Clinical Characteristics of Coronavirus Disease 2019 (COVID-19) among Patients at a Movement Disorders Center

It is not established whether SARS-CoV-2 (COVID-19) patients with movement disorders, are at greater risk for more serious outcomes than the larger COVID-19 population beyond the susceptibility associated with greater age. We reviewed electronic health records and conducted telephone interviews to collect the demographics and clinical outcomes of patients seen at our Movement Disorders Center who tested positive for COVID-19 from 8 March 2020 through 6 June 2020. Thirty-six patients were identified, 23 men and 13 women, median age of 74.5 years. They primarily carried diagnoses of idiopathic Parkinson disease (n = 22; 61%) and atypical parkinsonism (n = 7; 19%) with the balance having other diagnoses. Twenty-seven patients (75%) exhibited alteration in mental status and fifteen (42%) had abnormalities of movement as common manifestations of COVID-19; in 61% and 31%, respectively, these were the presenting symptoms of the disease. Sixty-seven percent of patients in our cohort required hospitalization, and the mortality rate was 36%. These data demonstrate that in patients with movement disorders, the likelihood of hospitalization and death after contracting COVID-19 was greater than in the general population. Patients with movement disorders frequently presented with altered mental status, generalized weakness, or worsening mobility but not anosmia.

Clinical Characteristics of Coronavirus disease 2019 (COVID-19) Among Patients at a Movement Disorders Center

It is not established whether SARS-CoV-2 (COVID-19) patients with movement disorders, are at greater risk for more serious outcomes than the larger COVID-19 population beyond the susceptibility associated with greater age. We reviewed electronic health records and conducted telephone interviews to collect the demographics and clinical outcomes of patients seen at our Movement Disorders Center who tested positive for COVID-19 from 8 March 2020 through 6 June 2020. Thirty-six patients were identified, 23 men and 13 women, median age of 74.5 years. They primarily carried diagnoses of idiopathic Parkinson disease (n=22; 61%) and atypical parkinsonism (n=7; 19%) with the balance having other diagnoses. Twenty-seven patients (75%) exhibited alteration in mental status and fifteen (42%) had abnormalities of movement as common manifestations of COVID-19; in 61% and 31%, these were the presenting symptoms of the disease. 67% of patients in our cohort required hospitalization, and the mortality rate was 39%.. These data demonstrate that in patients with movement disorders, the likelihood of hospitalization and death after contracting COVID-19 was substantially greater than in the general population. Patients with movement disorders frequently presented with altered mental status, generalized weakness, or worsening mobility but not anosmia.

Deep Brain Stimulation Targeting the Ventral Intermediate Nucleus of the Thalamus for Parkinsonian Tremor and Later Adding the Globus Pallidus Interna for Parkinson Disease Features

Deep brain stimulation (DBS) targeting the ventral intermediate (Vim) nucleus of thalamus has been established as an effective therapy for patients with debilitating essential tremor. However, some patients initially diagnosed with essential tremor (ET) later develop idiopathic Parkinson disease (PD), and Vim DBS is not as effective for other PD-related symptoms, including bradykinesia, rigidity, and dyskinesia. This chapter describes a patient with PD who initially presented with debilitating right-dominant tremor that was misdiagnosed as ET. He received bilateral Vim DBS with good tremor control. Two years later, he received bilateral globus pallidus internus (GPi) DBS for progression of his PD, and he has been reporting adequate relief of his PD symptoms. For patients with debilitating tremor, but relatively mild or no parkinsonian symptoms on presentation, after medical trials have been administered, a Vim DBS is a reasonable option for tremor relief. A second DBS placement targeting the GPi or subthalamic nucleus (STN) may be considered if more parkinsonian symptoms evolve and progress.

Using Crowdsourced Listeners' Ratings to Measure Speech Changes in Hypokinetic Dysarthria: A Proof-of-Concept Study

Purpose Interventions for speech disorders aim to produce changes that are not only acoustically measurable or perceptible to trained professionals but are also apparent to naive listeners. Due to challenges associated with obtaining ratings from suitably large listener samples, however, few studies currently evaluate speech interventions by this criterion. Online crowdsourcing technologies could enhance the measurement of intervention effects by making it easier to obtain real-world listeners' ratings. Method Stimuli, drawn from a published study by Sapir et al. (“Effects of intensive voice treatment (Lee Silverman Voice Treatment [LSVT]) on vowel articulation in dysarthric individuals with idiopathic Parkinson disease: Acoustic and perceptual findings” in Journal of Speech, Language, and Hearing Research, 50 (4), 2007), were words produced by individuals who received intensive treatment (LSVT LOUD) for hypokinetic dysarthria secondary to Parkinson's disease. Thirty-six online naive listeners heard randomly ordered pairs of words elicited pre- and posttreatment and reported which they perceived as “more clearly articulated.” Results Mixed-effects logistic regression indicated that words elicited posttreatment were significantly more likely to be rated “more clear.” Across individuals, acoustically measured magnitude of change was significantly correlated with pre–post difference in listener ratings. Conclusions These results partly replicate the findings of Sapir et al. (2007) and demonstrate that their acoustically measured changes are detectable by everyday listeners. This supports the viability of using crowdsourcing to obtain more functionally relevant measures of change in clinical speech samples. Supplemental Material https://doi.org/10.23641/asha.12170112