Televisits are a valuable tool for Parkinson’s disease (PD) follow-up; however, their implementation is hindered by a fragmented evidence base. This narrative review synthesizes 41 articles (31 observational, 10 comparative) spanning three decades, categorizing findings into three domains: feasibility, clinical outcomes, and efficiency. Results indicate high feasibility with visit completion frequently exceeding 70

Gait disturbances represent a prominent feature of Functional Movement Disorders (FMD), but their characterization with respect to both healthy individuals (HC) and patients with organic motor disorders remains incomplete. The present study compared gait performance among 75 patients with FMD, 40 patients with organic motor disorders, and 75 HC. Participants performed walking trials under single-task and dual-task conditions (motor, cognitive, and visual) while gait parameters were captured using a 3D motion analysis system. Results showed that patients with FMD exhibited impaired gait compared with HC across all conditions. FMD patients versus HC displayed longer stride and stance times, reduced stride length, slower walking speed, and increased variability. However, in most parameters, FMD patients performed better than those with organic motor disorders, who displayed the most severe gait pattern.

The latest tremor classification suggested to stratify patients with Essential Tremor (ET) into pure (pET) and plus (ET-plus) forms. Cognitive dysfunction in ET might reflect the Cerebellar Cognitive Affective Syndrome (CCAS), but there is no evidence in ET-plus. We aimed to evaluate the CCAS in ET-plus, further attempting to explore possible motor-cognitive associations.Thirty-nine patients with ET-plus and 19 matched healthy controls (HC) performed the CCAS-scale (CCAS-S). Patients were also assessed using the Tremor Research Group Essential Tremor Rating Scale and the Scale for the Assessment and Rating of Ataxia. Moreover, data about their soft signs were recorded. The obtained data were further compared to a published series of pET. Patients with ET-plus had worse CCAS-S performances than HC, with 69.4% of the former having a definite CCAS. Cognitive performances did not correlate with any of the clinical data, but with the presence of slowing. While the rate of definitive CCAS was similar between pET and ET-plus, they demonstrated different cognitive profiles. Poorer CCAS-S performance had a detrimental impact on activity of daily living beyond tremor severity. Our results demonstrate a pervasive cognitive impairment in ET-plus, possibly sustained by a cerebellar dysfunction. However, the association of cognitive deficits with the presence of slowing and the qualitative differences between ET-plus and pET might suggest a more widespread pathology with the involvement of extra-cerebellar brain areas, indicating that they reflect two different entities.

Gut microbiota changes and brain-gut-axis (BGA) dysregulation are common in people with Parkinson’s Disease (PD). Probiotics and prebiotics are emerging as a potential therapeutic approach for PD patients. The aim of this paper was to assess the neurological and gastroenterological effects in PD patients with constipation after the administration of a synbiotic product, with a focus on behavioral and cognitive symptoms. We enrolled patients with stable PD who met diagnostic criteria for functional constipation and/or irritable bowel syndrome with constipation according to Rome IV Criteria. Patients received a synbiotic treatment (Enterolactis Duo, containing the probiotic strain Lacticaseibacillus paracasei DG and the prebiotic fiber inulin) for 12 weeks. A neurological and a gastroenterological evaluation were collected before and after the treatment. In addition, 16S rRNA gene profiling and short chain fatty acid quantification were performed to characterize the microbial ecosystem of fecal samples collected before (n = 22) and after (n = 9) the synbiotic administration. 30 patients were consecutively enrolled. After treatment, patients performed better in MDS-UPDRS part 1 (p = 0.000), SCOPA-AUT (p = 0.001), TAS-20 (p = 0.014), HAM-D (p = 0.026), DIFt (p = 0.003), PAS-A (p = 0.048). Gastroenterological evaluations showed improvements in PAC-SYM score (p < 0.001), number of complete bowel movement (p < 0.001) and BSFS (p < 0.001). After the synbiotic administration, we observed a significant increase in the abundance of the order Oscillospirales, as well as the Oscillospiraceae family and the species Faecalibacterium prausnitzii within this order in fecal samples. Synbiotic treatment demonstrates potential efficacy in ameliorating non-motor features in PD patients.

Background: Pain in a common symptom in adult-onset idiopathic dystonia (AOID). An appropriate tool to understand this symptom is needed to improve AOID patients’ care. We developed a rating instrument for pain in AOID and validated it in cervical dystonia (CD). Methods: Development and validation of the Pain in Dystonia Scale (PIDS) in three phases: 1. International experts and participants generated and evaluated the preliminary items for content validity; 2. The PIDS was drafted and revised, followed by cognitive interviews to ensure suitability for self-administration; and 3. the clinimetric properties of the final PIDS were assessed in 85 participants. Results: PIDS evaluates pain severity (by body part), functional impact and external modulating factors. It showed high test-retest reliability the total score (0.9, p<0.001), intraclass correlation coefficients higher than 0.7 for all items and high internal consistency (Cronbach’s alpha 0.9). Convergent validity analysis revealed a strong correlation between the PIDS severity score and the TWSTRS pain subscale (0.8, p<0.001), the brief pain inventory short form (0.7, p<0.001) and impact of pain on daily functioning (0.7, p<0.001). Conclusions: The PIDS is the first specific questionnaire developed to evaluate pain in patients with AOID with high-level clinimetric properties in people with CD.

Introduction Bipolar Disorder (BD) has been suggested to be a risk factor for development of Parkinson Disease. Psychiatric drugs used as standard treatment of BD includes many drugs that are known to induce drug-induced parkinsonism (DIP). Objectives Clinical differentiation between PD and DIP is a clinical and scientific crucial result. It might be aided by functional neuroimaging of the dopaminergic nigrostriatal pathway. Methods Twenty consecutive BD patients with parkinsonism were clinically assessed and underwent 123 I-ioflupane dopamine transporter SPECT. Imaging data of BD patients with pathological nigrostriatal pathway were further compared to a population of de-novo PD patients. Results Four BD patients had abnormal scans; they had higher putaminal binding ratio and putamen-to-caudate ratios than PD patients, despite similar motor symptom burden. Conclusions in our initial results, up to 20% of BD patients with parkinsonism might have an underlying dopaminergic deficit, which is higher than excepted in the general population. This evidences supports that BD represents a risk factor for subsequent development of neurodegenerative parkinsonism. Disclosure of Interest None Declared

Background: Pain in a common symptom in adult-onset idiopathic dystonia (AOID). An appropriate tool to understand this symptom is needed to improve AOID patients’ care. We developed a rating instrument for pain in AOID and validated it in cervical dystonia (CD). Methods: Development and validation of the Pain in Dystonia Scale (PIDS) in three phases: 1. International experts and participants generated and evaluated the preliminary items for content validity; 2. The PIDS was drafted and revised, followed by cognitive interviews to ensure suitability for self-administration; and 3. the clinimetric properties of the final PIDS were assessed in 85 participants. Results: PIDS evaluates pain severity (by body part), functional impact and external modulating factors. It showed high test-retest reliability the total score (0.9, p<0.001), intraclass correlation coefficients higher than 0.7 for all items and high internal consistency (Cronbach’s alpha 0.9). Convergent validity analysis revealed a strong correlation between the PIDS severity score and the TWSTRS pain subscale (0.8, p<0.001), the brief pain inventory short form (0.7, p<0.001) and impact of pain on daily functioning (0.7, p<0.001). Conclusions: The PIDS is the first specific questionnaire developed to evaluate pain in patients with AOID with high-level clinimetric properties in people with CD.

OBJECTIVE:The contribution of psychological and psychiatric symptoms in the development of Functional Neurological Disorders (FND) is unclear. We therefore aimed to investigate the role of different attachment styles (AS) and their relationship with psychiatric symptoms in FND patients as compared with both subjects with neurological disorders (ND) and healthy controls (HC); and the possible differences between patients with functional movement disorders (FMD) and with functional seizures.METHODS:In this case-control study, forty-six patients with FND were compared to 34 with ND and 30 HC, by means of an extensive battery to investigate the presence of alexithymia, depression, anxiety, dissociation and to explore their AS using the Revised Experiences in Close Relationships instrument (ECR-R).RESULTS:Patients with FND had higher depression and alexithymia as well as an avoidant pattern on the ECR-R than patients with ND. In the FND group, ECR-R avoidance was an independent predictor of psychiatric symptoms and, altogether, ECR-R avoidance, the somatic-affective component of depression and difficulty identifying feelings were independent predictors of FND. Gender, anxiety and difficulty identifying feelings predicted the presence of functional seizures.CONCLUSION:The avoidant AS may be an important psychological factor influencing the presence of mood disorders and alexithymia. Their co-occurence might drive maladaptive responses underlying the presence of FND. Although we demonstrated a large overlap between FND phenotypes, patients with functional seizures might have higher alexithymia, which in turn could explain a defensive response less anchored to body reactions and physical symptoms.