Evidence for Early and Regular Physical Therapy and Exercise in Parkinson's Disease

AbstractAdvances in medical management of Parkinson's disease (PD) have resulted in living longer with disability. Although disability worsens over the course of the disease, there are signs of disability even in the early stages. Several studies reveal an early decline in gait and balance and a high prevalence of nonmotor signs in the prodromal period that contribute to early disability. There is a growing body of evidence revealing the benefits of physical therapy and exercise to mitigate motor and nonmotor signs while improving physical function and reducing disability. The presence of early disability coupled with the benefits of exercise suggests that physical therapy should be initiated earlier in the disease. In this review, we present the evidence revealing early disability in PD and the effectiveness of physical therapy and exercise, followed by a discussion of a secondary prevention model of rehabilitation to reduce early disability and optimize long-term outcomes.

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Comparison of elderly and young patient populations treated with deep brain stimulation for Parkinson’s disease: long-term outcomes with up to 7 years of follow-up

Journal of Neurosurgery ◽

10.3171/2018.4.jns171909 ◽

2019 ◽

Vol 131 (3) ◽

pp. 807-812 ◽

Cited By ~ 1

Author(s):

Joshua A. Hanna ◽

Tyler Scullen ◽

Lora Kahn ◽

Mansour Mathkour ◽

Edna E. Gouveia ◽

...

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Elderly Patients ◽

Motor Function ◽

The Elderly ◽

Young Group ◽

Long Term Outcomes ◽

Deep Brain

OBJECTIVEDeep brain stimulation (DBS) is the procedure of choice for Parkinson’s disease (PD). It has been used in PD patients younger than 70 years because of better perceived intra- and postoperative outcomes than in patients 70 years or older. However, previous studies with limited follow-up have demonstrated benefits associated with the treatment of elderly patients. This study aims to evaluate the long-term outcomes in elderly PD patients treated with DBS in comparison with a younger population.METHODSPD patients treated with DBS at the authors’ institution from 2008 to 2014 were divided into 2 groups: 1) elderly patients, defined as having an age at surgery ≥ 70 years, and 2) young patients, defined as those < 70 years at surgery. Functional and medical treatment outcomes were evaluated using the Unified Parkinson’s Disease Rating Scale part III (UPDRS III), levodopa-equivalent daily dose (LEDD), number of daily doses, and number of anti-PD medications. Study outcomes were compared using univariate analyses, 1-sample paired t-tests, and 2-sample t-tests.RESULTSA total of 151 patients were studied, of whom 24.5% were ≥ 70 years. The most common preoperative Hoehn and Yahr stages for both groups were 2 and 3. On average, elderly patients had more comorbidities at the time of surgery than their younger counterparts (1 vs 0, p = 0.0001) as well as a higher average LEDD (891 mg vs 665 mg, p = 0.008). Both groups experienced significant decreases in LEDD following surgery (elderly 331.38 mg, p = 0.0001; and young 108.6 mg, p = 0.0439), with a more significant decrease seen in elderly patients (young 108.6 mg vs elderly 331.38 mg, p = 0.0153). Elderly patients also experienced more significant reductions in daily doses (young 0.65 vs elderly 3.567, p = 0.0344). Both groups experienced significant improvements in motor function determined by reductions in UPDRS III scores (elderly 16.29 vs young 12.85, p < 0.0001); however, reductions in motor score between groups were not significant. Improvement in motor function was present for a mean follow-up of 3.383 years postsurgery for the young group and 3.51 years for the elderly group. The average follow-up was 40.6 months in the young group and 42.2 months in the elderly group.CONCLUSIONSThis study found long-term improvements in motor function and medication requirements in both elderly and young PD patients treated with DBS. These outcomes suggest that DBS can be successfully used in PD patients ≥ 70 years. Further studies will expand on these findings.

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How can we judge the ‘long term’ outcomes of novel interventions in Parkinson’s disease?

Neuroreport ◽

10.1097/wnr.0000000000000065 ◽

2013 ◽

Vol 24 (18) ◽

pp. 1005-1009 ◽

Cited By ~ 1

Author(s):

Zinovia Kefalopoulou ◽

Tom Foltynie

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Long Term Outcomes

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Neural Transplantation in Parkinson's Disease

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/s0317167100032959 ◽

1997 ◽

Vol 24 (04) ◽

pp. 292-301 ◽

Cited By ~ 18

Author(s):

V. Mehta ◽

J. Spears ◽

I. Mendez

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Medical Management ◽

Neurodegenerative Disorder ◽

Fetal Tissue ◽

Neural Transplantation ◽

Current Status ◽

Neurosurgical Procedures ◽

Nigrostriatal Pathway

ABSTRACT:Parkinson's disease is a neurodegenerative disorder that affects about 1% of Canadians between the ages of fifty and seventy. The medical management for these patients consists of drug therapy that is initially effective but has limited long term benefits and does not alter the progressive course of the disease. The recalcitrance of longstanding Parkinson's disease to medical management has prompted the use of alternative surgical therapies. Many neurosurgical procedures have been utilized in order to improve the disabling symptoms these patients harbour. Although most of the current procedures involve making destructive lesions within various basal ganglia nuclei, neural transplantation attempts to reconstitute the normal nigrostriatal pathway and restore striatal dopamine. The initial success of neural transplantation in the rodent and primate parkinsonian models has led to its clinical application in the treatment of parkinsonian patients. Currently, well over one hundred patients throughout the world have been grafted with fetal tissue in an effort to ameliorate their parkinsonian symptoms. Although the results of neural transplantation in clinical trials are promising, a number of issues need to be resolved before this technology can become a standard treatment option. This review focuses on the current status of neural transplantation in Parkinson's disease within the context of other surgical therapies in current use.

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Long-Term Outcomes of Bilateral Subthalamic Nucleus Stimulation in Patients with Advanced Parkinson’s Disease

Stereotactic and Functional Neurosurgery ◽

10.1159/000096495 ◽

2006 ◽

Vol 84 (5-6) ◽

pp. 221-227 ◽

Cited By ~ 51

Author(s):

Grace S. Liang ◽

Kelvin L. Chou ◽

Gordon H. Baltuch ◽

Jurg L. Jaggi ◽

Catherine Loveland-Jones ◽

...

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Subthalamic Nucleus ◽

Long Term Outcomes ◽

Advanced Parkinson’S Disease ◽

Subthalamic Nucleus Stimulation

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Advanced Parkinson’s Disease Treatment Simplification and Long-Term Outcomes with Levodopa Carbidopa Intestinal Gel: COSMOS Romanian Subanalysis

Brain Sciences ◽

10.3390/brainsci11121566 ◽

2021 ◽

Vol 11 (12) ◽

pp. 1566

Author(s):

Mihaela Adriana Simu ◽

Dragos Catalin Jianu ◽

Adriana Octaviana Dulamea ◽

Viorelia Adelina Constantin ◽

Diana Popescu ◽

...

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Long Term Outcomes ◽

Disease Treatment ◽

Cross Sectional ◽

Advanced Parkinson’S Disease ◽

Retrospective Data Collection ◽

The Moment ◽

Treatment Simplification

The aim of the COmedication Study assessing Mono- and cOmbination therapy with levodopa-carbidopa inteStinal gel (COSMOS) was to assess the use of levodopa/carbidopa intestinal gel (LCIG) as monotherapy in patients with advanced Parkinson’s disease (APD) in routine clinical practice. COSMOS was an international observational study with one cross-sectional visit and retrospective data collection. In Romania, 95 adult patients with APD on LCIG treatment for at least 12 months were enrolled and stratified according to their LCIG therapy after 12 months: monotherapy (without any add-on PD medication), monotherapy with night PD medication and LCIG + add-on medication. Compared to the moment of LCIG initiation, the percentage of patients on monotherapy increased at three months after LCIG initiation and remained constant up to 12 months, when 30.5% of the patients were on LCIG monotherapy and 11.6% were on monotherapy with night medication. “Off” time and “On” time with dyskinesia decreased from LCIG initiation to patient visit in all groups. LCIG monotherapy with or without night medication may provide a simplified treatment option for selected APD patients, with long-term efficacy similar to that of LCIG plus add-on medication.

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Long-term clinical outcomes of bilateral GPi deep brain stimulation in advanced Parkinson’s disease: 5 years and beyond

Journal of Neurosurgery ◽

10.3171/2020.6.jns20617 ◽

2020 ◽

pp. 1-10

Author(s):

Takashi Tsuboi ◽

Janine Lemos Melo Lobo Jofili Lopes ◽

Kathryn Moore ◽

Bhavana Patel ◽

Joseph Legacy ◽

...

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Deep Brain Stimulation ◽

Brain Stimulation ◽

Statistical Significance ◽

Motor Symptoms ◽

Single Center ◽

Long Term Outcomes ◽

Deep Brain

OBJECTIVEFew studies have reported long-term outcomes of globus pallidus internus (GPi) deep brain stimulation (DBS) in Parkinson’s disease (PD). The authors aimed to investigate long-term outcomes of bilateral GPi DBS for 5 years and beyond for PD patients.METHODSThe authors retrospectively analyzed the clinical outcomes in 65 PD patients treated with bilateral GPi DBS at a single center. The outcome measures of motor symptoms and health-related quality of life (HRQoL) included the Unified Parkinson’s Disease Rating Scale (UPDRS) and the Parkinson’s Disease Questionnaire (PDQ-39). Scores at baseline were compared with those at 1, 3, 5, and 6–8 years after implantation using Wilcoxon signed-rank tests with α correction.RESULTSGPi DBS significantly improved the off-medication UPDRS III total scores, UPDRS IV, and dyskinesia score at 1 year when compared with baseline (all p < 0.001). The off- and on-medication tremor scores, UPDRS IV, and dyskinesia scores showed moderate and sustained improvement (the ranges of the mean percentage improvement at each time point were 61%–75%, 30%–80%, 29%–40%, and 40%–65%, respectively) despite lacking statistical significance at long-term follow-up with diminishing sample sizes. The off-medication UPDRS III total scores did not show significant improvement at 5 years or later, primarily because of worsening in rigidity, akinesia, speech, gait, and postural stability scores. The on-medication UPDRS III total scores also worsened over time, with a significant worsening at 6–8 years when compared with baseline (p = 0.008). The HRQoL analyses based on the PDQ-39 revealed significant improvement in the activities of daily living and discomfort domains at 1 year (p = 0.003 and 0.006, respectively); however, all the domains showed gradual worsening at the later time points without reaching statistical significance. At 3 years, the communication domain showed significant worsening compared with baseline scores (p = 0.002).CONCLUSIONSGPi DBS in PD patients in this single-center cohort was associated with sustained long-term benefits in the off- and on-medication tremor score and motor complications. HRQoL and the cardinal motor symptoms other than tremor may worsen gradually in the long term. When counseling patients, it is important to recognize that benefits in tremor and dyskinesia are expected to be most persistent following bilateral GPi DBS implantation.

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