Florin Gandor

• associate Professor, MD, PD habil
• Neurologist at Macquarie University

Background Delineation of Parkinson's disease (PD) from multiple system atrophy (MSA) can be challenging in early disease stages. Speech characteristics have been studied as digital biomarkers in PD and ataxias. Currently, data on speech in MSA is limited. Objectives To determine whether speech characteristics can serve as a digital biomarker to d...

Background Motor fluctuations are routinely documented using the Parkinson's disease (PD) home diary. However, the validity of this diary when compared to clinical observers is limited. Objective This study disassembled the effects of nonmotor symptoms (NMS) on inter‐method agreement between the PD home motor diary and clinical observers (outside...

Background Patients with Progressive Supranuclear Palsy (PSP) suffer from several neuropsychological impairments. These mainly affect the frontal lobe and subcortical brain structures. However, a scale for the assessment of cognitive and neuropsychiatric disability in PSP is still missing. Objectives To create and validate a new scale for cognitiv...

Background The recent Movement Disorders Society (MDS)‐progressive supranuclear palsy (PSP) diagnostic criteria conceptualized three clinical diagnostic certainty levels: “suggestive of PSP” for sensitive early diagnosis based on subtle clinical signs, “possible PSP” balancing sensitivity and specificity, and “probable PSP” highly specific for PSP...

Background Pain fluctuations are a characteristic phenomenon in advanced Parkinson’s disease (PD), but their temporal association with motor and non-motor symptom (NMS) fluctuations remains largely enigmatic. Moreover, data on their importance for disease severity perception and health-related quality-of-life (hr-QoL) is limited. Objective To diss...

Disease-modifying therapeutics in the α-synucleinopathies multiple system atrophy (MSA) and Parkinson’s Disease (PD) are in early phases of clinical testing. Involving patients’ preferences including therapy-associated risk willingness in initial stages of therapy development has been increasingly pursued in regulatory approval processes. In our st...

Objective The Progressive Supranuclear Palsy quality of life scale (PSP‐QoL) has been shown to be a useful tool for capturing health‐related quality of life of patients in “everyday life” and in progressive supranuclear palsy (PSP) research. However, at 45 items in length, the questionnaire can take a long time, exhausting PSP patients, in particul...

Background. Pain is common in Parkinson’s disease (PD) and impairs quality of life. The King’s PD pain questionnaire (KPPQ) is a standardized, reliable, and valid self-administered questionnaire for screening of pain in PD. We developed a linguistically validated German version of the KPPQ and applied it to a cohort with fluctuating PD. Methods. Th...

Background Visual acuity and image stability are crucial for daily activities, particularly during head motion. The vestibulo-ocular reflex (VOR) and its suppression (VORS) support stable fixation of objects of interest. The VOR drives a reflexive eye movement to counter retinal slip of a stable target during head motion. In contrast, VORS inhibits...

Background: Delineation of Parkinson’s disease (PD) from multiple system atrophy (MSA) can be challenging, especially in early disease stages, and clinical markers are needed for early detection of MSA. Speech characteristics have been studied as digital biomarkers in PD and ataxias, but there is only little data on MSA. Objectives: To determine w...

Background Multiple system atrophy (MSA) is a complex and fatal neurodegenerative movement disorder. Understanding the comorbidities and drug therapy is crucial for MSA patients’ safety and management. Objectives To investigate the pattern of comorbidities and aspects of drug therapy in MSA patients. Methods Cross-sectional data of MSA patients a...

Flexible Endoscopic Evaluation of Swallowing (FEES) is one of two diagnostic gold standards for pharyngeal dysphagia in Parkinson's disease (PD), however, validated global outcome measures at the patient level are widely lacking. The Dynamic Imaging Grade of Swallowing Toxicity for Flexible Endoscopic Evaluation of Swallowing (DIGEST-FEES) represen...

Advanced Parkinson’s disease (PD) is characterized by motor fluctuations including unpredictable oscillations remarkably impairing quality of life. Effective management and development of novel therapies for these response fluctuations largely depend on clinical rating instruments such as the widely-used PD home diary, which are associated with bia...

Background Progressive supranuclear palsy (PSP) is usually diagnosed in elderly. Currently, little is known about comorbidities and the co-medication in these patients. Objectives To explore the pattern of comorbidities and co-medication in PSP patients according to the known different phenotypes and in comparison with patients without neurodegene...

Introduction: Foslevodopa/foscarbidopa, a soluble formulation of levodopa/carbidopa (LD/CD) prodrugs for the treatment of Parkinson's disease (PD), is administered as a 24-hour/day continuous subcutaneous infusion (CSCI) with a single infusion site. The efficacy and safety of foslevodopa/foscarbidopa versus oral immediate-release LD/CD was previou...

Dysphagie ist ein klinisch relevan- tes Problem bei Parkinson-Syndro- men. Das umfasst neben der idio- pathischen Parkinson-Erkrankung auch die atypischen Parkinson- Syndrome. Bei allen Parkinson- Syndromen ist das Dysphagie-be- dingt erhöhte Aspirationsrisiko mit einer reduzierten Lebensquali- tät assoziiert, und Aspirationsp- neumonien sind ebenf...

Objectives. Recent studies showed only fair agreement between observer and patients’ motor state assessments on the Parkinson’s disease (PD) home diary (HD). This could possibly be explained by the patients’ insufficient knowledge about motor fluctuations. Therefore, the study is aimed at investigating the effect of structured training concerning m...

Dysphagia is a clinically relevant problem in Parkinson's disease as well as in atypical Parkinsonian syndromes, such as multiple system atrophy and diseases from the spectrum of 4‑repeat tauopathies, which affect most patients to a varying degree in the course of their disease. This results in relevant restrictions in daily life due to impaired in...

Background Parkinson’s disease (PD) is a progressive, neurodegenerative disorder. In the advanced stages it can result in severe disability despite optimal treatment. Data suggests heterogeneous classification of PD stages among physicians in different countries. The purpose of the OBSERVE-PD study was to evaluate the proportion of patients with ad...

Up to 80% of patients with Parkinson’s disease suffer from a wide range of sleep disorders in all stages of the disease. While restless legs syndrome as one contributor to a disturbed night sleep can be present at any stage in the disease, sleep disturbances in the advanced stages of Parkinson’s disease are usually linked to motor impairment during...

Background The Parkinson Disease (PD) Home Diary (HD) is a commonly used clinical outcome measure, but it has not been extensively compared to direct assessments by experienced observers. Objective Validation of patient-reported HD by investigating the agreement between motor state assessments by patients and observers. Methods This observational...

The Parkinson’s disease (PD) home diary is frequently used in clinical trials to measure efficacy of medical treatments for motor fluctuations in advanced PD. This prospective study in fluctuating PD patients examines the validity of the diary for quantification of motor states in comparison to direct clinical observation. 51 patients (median age:...

Background Gait disturbances are frequent side effects related to chronic thalamic deep brain stimulation (DBS) that may persist beyond cessation of stimulation. Objective We investigate the temporal dynamics and clinical effects of an overnight unilateral withdrawal of DBS on gait disturbances. Methods 10 essential tremor (ET) patients with gait...

Background: Sexual dysfunctions (SD) are common but underreported in Parkinson’s disease (PD) and have negative impacts on the quality of life (QoL) and partnership. Methods: We analyzed the data set from the PRISM study for demographics of SD and their influence on quality of life and partnership. Results: 449/861 (52.1%) PD patients reported SD,...

Background: Dysphagia is a major clinical concern in multiple system atrophy (MSA). A detailed evaluation of its major endoscopic features compared with Parkinson's disease (PD) is lacking. Objective: This study systematically assessed dysphagia in MSA compared with PD and correlated subjective dysphagia to objective endoscopic findings. Method...

Objective: To characterize socio-demographic and disease-specific data of Parkinson’s disease patients before and 1 year after therapy escalation with subcutaneous apomorphine (APO), levodopa/carbidopa intestinal gel (LCIG), or subthalamic deep brain stimulation (STN-DBS) in an observation trial under real life conditions. Methods: Between 2014-201...

Background: Reduction of arm swing during gait is an early and common symptom in Parkinson's disease (PD). By using the technology of a mobile phone, acceleration of arm swing can be converted into a closed-loop musical feedback (musification) to improve gait. Objectives: To assess arm swing in healthy subjects and the effects of musification on...

Objective: To characterize socio-demographic and disease-specific data of Parkinson's disease patients before and 1 year after therapy escalation with subcutaneous apomorphine (APO), levodopa/carbidopa intestinal gel (LCIG), or subthalamic deep brain stimulation (STN-DBS) in an observation trial under real life conditions. Methods: Between 2014-201...

Abstract Background The efficacy and safety of opicapone, a once-daily catechol-O-methyltransferase inhibitor, have been established in two large randomized, placebo-controlled, multinational pivotal trials. Still, clinical evidence from routine practice is needed to complement the data from the pivotal trials. Methods OPTIPARK (NCT02847442) was a...

The article Diagnostic accuracy of a smartphone bedside test to assess the fixation suppression of the vestibulo‑ocular reflex: when nothing else matters, written by Florin Gandor, Manfred Tesch, Hannelore Neuhauser, Doreen Gruber, Hans‑Jochen Heinze, Georg Ebersbach and Thomas Lempert, was originally published electronically on the publisher's int...

Background Multiple system atrophy (MSA) is a rare neurodegenerative disorder, and its parkinsonian variant can be difficult to delineate from Parkinson's disease (PD). Despite laryngeal dysfunction being associated with decreased life expectancy and quality of life, systematic assessments of laryngeal dysfunction in large cohorts are missing. Obj...

Objective: Validation of a bedside test to objectify the fixation suppression of the vestibulo-ocular reflex (FS-VOR) in patients with a cerebellar syndrome and healthy controls. Methods: The vestibulo-ocular reflex and its fixation suppression were assessed by video-nystagmography (VNG) in 20 healthy subjects (mean age 56 ± 15) and 19 patients...

Background Parkinson’s disease (PD) is an age dependent neurodegenerative disorder with increasing prevalence. Digital technologies like computers and smartphones offer mobile telecommunication, diagnostic and monitoring and may connect the patient continuously with his healthcare team, providing disease related information, and support healthcare....

Cannabis and synthetic cannabinoid formulations have now been legally approved in several countries for treatment of patients with Parkinson’s disease (PD). Hence, PD patients consult physicians more frequently for prescription of cannabinoids to alleviate symptoms that might not respond well to dopaminergic treatment. Despite the increasing volume...

Background: Multiple system atrophy is a rare neurodegenerative disease characterised by aggregation of α-synuclein in oligodendrocytes and neurons. The polyphenol epigallocatechin gallate inhibits α-synuclein aggregation and reduces associated toxicity. We aimed to establish if epigallocatechin gallate could safely slow disease progression in pat...

In its early stages multiple system atrophy (MSA), a neurodegenerative movement disorder, can be difficult to differentiate from idiopathic Parkinson's disease (PD), and emphasis has been put on identifying premotor symptoms to allow for its early identification. The occurrence of vegetative symptoms in addition to motor impairment, such as orthost...

Irregular arytenoid cartilages movements during postural maneuver in MSA patient.

Irregular arytenoid cartilages movements at rest in MSA patient.

Background The pedunculopontine nucleus has been suggested as a potential deep brain stimulation target for axial symptoms such as gait and balance impairment in idiopathic Parkinson's disease as well as atypical Parkinsonian disorders. Methods Seven consecutive patients with progressive supranuclear palsy received bilateral pedunculopontine nucle...

Zusammenfassung Aufgrund der Legalisierung von medizinischem Cannabis und Derivaten in zahlreichen Ländern gelangt diese Behandlungsoption zunehmend in die wissenschaftliche und öffentliche Debatte. Zunehmend häufig werden Behandler von Patienten mit idiopathischer Parkinson-Erkrankung mit der Frage nach Cannabis als Behandlungsalternative insbeson...

Due to the changing legal status of medical cannabis and derivatives in numerous countries, this therapeutic option has moved into the field of public debate. Neurologists treating patients with idiopathic Parkinson’s disease are increasingly confronted with questions regarding cannabis as a treatment alternative, especially for levodopa-resistant...

Background: Nonmotor symptoms (NMS) are known to fluctuate together with motor oscillations in advanced PD, but their timing and kinetics remains enigmatic. Objective: To evaluate timing and kinetics of NMS fluctuations. Methods: Analysis of diary data from 17 fluctuating PD patients. Diaries were completed by rating NMS as absent (defined herein a...

Introduction: Effective management and development of new treatment strategies for response fluctuations in advanced Parkinson's disease (PD) largely depends on clinical rating instruments such as the PD home diary. The Parkinson's kinetigraph (PKG) measures movement accelerations and analyzes the spectral power of the low frequencies of the accel...

Frequencies of motor states from diaries, raw PKG and calibrated PKG data per day on the patient level. Displayed are the mean number of hours per day per patient collected during the five days from each patient (n = 24) in motor Off state (A), motor On state without dyskinesia (B) and dyskinetic state (C) as per the diaries, PKG raw and calibrated...

Types of motor complications. (DOCX)

Matching between calibrated PKG and diary data in identification of bradykinesia. (DOCX)

Demographic and clinical data. (DOCX)

Data of PKG recordings and PD home diary entries. (DOCX)

Correlation of diary data with PKG results (per day on the patient level). (DOCX)

Matching between calibrated PKG and diary data in identification of dyskinesia. (DOCX)

Background: Since previous studies aimed to study nonmotor symptom (NMS) fluctuations in direct conjunction with motor oscillations, there are no data available on the temporal context of NMS fluctuations and motor oscillations in advanced Parkinson’s disease (PD). Objective: To evaluate circadian patterns and temporal connections of NMS and motor...

Lateral trunk flexion (LTF) is a common phenomenon in patients with Parkinson’s disease (PD) and has recently been associated with peripheral vestibular dysfunction. Since deviation of the subjective visual vertical (SVV) is a well-recognized feature of disorders involving vestibular processing, we analyzed SVV angles in 30 PD patients with and wit...

LSVT-BIG is an exercise for patients with Parkinson's disease (PD) comprising of 16 1-h sessions within 4 weeks. LSVT-BIG was compared with a 2-week short protocol (AOT-SP) consisting of 10 sessions with identical exercises in 42 patients with PD. UPDRS-III-score was reduced by -6.6 in LSVT-BIG and -5.7 in AOT-SP at follow-up after 16 weeks (p < 0....

Functional Popliteal Entrapment Syndrome (FPES) is caused by compression of neurovascular structures in the popliteal fossa by hypertrophic muscles, provoking severe leg pain with exercise. Treatment is limited to myotomy of hypertrophic musculature. 8 FPES patients underwent imaging and exercise studies, before receiving botulinum toxin A injectio...

To determine whether physical activity may influence cognitive performance in patients with Parkinson's disease (PD) by measuring reaction times in patients participating in the Berlin BIG study. randomized controlled trial, rater-blinded SETTING: ambulatory care PARTICIPANTS: 60 patients with mild to moderate PD were randomly allocated to three tr...

Disturbances of gait manifest in almost all cases of Parkinson's disease (PD), often leading to loss of mobility and increased mortality. In this review a clinically oriented approach to gait disorders in different stages of PD is presented. In addition, interactions between motor behavior and mental processing will be discussed. Analyzing the clin...

Parkinson’s disease (PD) is associated with numerous non-motor phenomena, among which sexual dysfunction and abnormal sexual behavior play a major role, as they are often associated with deterioration in quality of life and satisfaction in their partnership for the patient as well as their partner. Male PD patients suffer from erectile dysfunction,...

Zusammenfassung Das idiopathische Parkinson-Syndrom (IPS) geht mit einer Reihe nicht motorischer Phänomene einher. Dabei spielen Störungen der Sexualfunktion und des Sexualverhaltens eine wichtige Rolle, da sie oft mit einer Verschlechterung der Lebensqualität und Zufriedenheit in der Partnerschaft verbunden sein können. Bei männlichen Parkinson-Pa...

Statins [3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase inhibitors] exert cholesterol-independent pleiotropic effects that include anti-thrombotic, anti-inflammatory, and anti-oxidative properties. Here, we examined direct protective effects of atorvastatin on neurones in different cell damage models in vitro. Primary cortical neurones w...