQoL). Following scales were also applied: Epworth Sleepiness Scale (ESS), Hamilton Scale for Depression (HamD), and Krupp’s Fatigue Severity Scale (FSS). Mean SF-36 score was 52.4 ± 23.5, and physical composite score was worse than mental. Total INQoL score was 46.1 ± 20.4, with worst results obtained for weakness, fatigue and independence, while social relationships and emotions showed better results. Significant predictors of worse SF-36 score in LGMD patients were higher fatigue level (β = ? 0.470, p < 0.01) and use of assistive device (β = ? 0.245, p < 0.05). Significant predictors of worse INQoL score were higher fatigue level (β = 0.514, p < 0.01) and presence of cardiomyopathy (β = ? 0.385, p < 0.01). It is of special interest that some of the identified factors that correlated with worse QoL in LGMD patients were amenable to treatment.     

What are the most important nonmotor symptoms in patients with Parkinson's disease and are we missing them?

Nonmotor symptoms (NMS) are increasingly recognized as important and neglected aspects of Parkinson's disease (PD). We evaluated their relative frequency and comparative impact on health‐related quality of life (Hr‐QoL) using validated questionnaires. In addition, we assessed the rate of reporting of NMS in neurology clinics compared with their subjective impact on patients. We used a range of validated clinimetric scales of motor and nonmotor symptoms and Hr‐QoL to assess consecutive patients with PD. Reporting of NMS was assessed by comparison with case note documentation. A mean of 11 of 30 NMS per patient were elicited on the NMS questionnaire of which on average 4.8 were reported in the clinical notes (44%). The most common NMS were autonomic (particularly urinary). The Hr‐QoL scores correlated most strongly with autonomic dysfunction (r = 0.84; particularly urinary and gastrointestinal symptoms), mood (r = 0.74), fatigue (r = 0.74), sleep problems (nocturnal r = 0.55; daytime somnolence r = 0.65), pain (r = 0.56), and psychosis (r = 0.55, all p < 0.0001) followed by UPDRS motor score (r = 0.48, p < 0.0001). Greater motor fluctuations (r = 0.57) and dyskinesia (r = 0.43, both p < 0.0001) were also associated with worse Hr‐QoL. In multivariate analysis, depression had the strongest association with Hr‐QoL (adjusted R² = 0.53, p = 0.005) followed by fatigue, thermoregulatory, gastrointestinal, and cardiovascular autonomic function (especially orthostatic hypotension), daytime somnolence, and urinary problems. This study demonstrates that a autonomic dysfunction, psychiatric complications, pain, fatigue, and sleep problems are major correlates of poor Hr‐QoL. However, whilst psychiatric problems are increasingly documented, many symptoms (particularly those possibly perceived as embarrassing or unrelated) remain under‐reported. © 2010 Movement Disorder Society     

3,4‐diaminopyridine base effectively treats the weakness of Lambert‐Eaton myasthenia

Introduction: 3,4‐diaminopyridine has been used to treat Lambert‐Eaton myasthenia (LEM) for 30 years despite the lack of conclusive evidence of efficacy. Methods: We conducted a randomized double‐blind placebo‐controlled withdrawal study in patients with LEM who had been on stable regimens of 3,4‐diaminopyridine base (3,4‐DAP) for ≥ 3 months. The primary efficacy endpoint was >30% deterioration in triple timed up‐and‐go (3TUG) times during tapered drug withdrawal. The secondary endpoint was self‐assessment of LEM–related weakness (W‐SAS). Results: Thirty‐two participants were randomized to continuous 3,4‐DAP or placebo groups. None of the 14 participants who received continuous 3,4‐DAP had > 30% deterioration in 3TUG time versus 72% of the 18 who tapered to placebo (P < 0.0001). W‐SAS similarly demonstrated an advantage for continuous treatment over placebo (P < 0.0001). Requirement for rescue and adverse events were more common in the placebo group. Discussion: This trial provides significant evidence of efficacy of 3,4‐DAP in the maintenance of strength in LEM. Muscle Nerve 57 : 561–568, 2018     

Excessive postural sway and the risk of falls at different stages of Parkinson's disease

Excessive postural sway may result in falls in Parkinson's disease (PD). We measured postural sway using the sensory organization test (SOT) of dynamic posturography in static (platform still) and dynamic (sway referenced platform) conditions with normal, no and inappropriate visual feedback in 102 subjects with PD, off medication. Twenty‐five healthy subjects were used as age‐matched controls. Eighteen very early stage PD subjects had never used dopaminergic medication. Postural sway was normal in those subjects in all conditions, but was abnormal in subjects with more advanced symptoms (UPDRS III > 20, P < 0.01). Postural sway increased with disease severity in all conditions except static, eyes closed (P < 0.0001). We developed the SOT Fall Severity Scale (SOTFSS) from the number of times postural sway was so large that the subject had to take a step (registered as a “fall”) and showed that falls mainly occurred in dynamic conditions, and were correlated with disease severity (P < 0.0001). In dynamic conditions the SOTFSS was correlated with the retropulsion score from the UPDRS III (N = 102, P < 0.0001) and with the subjects' self‐reported fall frequency from the UPDRS II (N = 62, SOT5: P = 0.0419, SOT6: P = 0.0034). © 2008 Movement Disorder Society     

Age‐related fatigue resistance in the knee extensor muscles is specific to contraction mode

The question of whether skeletal muscle fatigue is preserved or enhanced in older adults is a point of controversy. Disparate findings may be attributed to differences in subject population and study protocols, including contraction mode. The purpose of this study was to test the hypotheses that healthy older (65–80 years of age, 8 males and 8 females) adults who were matched to young adults (21–35 years of age; 8 males and 8 females) with similar physical activity levels would: (1) fatigue less during isometric knee extensor (KE) contractions, but (2) would show similar fatigue during dynamic KE contractions performed at 120° s^?1. Fatigue was induced with 4 minutes of intermittent, isometric, or dynamic maximal voluntary contractions, performed on separate days. Electrically stimulated contractions were used to evaluate central activation during both fatigue protocols. Older subjects maintained a higher percentage of baseline maximum voluntary contraction (MVC) torque than young subjects during isometric contractions (mean ± SE: 71 ± 3% and 57 ± 3%, respectively, P < 0.01). In contrast, there was no difference between age groups in torque maintenance during dynamic contractions (43 ± 3% and 44 ± 3%, respectively, P = 0.86). For both groups, changes in electrically stimulated and voluntary contractions followed similar trends, suggesting that central activation did not play a role in the age‐related differences in fatigue. Fatigue during the isometric protocol was associated with fatigue during the dynamic protocol in the young group only (r = 0.62, P = 0.01), suggesting that distinct mechanisms influence fatigue during isometric and dynamic contractions in older adults. Muscle Nerve 39: 692–702, 2009     

Development and Validation of the Dystonia-Pain Classification System: A Multicenter Study

Background

Dystonia is associated with disabling nonmotor symptoms like chronic pain (CP), which is prevalent in dystonia and significantly impacts the quality of life (QoL). There is no validated tool for assessing CP in dystonia, which substantially hampers pain management.

Objective

The aim was to develop a CP classification and scoring system for dystonia.

Methods

A multidisciplinary group was established to develop the Dystonia-Pain Classification System (Dystonia-PCS). The classification of CP as related or unrelated to dystonia was followed by the assessment of pain severity score, encompassing pain intensity, frequency, and impact on daily living. Then, consecutive patients with inherited/idiopathic dystonia of different spatial distribution were recruited in a cross-sectional multicenter validation study. Dystonia-PCS was compared to validated pain, mood, QoL, and dystonia scales (Brief Pain Inventory, Douleur Neuropathique-4 questionnaire, European QoL-5 Dimensions-3 Level Version, and Burke–Fahn–Marsden Dystonia Rating Scale).

Results

CP was present in 81 of 123 recruited patients, being directly related to dystonia in 82.7%, aggravated by dystonia in 8.8%, and nonrelated to dystonia in 7.5%. Dystonia-PCS had excellent intra-rater (Intraclass Correlation Coefficient - ICC: 0.941) and inter-rater (ICC: 0.867) reliability. In addition, pain severity score correlated with European QoL-5 Dimensions-3 Level Version's pain subscore (r = 0.635, P < 0.001) and the Brief Pain Inventory's severity and interference scores (r = 0.553, P < 0.001 and r = 0.609, P < 0.001, respectively).

Conclusions

Dystonia-PCS is a reliable tool to categorize and quantify CP impact in dystonia and will help improve clinical trial design and management of CP in patients affected by this disorder. © 2023 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.     

Effects of hemodialysis on intraneural blood flow in end‐stage kidney disease

Introduction: We quantified intraneural blood flow (INBF) in 18 patients with end‐stage kidney disease (ESKD) and examined its relationship with nerve size, neuropathy severity, and nerve excitability parameters. Methods: Sonographic measurements of the median nerve were performed at the same site before and after hemodialysis. INBF was quantified by analyzing power Doppler sonograms to obtain the vessel score (VSc) and maximum perfusion intensity (MPI). Corresponding median motor nerve excitability studies were performed. Neuropathy severity was assessed using Total Neuropathy Score. Results: A total of 39% of ESKD patients had detectable INBF compared with none in the control group (P < 0.0001). Patients with detectable INBF had larger nerves and more severe neuropathy (P < 0.01). INBF parameters were significantly reduced after a session of dialysis (VSc: P < 0.01; MPI: P < 0.01). A significant relationship was found between interdialytic change in INBF and changes in nerve excitability. Conclusions: Increased INBF is a potential marker for neuropathy severity in ESKD patients. Muscle Nerve 57: 287–293, 2018     

Serum CXCL12 levels are associated with stroke severity and lesion volumes in stroke patients

Abstract

Objective:

Previous studies had shown that CXC chemokine ligand-12 (CXCL12) might play a significant role in stroke. The aim of this study was to test the serum baseline CXCL12 levels in Chinese patients with acute ischemic stroke (AIS).

Methods:

All consecutive patients with first-ever AIS from January 2013 to June 2014 were recruited to participate in the study. CXCL12 and National Institutes of Health Stroke Scale were measured at the time of admission. Logistic regression analysis was used to evaluate the risk of stroke according to serum CXCL12 levels. Receiver operating characteristic (ROC) curve was used to evaluate the accuracy of serum CXCL12 in diagnosing stroke.

Results:

From 306 screened patients, a total of 239 patients with first-ever AIS were included in this study. The results indicated that the serum CXCL12 levels were significantly higher in AIS patients as compared to normal controls (P?<?0.0001). Serum CXCL12 were positively correlated with infarct volume(r?=?0.307, P?<?0.0001) and stroke severity(r?=?0.288, P?<?0.0001). After adjusting for all other possible covariates, CXCL12 was a stroke predictor with an adjusted OR of 2.047 [95% confidence interval (CI), 1.781–2.352; P?<?0.0001]. Based on the ROC curve, the optimal cutoff value of serum CXCL12 levels as an indicator for auxiliary diagnosis of AIS was projected to be 3.4?ng/ml, which yielded a sensitivity of 87.9% and a specificity of 72.0%, with the area under the curve at 0.902 (95% CI, 0.875–0.929).

Conclusion:

Our study demonstrated that serum CXCL12 levels increased significantly following AIS, and these changes in serum CXCL12 were positively correlated with infarct volume and stroke severity in Chinese sample.     

AANEM News and Comments

Introduction: Cognitive fatigue has frequently been reported in myasthenia gravis (MG). However, objective assessment of cognitive fatigability has never been evaluated. Methods: Thirty‐three MG patients with stable generalized disease and 17 healthy controls underwent a test battery including repeated testing of attention and concentration (d2‐R) and Paced Auditory Serial Addition Test. Fatigability was based on calculation of linear trend (LT) reflecting dynamic performance within subsequent constant time intervals. Additionally, fatigue questionnaires were used. Results: MG patients showed a negative LT in second d2‐R testing, indicating cognitive fatigability. This finding significantly differed from stable cognitive performance in controls (P < 0.05). Results of Paced Auditory Serial Addition Test testing did not differ between groups. Self‐assessed fatigue was significantly higher in MG patients compared with controls (P < 0.001), but did not correlate with LT. Conclusions: LT quantifies cognitive fatigability as an objective measurement of performance decline in MG patients. Self‐assessed cognitive fatigue is not correlated with objective findings. Muscle Nerve 56: 449–457, 2017     

Duodenal levodopa/carbidopa infusion therapy in patients with advanced Parkinson’s disease leads to improvement in caregivers’ stress and burden

Background: Continuous duodenal levodopa infusion (DLI) is an effective therapy that improves quality of life (QoL) in advanced Parkinson’s disease (PD). However, the impact of DLI on caregivers’ stress and burden has not been reported. Methods: We evaluated prospectively open‐label seven advanced PD patients (65.7 ± 9.6 years, 71.4% men) treated with DLI. Schwab & England Activities of Daily Living Scale (ADLS), 39‐item Parkinson’s disease QoL Questionnaire Summary Index score (PDQ‐39SI), Zarit Caregiver Burden Interview (ZCBI), and Caregiver Strain Index (CSI) were used. Comparisons were made between scores obtained at baseline and those at a mean follow‐up of 31.4 ± 7.9 months (range, 23–42). Results: In patients, mean ± SD ADLS was increased from 50 ± 8.2 to 80 ± 11.6 (P = 0.014), and mean ± SD PDQ‐39SI was decreased from 53.7 ± 11.9 to 33.6 ± 12.8 (P = 0.018). In caregivers, ZCBI decreased from 43 ± 13.3 to 20.7 ± 12.1 (P = 0.018) and CSI from 6.3 ± 2.5 to 1.6 ± 0.9 (P = 0.018). At baseline, 57.1% of caregivers reported moderate to severe burden (ZCBI 41–88) compared to 28.6% at the end of the follow‐up (P = 0.015); at that time, no caregiver reported high level of stress (CSI ≥ 7) compared to 57.1% at baseline (P = 0.046). There were significant correlations between ZCBI and CSI improvement (r = 0.813, P = 0.026), ZCBI and PDQ‐39SI (r = 0.875, P = 0.01), and ZCBI and ADLS (r = 0.813, P = 0.026). Conclusions: Duodenal levodopa infusion‐related clinical improvement in patients with advanced PD leads to substantial reductions in caregivers’ stress and burden.     

Fatigue,sleepiness, and physical activity in patients with multiple sclerosis

Fatigue is a frequent and disabling symptom in patients with multiple sclerosis (MS). The objective of the study was to compare fatigue and sleepiness in MS, and their relationship to physical activity. Eighty patients with MS rated the extent of experienced fatigue (Fatigue Severity Scale, FSS) and sleepiness (Epworth Sleepiness Scale, ESS). The relationship between the scales was analysed for the scales as a whole and for single items. The clinical status of the patients was measured with the Extended Disability Status Scale (EDSS). In addition, physical activity was recorded continuously for 1 week by wrist actigraphy. The mean scores of fatigue and sleepiness were significantly correlated (FSS vs. ESS r = 0.42). Single item analysis suggests that fatigue and sleepiness converge for situations that demand self-paced activation, while they differ for situations in which external cues contribute to the level of activation. While fatigue correlated significantly with age (r = 0.40), disease severity (EDSS, r = 0.38), and disease duration (r = 0.25), this was not the case for sleepiness. Single patient analysis showed a larger scatter of sleepiness scores in fatigued patients (FSS > 4) than in non-fatigued patients. Probably, there is a subgroup of MS patients with sleep disturbances that rate high on ESS and FSS. The amount of physical activity, which was measured actigraphically, decreased with disease severity (EDSS) while it did not correlate with fatigue or sleepiness.     

Matters of fiber size and myonuclear domain: Does size matter more than age?

Introduction: The relationship between fiber size and myonuclear content is poorly understood. Methods: Biopsy cross‐sections from young and old trained and untrained healthy individuals were analyzed for fiber area and myonuclei, and 2 fiber‐size‐dependent cluster analyses were performed. Results: When comparing fibers of similar size, no effect of training or age was found for myonuclear domain. There was a linear relationship between fiber area and myonuclei per fiber (r = 0.99; P < 0.001) and a non‐linear relationship between fiber area and domain (r = 0.97–0.99; P < 0.0001), with a markedly smaller domain in fibers <3,000 µm². A higher proportion of type II fibers <3,000 µm² was observed in the old subjects. Conclusions: These findings suggest that age‐related reductions in myonuclear domain size could be explained by the greater proportion of small fibers. The data also highlight the usefulness of determining fiber‐size‐based clusters for gaining mechanistic insight into the relationship between skeletal muscle fiber size and myonuclear content. Muscle Nerve 52 : 1040–1046, 2015