Khashayar Dashtipour

• MD, PhD
• Managing Director at Loma Linda University

We thank Trosch et al [...]

Background Continuous subcutaneous apomorphine infusion (CSAI) has been used globally since the 1980s for Parkinson disease (PD) motor fluctuations but has not been available in the United States (US). Objective Evaluate CSAI for motor fluctuations in the US setting. Methods This open-label study (NCT02339064) enrolled patients with PD experienci...

Rotigotine is a dopamine receptor agonist commonly prescribed for Parkinson’s disease (PD) and restless leg syndrome. Although some common side effects have been previously reported, the rotigotine-induced leukoderma is a very rare presentation. Herein, we report a 37-year-old female with PD who developed depigmentation patches after 1 year of roti...

The first-line management of cervical dystonia (CD) symptoms is intramuscular injection of botulinum toxin type A (BoNTA). However, a comparison of safety among BoNTAs is difficult because, per regulatory authorities, units of BoNTA activity are not interchangeable. Dysphagia and muscle weakness are widely considered two key adverse events to monit...

Introduction Rotigotine is a dopamine receptor agonist commonly prescribed for Parkinson’s disease (PD) and restless leg syndrome. Although some common side effects have been previously reported, the rotigotine induced leukoderma is a very rare presentation. Case Presentation Herein, we report a 37-year-old female with PD who developed depigmentat...

Background Tardive Dyskinesia (TD) is a neurological disorder characterized by involuntary movements, often caused by dopamine receptor antagonists. Vesicular Monoamine Transporter 2 (VMAT2) inhibitors, such as valbenazine and deutetrabenazine, have emerged as promising therapies for TD and several clinical trials have shown their efficacy. This st...

Objective To evaluate the safety of onabotulinumtoxinA treatment for spasticity across dose ranges in real-world practice. Design Adult Spasticity International Registry (ASPIRE) was a multicenter, prospective, observational study (NCT01930786) of onabotulinumtoxinA treatment for adult spasticity over 2 years. Adverse events (AEs), serious AEs (SA...

Background As evidence continues to accumulate regarding the multi-organ dysfunction associated with Parkinson’s disease (PD), it is still unclear as to whether PD increases the risk of hematological pathology. In this study, the authors investigate the association between PD and hematological pathology risk factors. Methods This retrospective coh...

Importance As evidence continues to accumulate regarding the multi-organ dysfunction associated with Parkinson’s Disease (PD), it is still unclear as to whether PD increases the risk of hematological pathology. Objective To investigate the association between PD and hematological pathology and relevant risk factors. Design, Setting, and Participant...

Introduction Cervical dystonia (CD) is a neurologic movement disorder with potentially disabling effects and significant impact on quality of life of those affected. AbobotulinumtoxinA (aboBoNT-A) was initially approved for a dilution of 500 U/1 mL and subsequently for a dilution of 500 U/2 mL, providing flexibility for clinicians to treat CD. Here...

Background: Many patients with hypermobile Ehlers-Danlos Syndrome (EDS) suffer from cervical dystonia. Intramuscular injection of botulinum toxin may exacerbate myeloradiculopathy or atlantoaxial subluxation in this patient population. Case: Three patients with hypermobile EDS underwent low-dose OnabotulinumtoxinA injections for cervical dystoni...

As evidence continues to accumulate regarding the multi-organ dysfunction associated with Parkinson’s Disease (PD), it is still unclear as to whether PD increases the risk of hematological pathology. To investigate the association between PD and hematological pathology and relevant risk factors. This retrospective cohort analysis was conducted usin...

[This corrects the article DOI: 10.1371/journal.pone.0245827.].

Purpose of Review In autonomic failure, neurogenic orthostatic hypotension (nOH) and neurogenic supine hypertension (nSH) are interrelated conditions characterized by postural blood pressure (BP) dysregulation. nOH results in a sustained BP drop upon standing, which can lead to symptoms that include lightheadedness, orthostatic dizziness, presyncop...

Cervical dystonia (CD) is primarily treated with botulinum toxin, at intervals of ≥ 12 weeks. We present efficacy, patient-reported outcomes (PROs), and safety in adults with CD at the last available visit after a single set of abobotulinumtoxinA (aboBoNT-A) injections versus placebo using 500 U in a 2-mL injection volume. In this 12-week, randomiz...

Background: Cervical dystonia (CD), the most common focal dystonia, is a chronic neurological movement disorder characterized by sustained involuntary contractions of the neck muscles, leading to abnormal postures. AbobotulinumtoxinA (aboBoNT-A) was approved in the US initially as a 500 U per 1-mL dilution and subsequently, as a 500 U/2-mL dilutio...

Hyperkinetic movement disorders comprise a variety of conditions characterized by involuntary movements, which include but are not limited to tardive dyskinesia, chorea associated with Huntington's Disease, and tic disorders. The class of medications that have been used to treat these conditions includes Vesicular Monoamine Transporter-2 (VMAT2) in...

Importance RimabotulinumtoxinB (RIMA) may be preferable as an anti-sialorrhea treatment compared with current oral anticholinergic drugs in people with neurological disorders. Objective To assess the safety, efficacy, and tolerability of RIMA injections for the treatment of sialorrhea in adults. Design, Setting, and Participants This randomized,...

Background Essential tremor (ET) is a neurological syndrome of unknown origin with poorly understood etiology and pathogenesis. It is suggested that the cerebellum and its tracts may be involved in the pathophysiology of ET. DNA methylome interrogation of cerebellar tissue may help shine some light on the understanding of the mechanism of the devel...

Objective: To determine the minimal clinically important change (MCIC) on Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) scores using data from Cervical Dystonia Patient Registry for Observation of OnabotulinumtoxinA Efficacy (CD PROBE), which captured real-world practices and outcomes. Methods: Changes in the baseline TWSTRS scores...

Objective: The purpose of this article was to determine the efficacy and tolerability of quetiapine compared with placebo or other interventions for psychosis in parkinsonism. Methods: Participants with a diagnosis of parkinsonism participated in randomized controlled trials (RCTs) investigating the efficacy and tolerability of quetiapine for psych...

Introduction: Levodopa-induced dyskinesia (LID) is a significant impediment to the long-term use of levodopa for Parkinson’s disease (PD). Relatively few studies exist that have described safe and effective therapy for LID. There is thus a significant need for therapy that can control LID to allow for greater sustainability of levodopa therapy. Ama...

Objective: The purpose of this article was to determine the efficacy and tolerability of quetiapine compared with placebo or other interventions for psychosis in parkinsonism. Methods: Participants with a diagnosis of parkinsonism participated in randomized controlled trials (RCTs) investigating the efficacy and tolerability of quetiapine for ps...

The prevalence of speech disorders among individuals with Parkinson's disease (PD) has been reported to be as high as 89%. Speech impairment in PD results from a combination of motor and nonmotor deficits. The production of speech depends upon the coordination of various motor activities: respiration, phonation, articulation, resonance and prosody....

Introduction: Many experts assume bilateral deep brain stimulation (DBS) is necessary to improve axial tremor in essential tremor (ET). In the largest clinical trial of DBS for ET to date evaluating a non-directional, constant current device, we studied the effects of unilateral and staged bilateral DBS on axial tremor. Methods: We included all...

Background: The comparative effects of droxidopa and midodrine on standing systolic blood pressure (sSBP) and risk of supine hypertension in patients with neurogenic orthostatic hypotension (NOH) are unknown. Objective: To perform a Bayesian mixed-treatment comparison meta-analysis of droxidopa and midodrine in the treatment of NOH. Methods: T...

Purpose/aim: AbobotulinumtoxinA (Dysport®, Ipsen Biopharmaceuticals, Inc., Basking Ridge, NJ, USA) is an acetylcholine release inhibitor and a neuromuscular blocking agent. The United States prescribing information for abobotulinumtoxinA previously indicated only one dilution for cervical dystonia: 500 U/1 mL. Clinical trial data supporting a large...

Objective: To determine and compare DNA methylation patterns between patients with Parkinson’s disease (PD) and age- and sex-similar matched non-PD controls. Background: Epigenetic regulation is one of the major mechanisms for an organism to respond to the environment through changes in gene expression and has been implicated in numerous disease pr...

Objective The aim of this study was to examine the efficacy, safety and dosing practices of rimabotulinumtoxinB (BoNT-B) for the treatment of patients with sialorrhea based on a systematic review of clinical trials. Methods A systematic literature review was performed to identify randomized controlled trials and other comparative clinical studies...

Background: OnabotulinumtoxinA is approved for the treatment of upper and lower limb spasticity in adults. Guidance on common postures and onabotulinumtoxinA injection paradigms for upper limb spasticity has been developed via a Delphi Panel; however, similar guidance for lower limb spasticity has not been established. Objective: To define a cli...

Introduction: This study of thalamic deep brain stimulation (DBS) investigated whether a novel constant-current device improves tremor and activities of daily living (ADL) in patients with essential tremor (ET). Methods: A prospective, controlled, multicenter study was conducted at 12 academic centers. We investigated the safety and efficacy of...

A subgroup of heavy metals including arsenic, bismuth, cadmium, copper, iron, lead, manganese, mercury, thallium, and zinc is associated with neurological impairment that includes an array of movement disorders. Frequently the toxicities are attributed to abnormal environmental exposures or abnormal accumulations of heavy metals in the body. Each o...

Systematic Literature Review of Quetiapine for Hallucinosis/Psychosis in Parkinson’s Disease

Background: OnabotulinumtoxinA reduces muscle hypertonia associated with poststroke spasticity (PSS). PSS manifests as several common postures. Objective: To define treatment paradigms for PSS upper-limb common postures. Design: Modified Delphi method. Setting: Expert panel. Participants: Ten injectors experienced in the treatment and clin...

ULIS II, in patients receiving BoNT-A treatment, the change in MAS total score was only weakly associated with investigator and patient global assessment of benefit. •• This association was slightly stronger for investigator-reported benefits that for patient-reported benefits. •• A stronger relationship was seen between the goal attainment (change...

A systematic pair-wise comparison of all available botulinum toxin serotype A and B treatments for cervical dystonia (CD) was conducted, as direct head-to-head clinical trial comparisons are lacking. Five botulinum toxin products: Dysport(®) (abobotulinumtoxinA), Botox(®) (onabotulinumtoxinA), Xeomin(®) (incobotulinumtoxinA), Prosigne(®) (Chinese b...

Botulinum toxin (BoNT) formulations are being used for a variety of medical applications. The use of BoNT preparations is continuously expanding with new formulations and indications. Of the seven antigenically distinct BoNTs, only two serotypes, type A and type B are commonly available for therapeutic use. The four available BoNT products are not...

Background and Purpose. To determine whether the pattern of iron deposition in the fascicula nigrale in patients with Parkinson’s disease would be different from age-matched controls by utilizing quantitative susceptibility mapping to measure susceptibility change. Methods. MRIs of the brain were obtained from 34 subjects, 18 with Parkinson’s disea...

Table S1. Trials for movement disorders

Spastic paresis is a complex condition associated with damage to the upper motor neurons, typically caused by cerebral palsy, multiple sclerosis, stroke or trauma. Despite substantial impact on patients’ independence and burden on caregivers, there is a lack of consensus on optimal management of this condition and the patient journey remains unclea...

Background: The aim was to elucidate clinical trial efficacy, safety, and dosing practices of abobotulinumtoxinA (ABO) treatment in adult patients with blepharospasm and hemifacial spasm. To date, most literature reviews for blepharospasm and hemifacial spasm have examined the effectiveness of all botulinum neurotoxin type A products as a class. H...

Objective This systematic review was performed to elucidate dosing practices, dosing conversions, and related outcomes from randomized, controlled trials that directly compared onabotulinumtoxinA (ONA) and abobotulinumtoxinA (ABO) at various dose conversion ratios for therapeutic use in movement disorders.MethodsA systematic review of three medical...

To evaluate the long-term risk of developing cognitive symptoms (e.g., dementia, hallucinations), dyskinesia, falls, and freezing of gait (FoG) in patients with Parkinson's disease (PD) who received monoamine oxidase type B inhibitors (MAOB-Is) compared with patients who had never received MAOB-Is. Retrospective, cross-sectional, cohort study. Acad...

Background. Depression is the most commonly reported mood symptom affecting 2-8% of patients after deep brain stimulation (DBS). Usually, symptoms develop gradually; however there have been cases of reproducible events that the mood symptoms were elicited within seconds to minutes after stimulation and were immediately reversible upon cessation of...

OBJECTIVE: To determine the minimum quantitative change on UPDRS that is detectable by PGIC and Clinician Global Impression of Improvement (CGI-I). BACKGROUND: Published data do not address the correlation between changes in Unified Parkinson’s Disease Rating Scale (UPDRS) score (quantitative) and Patients’ Global Impressions of Change (PGIC) ratin...

Background. Iron is considered to lead to neurodegeneration and has been hypothesized as a possible cause of Parkinson’s disease (PD). Susceptibility-weighted imaging (SWI) is a powerful tool to measure phase related iron content of brain. Methods. Twelve de novo patients with PD were recruited from the Movement Disorders Clinic, Department of Neur...

Background. Novel rehabilitation strategies have demonstrated potential benefits for motor and non-motor symptoms of Parkinson’s disease (PD). Objective. To compare the effects of Lee Silverman Voice Therapy BIG (LSVT BIG therapy) versus a general exercise program (combined treadmill plus seated trunk and limb exercises) on motor and non-motor symp...

PURPOSE: To determine if susceptibility (iron deposition) in the striatonigral tract in patients with Parkinson's Disease is different from age matched controls. METHOD AND MATERIALS: MRI's of the brain were obtained from 22 patients consisting of 12 Parkinson's Disease (PD) patients and 10 age-matched controls. Susceptibility measurements were ma...

Parkinson's disease (PD) is a progressive, neurodegenerative disorder and it affects 4-5% of people age 85years or older. The etiopathogenesis of PD is a consequence of interaction between two factors, environmental pathogens and genetic susceptibility. If an environmental agent such as a toxin or pathogen were to play a major role in the causality...

Objective The aim of this study was to elucidate clinical trial efficacy, safety, and dosing practices of abobotulinumtoxinA (ABO) treatment in adult patients with upper limb spasticity (ULS). Methods A systematic literature review was performed to identify randomized controlled trials and other comparative clinical studies of ABO in the treatment...

A57 tive pulmonary diseases, asthma, coronary artery disease, diabetes, obesity, liver, or thyroid condition, cancer and stroke). Ordinary least square regression (OLS) and multinomial logistic regressions on low (< 1.0 mg/l), average (1-3 mg/l) and high (> 3 mg/l) were used to analyze the association between antidepressant use and CRP. Results: An...

Botulinum toxin (BoNT) is an acetylcholine release inhibitor and a neuromuscular blocking agent used for the treatment of a variety of neurologic and medical conditions. The efficacy and safety of BoNT depends on accurate selection and identification of intended targets but also may be determined by other factors, including physical spread of the m...

Botulinum neurotoxin (BoNT) is an acetylcholine release inhibitor and a neuromuscular-blocking agent used for the treatment of a variety of medical and cosmetic indications. Currently, in the United States, there are four BoNT formulations licensed for use: abobotulinumtoxinA, incobotulinumtoxinA, onabotulinumtoxinA, and rimabotulinumtoxinB. These...

Status epilepticus results in several neuroplastic changes to the granule cells of the hippocampal dentate gyrus. These include mossy fiber sprouting, granule cell dispersion, hilar ectopic granule cells and hilar basal dendrites. This chapter reviews the seizure-induced formation of hilar basal dendrites on granule cells in rodents. This aberrant...

Tetrabenazine (TBZ) is a monoamine storage inhibitor that was first introduced in the 1970s for the management of hyperkinetic movement disorders. Despite acceptance and usage worldwide, TBZ was only recently approved in the United States for the treatment of Huntington chorea. This review focuses on the use of TBZ in various hyperkinetic movement...

Sleep disturbances are common in patients with Parkinson's disease (PD). These disturbances can primarily affect the patient's quality of life and may worsen the symptoms of PD. Among the multiple sleep disturbances in PD patients, there has been a marked growing interest in rapid eye movement (REM) sleep behavior disorder (RBD). This is likely due...

Seizure-induced hilar basal dendrites on dentate granule cells are observed in several rodent models of temporal lobe epilepsy. Ultrastructural evidence showed that basal dendrites receive predominantly excitatory synapses, including many from mossy fibers. Such highly interconnected granule cells with basal dendrites are suggested to enhance hyper...

Rotigotine is a highly lipophilic dopamine-receptor agonist and the first transdermally delivered agent to demonstrate efficacy and safety as monotherapy in early Parkinson's disease and to reduce "off" hours in levodopa-treated patients with advanced Parkinson's disease. The rotigotine pharmacophore is nonergolinic and demonstrates high affinity f...

This review was conducted to establish the degree to which depression can intensify and further complicate the difficulty of living with Parkinson's disease. The authors evaluated the literature on depression in Parkinson's disease, to better understand and report on its pervasiveness, clinical manifestations, and treatment. As a result of an exten...

Parkinson's disease is a neurodegenerative disorder manifested by a combination of motor and non-motor symptoms. Levodopa, a dopamine precursor, is the most efficacious drug available to control the symptoms of Parkinson's disease. Almost all other medications with symptomatic benefit for Parkinson's disease show their effect by facilitating the do...

We performed a comprehensive literature search of clinical studies published between 1989 and 2007 concerning the use of botulinum neurotoxin (BoNT) in the treatment of writer's cramp (WC). Publications were categorized as Classes I-IV using the scale developed by the Therapeutics and Technology Assessment (TTA) subcommittee of the American Academy...

Cervical dystonia, which is the most common form of focal dystonia, presents with sustained neck spasms, abnormal head posture, head tremor, and pain. One of the interesting and unique features of cervical dystonia is the geste antagoniste. There is not a well-described pathophysiology for cervical dystonia, but several hypotheses report involvemen...

Inhibitors of monoamine oxidase (MAO) with selectivity and specificity for MAO type B (MAO-B) prolong the duration of action of both endogenously and exogenously derived dopamine. Rasagiline [N-propargyl-l(R)-aminoindan] is a second-generation propargylamine pharmacophore that selectively and irreversibly inhibits brain MAO-B and is specifically de...

Seizures increase dentate granule cell proliferation in adult rats but decrease proliferation in young pups. The particular period and number of perinatal seizures required to cause newborn granule cell suppression in development are unknown. Therefore, we examined cell proliferation with bromodeoxyuridine (BrdU) immunohistochemistry during the pea...

Granule cells with hilar basal dendrites (HBDs) are found after status epilepticus (SE) in three rat models of temporal lobe epilepsy. These granule cells are commonly located at the hilar border and could be newly born granule cells based on their location. The aim of this study was to determine how long it takes for HBDs to form on granule cells...

Granule cells with recurrent basal dendrites (RBDs) were previously reported in both control and epileptic rats. RBDs are dendrites that arise from the basal half of granule cell bodies and curve toward and extend into the molecular layer. They are increased in frequency in the pilocarpine model of epilepsy. The present study was undertaken to anal...

Using Golgi preparations, Cajal described many cell types and connections of the dentate gyrus. He described granule cells as having a round or elliptical cell body with their long axis perpendicular to the granule cell layer, dendrites arising from one pole and an axon arising from the other. Cajal apparently never studied the brains from epilepti...

Active caspase-3 immunoreactivity was detected in the rat forebrain proliferative regions at birth and remained high in these areas for about 2 weeks, during which period labeled cells were present centroperipherally across the olfactory bulb. By the end of the third postnatal week, only a small number of immunolabeled cells remained in these foreb...

Several investigators have shown the existence of dentate granule cells in ectopic locations within the hilus and molecular layer using both Golgi and retrograde tracing studies but the ultrastructural features and synaptic connections of ectopic granule cells were not previously examined. In the present study, the biocytin retrograde tracing techn...