PlaceholderThe image shows the "Knowledge Centre" that was built in Pécs as part of the European Capital of Culture Pécs 2010 programme. The part called "Kaptár" in Hungarian = "Hive" in English. The „Hive” connects 2 floors of the building and is covered with 60.000 colored „Zsolnay” ceramics.

WP4 UPÉCS: Clinical translation


Prof. Norbert Kovács leads the Movement Disorder Unit of the University of Pécs (MDU Pécs), which is one of the largest tertiary care centres in Hungary for PD and other movement disorders. MDU Pécs not only provides high quality clinical activity and integrated care for its patients, but also has a wealth of experience in clinical neuroscience research. Dedicated 3T MRI for research, a full neurophysiology and sleep diagnostic laboratory, and full-time neuropsychologists and Parkinson's nurses. Since 2013, MDU Pécs runs a prospective database of over 2,000 PD patients, which complies with the relevant ethical and data protection guidelines. Subjects in the database undergo detailed annual clinical examinations assessing their motor and non-motor symptoms. In addition to neurocognitive performance, depression and anxiety, there is a strong emphasis on the assessment and early diagnosis of sleep disorders and impulse control disorders.

State of the art clinical PD diagnostic. Prof. Norbert Kovács working group has validated several internationally recognized scales, which will be used in IronSleep, such as the Movement Disorder Society-sponsored Standardized Parkinson's Disease Rating Scale (MDS-UPDRS), the Parkinson's Disease Sleep Scale Version 2, the Non-Motor Symptoms Scale, Parkinson Anxiety Scale (PAS), Lille Apathy Scale (LARS) and several neurocognitive scales, and defined their clinimetric characteristics. The group conducted their own controlled and randomized trials to determine the effects of repetitive transcranial magnetic stimulation on motor and depressive symptoms in PD. They showed that high intensity training can have a positive effect on PD motor symptoms and that detecting internet addiction can help early diagnosis of impulse control disorders.

Improving neuroimaging biomarkers of PD. Prof. Norbert Kovács department implements and optimizes novel neuroimaging methods, neuroimaging routines and image analysis algorithms for clinical practice. They recently tested the usefulness of head size correction in research practice and the accuracy of different segmentation programs. They were among the first to show that depression induces characteristic grey matter and functional connectivity abnormalities in PD. In healthy subjects, we have shown that internet addiction results in morphological abnormalities not only in the right operculum and reward system, but also in functional connectivity. The team observed that iron concentration in deep gray matter structures is associated with worse visual memory performance in healthy young adults. The absence of nigral hyperintensity is a promising MR marker for PD, but its small size limits its routine use. We recently systematically compared the diagnostic utility of several established and novel imaging methods for nigral hypointensity assessment.

Multimodal neuroimaging. A major drawback of (123)I-FP-CIT SPECT scan, often used in the differential diagnosis of early PD and in the investigation of prodromal PD, is the diagnostic error due to the expertise or inexperience of the evaluator. In order to provide a more reliable and comparable evaluation, Kovacs’ team developed a novel automated MRI-based evaluation technique of dopamine transporter SPECT images.

Working plan within Iron Sleep

At the MDU Pécs centre, we will test the clinical applicability and diagnostic power of new neuroimaging technologies developed in WP1 and WP2. In addition to adapting the 7T MRI procedures to the more common clinical 3T MRI scanners, we aim to compare their sensitivity with the current gold-standard clinical criteria for prodromal and early PD of the International Parkinson and Movement Disorder Society (IPMDS). We will compare (123)I-FP-CIT SPECT images and multimodal 3T qMRI images used for clinical diagnosis in PD patients in addition to detailed phenotyping focused on non-motor symptoms in the early stages of PD without medication. By comparing the sensitivity and accuracy of SPECT and MRI scans, we will identify technical parameters with the highest diagnostic power in the detection of incipient PD.

Team – University of Pécs

Professor Dr Norbert Kovács

Professor Dr Norbert Kovács

Full professor, deputy clinical director
Norbert Kovács is a neurologist specialised in movement disorders. He organised the third level of progressive care at the University of Pécs and founded the Movement Disorders Unit. His aim was to provide patients with Parkinson's disease with high quality and integrated care from diagnosis, through medication and device-aided therapies including but not limited to deep brain stimulation, to psychosocial supportive care. He also places a high priority on carrying out scientific activities, involving not only neurologists but also dedicated Parkinson's nurses, neuropsychologists and Ph.D. students. He has established a clinical registry of more than 2000 Parkinson's patients and validated internationally accepted scales into Hungarian, which he routinely uses to assess the deep phenotyping of movement disorder patients. He has established close collaborations in the field of MRI and nuclear medicine based imaging. His areas of interest also include clinical electrophysiology, tremor analysis, intraoperative stimulation and neuronavigated magnetic stimulation.
Dr Gábor Perlaki

Dr Gábor Perlaki

Research associate professor
Gábor Perlaki is a physicist focusing mainly on brain imaging with magnetic resonance imaging (MRI). Together with his colleagues, they have provided the first quantitative support for increased brain iron deposition in cervical dystonia. His work has also contributed to the development and validation of a novel automated MRI-based evaluation technique of dopamine transporter single photon emission computed tomography (SPECT) images. He is the member of a research group supported by the Eötvös Lóránd Research Network. His areas of interest include functional MRI, MRI-based brain morphometry, diffusion MRI, MR relaxometry and preclinical MRI.
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