scholarly journals Freezing of gait and postural instability: the unpredictable response to levodopa in Parkinson’s disease

2019 ◽  
Vol 12 (7) ◽  
pp. e229224 ◽  
Author(s):  
Fradique Moreira ◽  
Inês Rebelo Gomes ◽  
Cristina Januário
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Freezing Of Gait ◽  
Postural Instability ◽  
Motor Symptoms ◽  
Levodopa Dose ◽  
Paradoxical Response ◽  
Axial Symptoms ◽  
Video Documentation ◽  
Dose Dependent

Freezing of gait (FOG) and postural instability are challenging motor symptoms that present a serious therapeutic dilemma in Parkinson’s disease. Appropriate distinction between FOG subtypes may be difficult during routine clinical visits, as shown in the case we present. The patient was examined in three different states in relation to levodopa (L-DOPA) and apomorphine subcutaneous (sc) tests with video documentation: (1) ‘overnight-off’, after 12 hours without medication; (2)‘on’, 60 min after intake of regular levodopa dose (200 mg) and 20 min after 2 mg of apomorphine sc; and (3) ‘supra-on’, after 350 mg of L-DOPA and 3 mg of apomorphine sc. The patient clearly showed a dose-dependent paradoxical response to L-DOPA treatment with the emergence of severe FOG and postural instability. The tendency to develop these axial symptoms was less pronounced with apomorphine at doses that achieved similar improvements of other Parkinsonian features.

Dance Rhythms Improve Motor Symptoms in Individuals with Parkinson’s Disease: A Randomized Clinical Trial

2021 ◽  
Author(s):  
Jéssica A. Moratelli ◽  
Kettlyn H. Alexandre ◽  
Leonessa Boing ◽  
Alessandra Swarowsky ◽  
Clynton L. Corrêa ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Clinical Trial ◽  
Parkinson's Disease ◽  
Randomized Clinical Trial ◽  
Rating Scale ◽  
Freezing Of Gait ◽  
Motor Symptoms ◽  
Score Change ◽  
Significant Difference ◽  
Binary Group

Background: Evidence-based practices involving dance modalities found in binary (two-beat rhythm) or quaternary (four-beat rhythm) show that dance positively influences the motor aspects of disease.Aim: This randomized clinical trial aimed to analyze the effect of two dance rhythm (binary and quaternary) on the balance, gait, and mobility in individuals with Parkinson’s disease (PD). Methods: Thirty-one individuals with PD were randomized into the binary group (n = 18) and the quaternary group (n = 13). Both groups participated in different dance rhythms lasting 12 weeks, twice a week, for 45 minutes. Results: The binary group showed a significant difference in balance (p = 0.003), freezing of gait (p = 0.007), as well as in the motor aspects of MDS-Unified Parkinson’s Disease Rating Scale (MDS-UPDRS), with emphasis on the total values with a score change of 3.23. In the quaternary group, significant differences were found in balance (p = 0.021) with a score change of -2.54 and in the motor aspects of the MDS-UPDRS Part III where the total values stood out with a change of 3.54. Discussion: When comparing the possible effects of binary and quaternary rhythms on the motor symptoms of individuals with PD, it was demonstrated that binary rhythm improved balance, freezing gait, and UPDRSIII. As for the quaternary rhythm, the benefits were in balance and the UPDRSIII. Conclusion: The binary and the quaternary rhythm dance protocols positively influenced the motor symptoms of individuals with PD after 12 weeks of intervention.

Sleep Problems Are Related to a Worse Quality of Life and a Greater Non-Motor Symptoms Burden in Parkinson’s Disease

2020 ◽  
pp. 089198872096425
Author(s):  
Diego Santos-García ◽  
E. Suárez Castro ◽  
T. de Deus Fonticoba ◽  
M. J. Feal Panceiras ◽  
J. G. Muñoz Enriquez ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Sleep Problems ◽  
Cross Sectional Study ◽  
Motor Symptoms ◽  
Levodopa Dose ◽  
Cross Sectional ◽  
Non Motor Symptoms

Introduction: The aim of the present study was to examine the frequency of self-reported sleep problems and their associated factors in a large cohort of PD patients. Methods: PD patients and controls, recruited from 35 centers of Spain from the COPPADIS cohort were included in this cross-sectional study. Sleep problems were assessed by the Spanish version of the Parkinson’s disease Sleep Scale version 1 (PDSS-1). An overall score below 82 or a score below 5 on at least 1 item was defined as sleep problems. Results: The frequency of sleep problems was nearly double in PD patients compared to controls: 65.8% (448/681) vs 33.5% (65/206) (p < 0.0001). Mean total PDSS score was lower in PD patients than controls: 114.9 ± 28.8 vs 132.8 ± 16.3 (p < 0.0001). Quality of life (QoL) was worse in PD patients with sleep problems compared to those without: PDQ-39SI, 19.3 ± 14 vs 13 ± 11.6 (p < 0.0001); EUROHIS-QoL8, 3.7 ± 0.5 vs 3.9 ± 0.5 (p < 0.0001). Non-motor symptoms burden (NMSS; OR = 1.029; 95%CI 1.015–1.043; p < 0.0001) and impulse control behaviors (QUIP-RS; OR = 1.054; 95%CI 1.009–1.101; p = 0.018) were associated with sleep problems after adjustment for age, gender, disease duration, daily equivalent levodopa dose, H&Y, UPDRS-III, UPDRS-IV, PD-CRS, BDI-II, NPI, VAS-Pain, VAFS, FOGQ, and total number of non-antiparkinsonian treatments. Conclusion: Sleep problems were frequent in PD patients and were related to both a worse QoL and a greater non-motor symptoms burden in PD. These findings call for increased awareness of sleep problems in PD patients.

Differential Gait Decline in Parkinson’s Disease Enhances Discrimination of Gait Freezers from Non-Freezers

2020 ◽  
Vol 10 (4) ◽  
pp. 1657-1673
Author(s):  
Aliyah Glover ◽  
Lakshmi Pillai ◽  
Shannon Doerhoff ◽  
Tuhin Virmani
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Regression Model ◽  
Stride Length ◽  
Freezing Of Gait ◽  
Binary Regression ◽  
Levodopa Dose ◽  
Gait Parameters ◽  
Neuroprotective Strategies ◽  
Change In Mean

Background: Freezing of gait (FOG) is a debilitating feature of Parkinson’s disease (PD) for which treatments are limited. To develop neuroprotective strategies, determining whether disease progression is different in phenotypic variants of PD is essential. Objective: To determine if freezers have a faster decline in spatiotemporal gait parameters. Methods: Subjects were enrolled in a longitudinal study and assessed every 3– 6 months. Continuous gait in the levodopa ON-state was collected using a gait mat (Protokinetics). The slope of change/year in spatiotemporal gait parameters was calculated. Results: 26 freezers, 31 non-freezers, and 25 controls completed an average of 6 visits over 28 months. Freezers had a faster decline in mean stride-length, stride-velocity, swing-%, single-support-%, and variability in single-support-% compared to non-freezers (p < 0.05). Gait decline was not correlated with initial levodopa dose, duration of levodopa therapy, change in levodopa dose or change in Montreal Cognitive Assessment scores (p > 0.25). Gait progression parameters were required to obtain 95% accuracy in categorizing freezers and non-freezers groups in a forward step-wise binary regression model. Change in mean stride-length, mean stride-width, and swing-% variability along with initial foot-length variability, mean swing-% and apathy scores were significant variables in the model. Conclusion: Freezers had a faster temporal decline in objectively quantified gait, and inclusion of longitudinal gait changes in a binary regression model greatly increased categorization accuracy. Levodopa dosing, cognitive decline and disease severity were not significant in our model. Early detection of this differential decline may help define freezing prone groups for testing putative treatments.

scholarly journals Plasma Exosomal Brain-Derived Neurotrophic Factor Correlated with the Postural Instability and Gait Disturbance–Related Motor Symptoms in Patients with Parkinson’s Disease

Diagnostics ◽  
2020 ◽  
Vol 10 (9) ◽  
pp. 684
Author(s):  
Chen Chih Chung ◽  
Pai Hao Huang ◽  
Lung Chan ◽  
Jia-Hung Chen ◽  
Li-Nien Chien ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Neurotrophic Factor ◽  
Rating Scale ◽  
Brain Derived Neurotrophic Factor ◽  
Postural Instability ◽  
Gait Disturbance ◽  
Enzyme Linked Immunosorbent Assay ◽  
Motor Symptoms ◽  
Bdnf Level

Brain-derived neurotrophic factor (BDNF) is an essential neurotrophin, responsible for neuronal development, function, and survival. Assessments of peripheral blood BDNF in patients with Parkinson’s disease (PD) previously yielded inconsistent results. Plasma exosomes can carry BDNF, so this study investigated the role of plasma exosomal BDNF level as a biomarker of PD. A total of 114 patients with mild to moderate PD and 42 non-PD controls were recruited, and their clinical presentations were evaluated. Plasma exosomes were isolated with exoEasy Maxi Kits, and enzyme-linked immunosorbent assay was used to assess plasma exosomal BDNF levels. Statistical analysis was performed using SPSS version 19.0, and findings were considered significant at p < 0.05. The analysis revealed no significant differences in plasma exosomal BDNF levels between patients with PD and controls. Patients with PD with low plasma exosomal BDNF levels (in the lowest quartile) exhibited a significant association with daily activity dysfunction but not with cognition/mood or overall motor symptoms as assessed using the Unified Parkinson’s Disease Rating Scale (UPDRS). Investigation of UPDRS part III subitems revealed that low plasma exosomal BDNF level was significantly associated with increased motor severity of postural instability and gait disturbance (PIGD)-associated symptoms (rising from a chair, gait, and postural stability) after adjustment for age and sex. In conclusion, although plasma exosomal BDNF level could not distinguish patients with PD from controls, the association with PIGD symptoms in patients with PD may indicate its potential role as a biomarker. Follow-up studies should investigate the association between plasma exosomal BDNF levels and changes in clinical symptoms.

scholarly journals Evaluation of Knee Proprioception and Factors Related to Parkinson’s Disease

2016 ◽  
Vol 2016 ◽  
pp. 1-6 ◽  
Author(s):  
Nathalie Ribeiro Artigas ◽  
Giovana Duarte Eltz ◽  
Alexandre Severo do Pinho ◽  
Vanessa Bielefeldt Leotti Torman ◽  
Arlete Hilbig ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Cognitive Ability ◽  
Rating Scale ◽  
Center Of Pressure ◽  
Postural Instability ◽  
Lower Limbs ◽  
Controlled Study ◽  
Motor Symptoms ◽  
Cross Sectional

Background. Changes in proprioception may contribute to postural instability in individuals with neurological disorders. Objectives. Evaluate proprioception in the lower limbs of patients with Parkinson’s disease (PD) and the association between proprioception and cognitive ability, motor symptoms, postural instability, and disease severity. Methods. This is a cross-sectional, controlled study that evaluated proprioception in PD patients and healthy age- and sex-matched individuals. Kinetic postural proprioception of the knee was evaluated using an isokinetic dynamometer (Biodex® Multi-Joint System 4 Pro). Participants were evaluated using the Montreal Cognitive Assessment (MoCA), the Hoehn and Yahr rating scale and postural instability (pull test and stabilometric analysis), and motor function (UPDRS-III) tests. Results. A total of 40 individuals were enrolled in the study: 20 PD patients and 20 healthy controls (CG). The PD patients had higher angular errors on the proprioceptive ratings than the CG participants (p=0.002). Oscillations of the center of pressure (p=0.002) were higher in individuals with PD than in the controls. Proprioceptive errors in the PD patients were associated with the presence of tremors as the dominant symptom and more impaired motor performance. Conclusion. These findings show that individuals with PD have proprioceptive deficits, which are related to decreased cognitive ability and impaired motor symptoms.

Effects of supervised slackline training on postural instability, freezing of gait, and falls efficacy in people with Parkinson’s disease

2016 ◽  
Vol 39 (16) ◽  
pp. 1573-1580 ◽  
Author(s):  
Luis Santos ◽  
Javier Fernandez-Rio ◽  
Kristian Winge ◽  
Beatriz Barragán-Pérez ◽  
Vicente Rodríguez-Pérez ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Freezing Of Gait ◽  
Postural Instability

scholarly journals Association of fall risk factors and non-motor symptoms in patients with early Parkinson’s disease

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Kyum-Yil Kwon ◽  
Suyeon Park ◽  
Eun Ji Lee ◽  
Mina Lee ◽  
Hyunjin Ju
Keyword(s):  
Risk Factors ◽  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Freezing Of Gait ◽  
Prior History ◽  
Motor Symptoms ◽  
Related Factors ◽  
Related Risk ◽  
History Of ◽  
Non Motor Symptoms

AbstractThe association of non-motor symptoms (NMSs) with fall-related factors in patients with Parkinson’s disease (PD) remains to be further elucidated in the early stages of the disease. Eighty-six patients with less than 5 years of the onset of PD were retrospectively enrolled in the study. We assessed potential fall-related risk factors including (1) a history of falls during the past year (faller versus non-faller), (2) the fear of falling (FoF), and (3) the freezing of gait (FoG). Different types of NMSs were measured using the Montreal Cognitive Assessment (MoCA), the Beck Depression Inventory (BDI), the Beck Anxiety Inventory (BAI), the Parkinson’s disease Fatigue Scale (PFS), and the Scales for Outcomes in Parkinson’s disease—Autonomic dysfunction (SCOPA-AUT). The faller group (37.2%) showed higher scores for BDI, BAI, PFS, and SCOPA-AUT, compared to the non-faller group. From logistic regression analyses, the prior history of falls was related to the gastrointestinal domain of SCOPA-AUT, FoF was associated with BAI, and gastrointestinal and urinary domains of SCOPA-AUT, and FoG was linked to BAI and gastrointestinal domain of SCOPA-AUT. In conclusion, we found that fall-related risk factors in patients with early PD were highly connected with gastrointestinal dysautonomia.

scholarly journals Deep brain stimulation in the treatment of Parkinson’s disease

2021 ◽  
Author(s):  
Bruna Alves Rocha ◽  
Lucas Oliveira Braga ◽  
Julia Beatriz Xavier do Nascimento ◽  
Angela dos Santos Avakian
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Meta Analysis ◽  
Postural Instability ◽  
Motor Symptoms ◽  
Subcortical Structures ◽  
Pubmed Database ◽  
Deep Brain

Introduction: Parkinson’s disease (PD) is neurodegenerative and has bradykinesia, rest tremor, stiffnes and postural instability. These changes come from the degeneration of dopaminergic neurons. The treatment, carried out based on levodopa, provides improvements in the condition of the patients, however, they provide side effects. Based on this, the Deep Brain Stimulation (DBS) technique - stimulation of subcortical structures with electrodes - is a good treatment option. Methods: A narrative review of the literature was carried out, using the PubMed database with the keywords “Deep brain stimulation”, “Therapeutic use” and “Parkinson’s disease”. Included articles of meta-analysis, systematic review and review published in the last year. Results: The DBS offers a significant improvement in motor symptoms, gait, postural instability, reduction in tremors and in their progression. However, DBS can offer risks to the patient. Comparing the effectiveness of DBS with other therapies for Parkinson’s, such as levodopa/ carbidopa intestinal infusion gel (LCIG) and best medical therapy (BMT), it was found that BMT is botton. The cost-effectiveness comparison of these techniques, showed that DBS is the most costly procedure. It stands out comparisons can have intrinsic biases, such as the conflict of interest with pharmaceutical companies. Conclusion: DBS is a beneficial intervention for patients with PD who have important motor symptoms. Performed only in cases with indication, due to the possibility of complications.

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