David Arkadir

• MD PhD
• Medical Doctor at Hadassah Medical Center

Carriers of Gaucher disease have an increased risk of developing Parkinson’s disease (PD). Identifying PD in its prodromal stage is crucial, as early detection before motor symptoms appear allows for potential interventions to salvage neurons and slow or prevent disease progression. At the Gaucher unit at Shaare Zedek Medical Center, we are followi...

INTRODUCTION In patients with cervical (focal) versus generalized dystonia, optimal Deep Brain Stimulation (DBS) target sites (within pallidothalamic loop) are thought to diverge and be specific for particular connections. METHODS This is a sub-analysis of patients with focal (cervical) dystonia only or cervical dystonia in context of segmental or...

Background Elevated low‐frequency activity (4–12 Hz) within the globus pallidus internus (GPi) has been consistently associated with dystonia. However, the impacts of the genetic etiology of dystonia on low‐frequency GPi activity remain unclear; yet it holds importance for adaptive deep brain stimulation (DBS) treatment. Methods We compared the pr...

Objective: Genetic dystonia is a complex movement disorder with diverse clinical manifestations resulting from pathogenic mutations in associated genes. A recent paradigm shift emphasizes the functional convergence among dystonia genes, hinting at a shared pathomechanism. However, the neural dynamics supporting this convergence remain largely unexp...

Background Compensatory mechanisms in Parkinson's disease (PD) are thought to explain the temporal delay between the beginning of the neurodegenerative process and the appearance of clinical signs. The enhanced structural integrity of the corticospinal tract was previously suggested as one of these mechanisms. Objective To understand the relations...

Estimates of the spectrum and frequency of pathogenic variants in Parkinson’s disease (PD) in different populations are currently limited and biased. Furthermore, although therapeutic modification of several genetic targets has reached the clinical trial stage, a major obstacle in conducting these trials is that PD patients are largely unaware of t...

Aim: Neurological manifestations are common in patients with chronic liver diseases. This study aimed to depict the association between liver cirrhosis and Parkinson’s disease (PD) and propose a clinically relevant diagnostic scheme. Methods: We examined patients’ medical records with PD and chronic liver impairment secondary to cirrhosis or liver...

Early, simple predictors for long-term survival in Parkinson’s disease (PD) may help identify patients at elevated risk and are crucial for more personalized treatment. This large, retrospective study examined whether higher levodopa equivalent daily dose (LEDD) a year after diagnosis predicts long-term survival. Mortality risk was increased among...

The subthalamic nucleus (STN) is pivotal in basal ganglia function in health and disease. Micro-electrode recordings of >25,000 recording sites from 146 Parkinson’s patients undergoing deep brain stimulation (DBS) allowed differentiation between subthalamic input, represented by local field potential (LFP), and output, reflected in spike discharge...

Parkinson's disease (PD) is a progressive neurodegenerative disorder dominated by motor and non-motor dysfunction. Despite extensive research, the in vivo characterization of PD-related microstructural brain changes remains an ongoing challenge, limiting advancements in diagnostic and therapeutic strategies. The putamen, a critical structure within...

Individuals with Parkinson's disease (PD) may exhibit impaired emotion perception. However, research demonstrating this decline has been based almost entirely on the recognition of isolated emotional cues. In real life, emotional cues such as expressive faces are typically encountered alongside expressive bodies. The current study investigated emot...

Genetic subtyping of patients with Parkinson's disease (PD) may assist in predicting the cognitive and motor outcomes of subthalamic deep brain stimulation (STN‐DBS). Practical questions were recently raised with the emergence of new data regarding suboptimal cognitive outcomes after STN‐DBS in individuals with PD associated with pathogenic variant...

Parkinson’s disease (PD) is the fastest-growing neurodegenerative disorder, currently affecting ~7 million people worldwide. PD is clinically and genetically heterogeneous, with at least 10% of all cases explained by a monogenic cause or strong genetic risk factor. However, the vast majority of our present data on monogenic PD is based on the inves...

Both local field potentials (LFP) and spiking (SPK) activity in the subthalamic nucleus (STN) are related to Parkinson's disease (PD) symptoms; however, their relationship is poorly understood. We explore it by separating STN signals of 146 PD patients (308 trajectories, >25,000 recording sites) into aperiodic and periodic components and whitening...

Background: As gene-targeted therapies are increasingly being developed for Parkinson's disease (PD), identifying and characterizing carriers of specific genetic pathogenic variants is imperative. Only a small fraction of the estimated number of subjects with monogenic PD worldwide are currently represented in the literature and availability of cl...

Background: It is unknown whether Parkinson's disease (PD) genetic heterogeneity, leading to phenotypic and pathological variability, is also associated with variability in the unique PD electrophysiological signature. Such variability might have practical implications for adaptive deep brain stimulation (DBS). Objective: The aim of our work was...

Background While treatment with levodopa remains the cornerstone of Parkinson's disease (PD) management, chronic oral therapy is often associated with the development of motor complications, that correlate to fluctuating levodopa plasma concentrations, limiting its clinical utility. Continuous infusion is considered to be the optimal delivery route...

Carriers of GBA1 gene variants have a significant risk of developing Parkinson’s disease (PD). A cohort study of GBA carriers between 40–75 years of age was initiated to study the presence of prodromal PD features. Participants underwent non-invasive tests to assess different domains of PD. Ninety-eight unrelated GBA carriers were enrolled (43 male...

Parkinson’s disease (PD) is taking a staggering toll on healthcare systems worldwide, with the bulk of the expenditures invested in the late stages of the disease. Considering the rising life expectancy and the increasing prevalence of PD across the globe, a clear understanding of the early signs and treatment options available for advanced PD (APD...

Purpose/background: Tardive dyskinesia (TD) is a hyperkinetic movement disorder caused by exposure to dopamine-receptor blockers. Data on TD burden in Israel are scarce. This analysis assesses the clinical and economic burden of TD in Israeli patients. Methods/procedures: This retrospective analysis used a national health plan database (Maccabi...

Omaveloxolone (RTA408) is a second-generation oleanane triterpenoid Nrf2 inducer with antioxidant and anti-inflammatory properties and was reported to improve mitochondrial bioenergetics. It is currently being tested in medical trials for Friedrich ataxia, a genetic, multi-organ disease involving mitochondrial dysfunction. Thus, omaveloxolone could...

Mannitol, a natural alcoholic-sugar, was recently suggested as a potential disease-modifying agent in Parkinson's disease. In animal models of the disease, mannitol interferes with the formation of α-synuclein fibrils, inhibits the formation of α-synuclein oligomers and leads to phenotypic recovery of impaired motor functions. Parkinson's patients...

Introduction: Precise lead localization is crucial for an optimal clinical outcome of subthalamic nucleus (STN) deep brain stimulation (DBS) treatment in patients with Parkinson's disease (PD). Currently, anatomical measures, as well as invasive intraoperative electrophysiological recordings, are used to locate DBS electrodes. The objective of this...

Background: Continuous, subcutaneous (SC) levodopa/carbidopa infusion with ND0612 is under development as a treatment for patients with Parkinson's disease (PD) and motor fluctuations. Objective: Evaluate 1-year safety data. Methods: BeyoND is an open-label study evaluating the long-term safety of two ND0612 dosing regimens. Results: Of the...

Objective To report the association between type 1 Gaucher disease (GD1) and amyotrophic lateral sclerosis (ALS) in 3 unrelated families and to explore whether GBA variants influence the risk of ALS. Methods We conducted retrospective chart reviews of patients with GD1 or their family members diagnosed with ALS. To further investigate whether ther...

Biallelic pathogenic variants in PRKN (PARK2), encoding the E3 ubiquitin ligase parkin, lead to early-onset Parkinson's disease. Structural variants, including duplications or deletions, are common in PRKN due to their location within the fragile site FRA6E. These variants are readily detectable by copy number variation analysis. We studied four si...

Objective. Adaptive deep brain stimulation (aDBS) based on subthalamic nucleus (STN) electrophysiology has recently been proposed to improve clinical outcomes of DBS for Parkinson’s disease (PD) patients. Many current models for aDBS are based on one or two electrophysiological features of STN activity, such as beta or gamma activity. Although thes...

Low penetrance of Parkinson’s disease (PD) associated with GBA pathogenic variants indicates the presence of modifiers genes. Clusters of PD cases in certain families with GBA variants would serve as a strong evidence for the clinical relevance of such modifiers. We studied eight family trees of non-Parkinsonian, GBA-N370S homozygote, Gaucher proba...

Background Ambroxol hydrochloride is being used in respiratory diseases as a broncholytic therapy. Beta-Glucosylceramide (GC) is a naturally occurring glycosphingolipid that exerts an immune protective effect. The aim of the present study was to determine the synergistic immunomodulatory effect between these two compounds. Methods Immune-mediated...

Background: Lymphoma of the nervous system is rare and usually involves the brain, spinal cord, or peripheral nerves. Hence, it has varied clinical presentations, and correct diagnosis is often challenging. Incorrect diagnosis delays the appropriate treatment and affects prognosis. We report 5 patients with delayed diagnosis of lymphoma involving...

Type-1 Gaucher disease (GD1) is considered to be non- neuronopathic however recent evidence of neurological involvement continues to accumulate. There is limited evidence of retinal abnormalities in GD1. The purpose of this study was to evaluate the retinal findings of patients with GD1. Thirty GD1 individuals and 30 healthy volunteers between the...

Tremor is a core feature of Parkinson's disease and the most easily recognized parkinsonian sign. Nonetheless, its pathophysiology remains poorly understood. Here, we show that multispectral spiking activity in the posterior-dorso-lateral oscillatory (motor) region of the subthalamic nucleus distinguishes resting tremor from the other Parkinsonian...

Patients with DYT1 dystonia caused by the mutated TOR1A gene exhibit risk neutral behaviour compared to controls who are risk averse in the same reinforcement learning task. It is unclear whether this behaviour can be linked to changes in cortico-striatal plasticity demonstrated in animal models which share the same TOR1A mutation. We hypothesised...

Neuronopathic Gaucher disease (nGD) has a very wide clinical and genotypic spectrum. However, there is no consensus definition of nGD, including no description of how best to diagnostically separate the acute form—Gaucher type 2—from the subacute or chronic form—Gaucher type 3. In this article, we define the various forms of Gaucher disease with pa...

Background A wide variety of conversion factors for a levodopa-equivalent-dose (LED) have been proposed for each Parkinson’s disease (PD) medication. The currently-used set of conversion factors is based on studies that relied on subjective experience or theoretical assumptions. This set was never validated in patients receiving polytherapy. Objec...

The subthalamic nucleus (STN), a preferred target for treating movement disorders, has a crucial role in inhibition and execution of movement. To better understand the mechanism of movement regulation in the STN of Parkinson's disease patients, we compared the same movement with different context, facilitation vs. inhibition context. We recorded su...

Patients with dystonia caused by the mutated TOR1A gene exhibit a risk neutral behaviour compared to controls who are risk averse in the same reinforcement learning task. We hypothesised this increased risk taking could be reproduced by a reinforcement learning model which included biologically realistic striatal plasticity learning rules. We aimed...

Background: Therapeutic outcomes of STN-DBS for movement and psychiatric disorders depend on electrode location within the STN. Electrophysiological and functional mapping of the STN has progressed considerably in the past years, identifying beta-band oscillatory activity in the dorsal STN as a motor biomarker. It also has been suggested that STN...

Objective: To determine whether blood cells expressed α-Syn can differentiate Parkinson's disease (PD) from healthy controls (HC). Methods: The concentrations of α-Syn were determined in samples of blood cell pellets using a quantitative Lipid-ELISA assay. In addition, the levels of total protein, hemoglobin, iron and H-ferritin were determined....

Objective: To develop, apply, and evaluate, a novel web-based classifier for screening for Parkinson disease among a large cohort of search engine users. Methods: A supervised machine learning classifier learned to distinguish web users with self-reported Parkinson's disease from controls based on their interactions with a search engine (Bing, M...

The introduction of disease-specific therapy for patients with type I Gaucher disease (GD1) was a revolution in the management of patients, but not without cost. Thus, the management of mildly affected patients is still debated. We herein report a long-term follow-up (median (range) of 20 (5–58) years) of 103 GD1 patients who have never received en...

Purpose of Review Until recently, the gene associated with the recessive form of familial brain calcification (PFBC, Fahr disease) was unknown. MYORG, a gene that causes recessive PFBC was only recently discovered and is currently the only gene associated with a recessive form of this disease. Here, we review the radiological and clinical findings...

Introduction: Treatment-resistant obsessive-compulsive disorder (OCD) is considered a severe psychiatric disorder that causes severe functional decline. In the past, these patients were treated by selective ablation of neuronal pathways related to the pathophysiology of OCD. Deep brain stimulation is an effective and safe treatment alternative tha...

Background Individuals with GBA (glucocerebrosidase) mutations are at increased risk of Parkinson's disease (PD). It is still debated, however, whether this increased risk results from impaired glucocerebrosidase activity leading to substrate accumulation. Comparing the presence of prodromal PD marker in GBA mutation carriers and in Gaucher patient...

Objective To investigate the genetic basis of the recessive form of primary familial brain calcification and study pathways linking a novel gene with known dominant genes that cause the disease. Methods Whole exome sequencing and Sanger‐based segregation analysis were used to identify possible disease causing mutations. Mutation pathogenicity was...

Figure S1 Additional brain CT (A) and MRI images (B) demonstrating hypointense signal in susceptibility weighted images (SWI) and FLAIR hyperintensity.

Figure S2. Protein modeling. D353 of the wild‐type MYORG (blue sticks) along with the equivalent position, D306, in the Escherichia coli homolog YicI (PDB model 2F2H) in yellow sticks.

Table S2. Disease characteristics of individuals with a homozygous MYORG mutation. Severity of neurological signs is qualitatively scored from mild (+) to severe (++++).

Table S1. Region and severity of brain calcification observed in individuals with a homozygous MYORG mutation. Extent of calcifications is qualitatively scored from mild (+) to severe (+++).

Parkinson's disease (PD) is a slowly progressing neurodegenerative disease with early manifestation of motor signs. Recently, there has been a growing interest in developing automatic tools that can assess motor function in PD patients. Here we show that mouse tracking data collected during people's interaction with a search engine can be used to d...

To better understand the mechanism of movement facilitation and inhibition in the subthalamic nucleus (STN), we recorded subthalamic multiunit activity intra-operatively while parkinsonian patients (n=43 patients, 173 sites) performed increasingly complex oddball paradigms: auditory (‘None-Go’, n=7, 28), simple movement (‘All-Go’, n=7, 26) and move...

Obsessive-compulsive disorder (OCD) is a common and serious psychiatric disorder. Although subthalamic nucleus deep brain stimulation (DBS) has been studied as a treatment for OCD patients the underlying mechanism of this treatment and the optimal method of stimulation are unknown. To study the neural basis of subthalamic nucleus DBS in OCD patient...

Parkinson's disease (PD) is a slowly progressing neurodegenerative disease with early manifestation of motor signs. Recently, there has been a growing interest in developing automatic tools that can assess motor function in PD patients. Here we show that mouse tracking data collected during people's interaction with a search engine can be used to d...

Subcallosal Brodmann's Area 25 (Cg25) Deep Brain Stimulation (DBS) is a new promising therapy for treatment resistant major depressive disorder (TR-MDD). While different DBS stimulating parameters may have an impact on the efficacy and safety of the therapy, there is no data to support a protocol for optimal stimulation parameters for depression. H...

Background Evidence for the effects of Parkinson disease on energy expenditure is incomplete and contradictory. A number of studies showed increased resting energy expenditure among patients with Parkinson disease whereas others did not. It was hypothesized that energy expenditure increases during exercise, based on findings in patients with a vari...

Table S1. Physical Activity Scale for the Elderly (PASE)

Classical models of the basal ganglia (BG) depict them as closed cortex–BG–cortex loops. The motor cortex activity is driven by the opposite effects of dopamine on the excitability of striatal projection neurons expressing D1 and D2 dopamine receptors and the subsequent change in discharge rate of neurons in the direct and indirect BG pathways. Mor...

Background: Subthalamic nucleus field potentials have attracted growing research and clinical interest over the last few decades. However, it is unclear whether subthalamic field potentials represent locally generated neuronal subthreshold activity or volume conductance of the organized neuronal activity generated in the cortex. Objective: This...

Histone lysine methylation, mediated by mixed-lineage leukemia (MLL) proteins, is now known to be critical in the regulation of gene expression, genomic stability, cell cycle and nuclear architecture. Despite MLL proteins being postulated as essential for normal development, little is known about the specific functions of the different MLL lysine m...

Both patients with non-neuronopathic Gaucher disease (GD) and heterozygous GBA mutation carrier are at increased risk for Parkinson's disease (PD). The risk for PD in these groups does not linearly increase with glucosylceramide (GC) accumulation or with acid β-glucocerebrosidase (GCase) activity. This observation, together with other clinical syst...

Heterozygote GBA (glucosylceramidase beta) mutations increase the risk of Parkinson's disease (PD). Data based on the measured frequencies of GBA mutated alleles in the healthy population suggest that severe GBA mutations are associated with even higher risk for PD. These data, however, are prone to methodological biases resulting from the rarity o...

Classical rate models of basal ganglia circuitry associate discharge rate of the globus pallidus external and internal segments (GPe, GPi respectively) solely with dopaminergic state and predict an inverse ratio between the discharge rates of the two pallidal segments. By contrast, the effects of other rate modulators such as general anesthesia (GA...

One of Parkinson’s disease early symptoms is called hypomimia (masked facies), and timely detection of this symptom could potentially assist early diagnosis. In this study we developed methods to automatically detect and assess the severity of hypomimia, using machine learning tools and a 3D sensor that allows for fairly accurate facial movements t...