Objective: Determine if NC001, an oral formulation of nicotine that reduces levodopa-induced dyskinesias (LIDs) in MPTP-Parkinson monkeys, could reduce falls, freezing of gait (FOG), and LIDs in Parkinson disease (PD) patients.Methods: Previously collected data from a study analyzing the effects of NC001 on LIDs in PD patients were reanalyzed. Because indirect-acting cholinergic drugs are sometimes helpful in reducing falls, we hypothesized that NC001, a direct-acting cholinergic agonist, could reduce falls in PD. The original 12-center, double-blind, randomized trial enrolled 65 PD patients. NC001 or placebo was administered 4 times per day for 10 weeks, beginning at 4 mg/day and escalating to 24 mg/day. Assessments included the Unified Dyskinesia Rating Scale (UDysRS) and Parts II-III of the original Unified Parkinson's Disease Rating Scale (UPDRS).Results: Randomization (1:1) resulted in 35 patients on NC001 and 30 on placebo at baseline. Thirty and 27 patients, respectively, had data available for an intent-to-treat analysis. NC001 was safe and well-tolerated. After 10 weeks, NC001 patients (14/30) had a significant reduction in falls vs. placebo patients (3/27) (p = 0.0041) as assessed by UPDRS Part II. NC001 patients (12/30) also had significantly reduced FOG vs. placebo patients (4/27) (p = 0.0043). NC001 patients, compared with placebo patients, had a significant improvement (p = 0.01) in UDysRS ambulation subtest (40% vs. 3%, respectively). Although NC001 patients had a greater reduction in dyskinesias on the UDysRS than placebo patients (30% vs. 19%, respectively), this was not significant (p = 0.09).Conclusions: NC001 significantly improved two refractory symptoms of PD, falls and FOG. The reduction in falls and FOG is attributed to selective stimulation of nicotinic receptors.Clinical Trial Registration: Conducted under IND 105, 268, serial number 0000. ClinicalTrials.gov identifier NCT00957918.

April 22, 2018April 10, 2018Free AccessNo Postural Stability Differences between Asymptomatic and Symptomatic Neurological Orthostatic Hypotension in Parkinson’s disease – A Pilot Study (P1.051)Victoria Smith, Christopher Frames, Markey Olson, Thurmon Lockhart, and Abraham LiebermanAuthors Info & AffiliationsApril 10, 2018 issue90 (15_supplement)https://doi.org/10.1212/WNL.90.15_supplement.P1.051 Letters to the Editor

Objective: The incidence and circumstances of falls in patients with Parkinson’s disease was studied longitudinally in order to better characterize falls and educate patients. Background: Falls result in serious injuries in Parkinson disease (PD) patients and the elderly. In addition to recognizing fall risks, it is important to recognize fall types: falls when standing differ from falls when walking. These differences are important in educating and training patients and caregivers in fall prevention. Design/Methods: Data were analyzed for 404 idiopathic PD patients who were followed for one year. All patients were examined using MDS-UPDRS Part III and fall diaries. Patients were assessed for fall occurrence and fall types: standing or walking. Results: Of the 404 patients, 197 (49%) did not fall, 142 (35%) fell once, and 65 (16%) fell more than once (“multiple fallers”). Fallers and non-fallers had a similar duration and severity of PD. Multiple fallers, the focus of our study, differed significantly from single fallers and non-fallers; multiple fallers had longer disease duration (p Conclusions: Patients who fell when standing generally fell when shifting their weight, such as during bending, reaching, or stretching. Patients who fell when walking fell when turning, walking through a doorway, or walking on an uneven surface. This information can be utilized to educate and train PD patients on how to avoid falls. Disclosure: Dr. Lieberman has nothing to disclose. Dr. Lockhart has nothing to disclose. Dr. Olson has nothing to disclose. Dr. Smith has nothing to disclose. Dr. Frames has nothing to disclose.

April 24, 2018April 10, 2018Free AccessEffect of NP002, a centrally acting cholinergic agent, in reducing dyskinesia, freezing of gait, and falls in patients with Parkinson’s disease (S26.007)Abraham Lieberman, Thurmon Lockhart, Markey Olson, Victoria Smith, and Christopher FramesAuthors Info & AffiliationsApril 10, 2018 issue90 (15_supplement)https://doi.org/10.1212/WNL.90.15_supplement.S26.007 Letters to the Editor

Falls are a recognized risk factor for unintentional injuries among older adults, accounting for a large proportion of fractures, emergency department visits, and urgent hospitalizations. Human balance and gait research traditionally uses linear or qualitative tests to assess and describe human motion; however, human motion is neither a simple nor a linear process. The objective of this research is to identify and to learn more about what factors affect balance using nonlinear dynamical techniques, such as basin boundaries. Human balance data was collected using dual force plates for leans using only ankle movements as well as for unrestricted leans. Algorithms to describe the basin boundary were created and compared based on how well each method encloses the experimental data points as well as captures the differences between the two leaning conditions.