Microelectrode-guided posteroventral medial radiofrequency pallidotomy for Parkinson's disease

1997 ◽  
Vol 87 (1) ◽  
pp. 52-59 ◽  
Author(s):  
Oleg Kopyov ◽  
Deane Jacques ◽  
Christopher Duma ◽  
Galen Buckwalter ◽  
Alex Kopyov ◽  
...  

✓ The outcome of radiofrequency-guided posteroventral medial pallidotomy was investigated in 29 patients with recalcitrant Parkinson's disease. Extracellular recordings were obtained in the target region to differentiate the internal from the external globus pallidus, and distinct waveforms were recorded in each region. Stimulation of the target site further verified the lesion location. Of the 29 patients treated during the course of 1 year, none showed any adverse side effects (such as hemianopsia or hemiparesis) from the procedure. Significant and immediate improvement in motor involvement (dyskinesia, rigidity, dystonia, freezing, and tremor) was observed as measured by the Unified Parkinson's Disease Rating Scale and the Hoehn and Yahr scale. Patients experienced improvements in their condition as measured on a self-rating scale, and their ability to perform the activities of daily living was also significantly improved. Although the onset and duration of the effect of a single dose of levodopa did not change, the number of hours in an “off” state of dyskinesia per day was significantly decreased. These results provide further evidence, in a large group of patients, that posteroventral medial pallidotomy results in significant control of the motor symptoms of Parkinson's disease with a minimum of undesirable side effects.

2013 ◽  
Vol 71 (9A) ◽  
pp. 591-595 ◽  
Author(s):  
Raimundo Nonato Campos-Sousa ◽  
Elizabeth Maria Aparecida Barasnevicius Quagliato ◽  
Kelson James Almeida ◽  
Inacio Augusto Dias de Castro ◽  
Viriato Campelo

Introduction Detrusor hyperactivity is the leading cause of urinary dysfunction in Parkinson's disease (PD). There are few studies correlating PD clinical aspects with this autonomic feature. Methods A cohort of 63 women with PD were prospectively examined for assessment of clinical aspects and disease severity using unified Parkinson's disease rating scale and Hoehn-Yahr scale, respectively. The urologic function was evaluated by the urodynamic study. Two groups were categorized at this time - groups with and without detrusor hyperactivity. After seven years, the same parameters were re-evaluated. Results Progression of the disease on mental scores was found in the group with detrusor hyperactivity. On follow-up, clinical symptoms and severity did not show significant worsening between the groups. Conclusion Detrusor hyperactivity is a frequent urodynamic finding in PD, and even though it is associated with dopaminergic dysfunction, it cannot be blamed as a factor of worsening motor performance, but is probably associated with poor cognitive and mental prognosis.


2002 ◽  
Vol 13 (3-4) ◽  
pp. 117-121 ◽  
Author(s):  
Kazuo Abe ◽  
Mayako Takanashi ◽  
Takehiko Yanagihara ◽  
Sabro Sakoda

Objectives:Fatigue is a complaint frequently encountered among patients with Parkinson’s disease (PD). Considering the possible relationship between fatigue and dopaminergic dysfuncion, we investigated the effect of pergolide mesilate (a D2 and D1 dopamine receptor agonist) and bromocriptine (a D2 selective dopamine receptor) in patients with PD.Methods:We evaluated 41 patients with PD and controls. We assessed the degree of fatigue by using a fatigue scale. The severity of PD was evaluated by the Hoehn and Yahr Scale and the unified Parkinson’s disease rating scale (UPDRS).Results:After five weeks from prescription, patients taking pergolide mesilate showed significant improvement in the fatigue scale (from 5.1 ± 0.7 to 4.4 ± 0.55,p< 0.05, ) but patients taking bromocriptine did not (from 4.8 ± 0.9 to 4.7 ± 0.8).Conclusions:Our study suggested the possibility of functional correlation between fatigue and D1 receptor in patients with PD.


2019 ◽  
Author(s):  
Αναστασία Μπουγέα

Θεωρητικό υπόβαθρο: Η νόσος του Πάρκινσον(PD), η άνοια στη νόσο του Πάρκινσον (PDD) και η άνοια με τα σώματα Lewy (DLB) αποτελούν κλινικά σύνδρομα γνωστά ως διαταραχές των σωματίων Lewy (LBD) επειδή έχουντα σωμάτια Lewyως κοινό παθολο-ανατομικό χαρακτηριστικό. Δεδομένου ότι η διάγνωσή τους παραμένει κυρίως κλινική, υπάρχει μεγάλο ενδιαφέρον για τη χρήση ενός ή περισσοτέρων βιοδεικτών για την έγκαιρη και έγκυρη διάγνωση και τη διαφορική διάγνωση μεταξύ αυτών των διαφορετικών μορφών παρκινσονισμού. Η α-συνουκλεΐνη (α-Syn) έχει κερδίσει την προσοχή ως εν δυνάμει βιοδείκτηςγια τις συνουκλεϊνοπάθειες. Ωστόσο,ο προσδιορισμός της ολικής α-Syn στο εγκεφαλονωτιαίο υγρό (ΕΝΥ) με τη μέθοδο ELISA και άλλες παρόμοιες τεχνικές απέδωσε αντικρουόμενα αποτελέσματα. Αντίστοιχες μελέτες της α-Syn στο πλάσμα/ορό έχουν επίσης δώσει αβέβαια αποτελέσματα. Τέτοιες αποκλίσεις έχουν συχνά αποδοθεί σε προ-αναλυτικούς και αναλυτικούς συγχυτικούς παράγοντες (ημερήσια διακύμανση, κεφαλοουραία διαβάθμιση της συγκλεντρωσης εντός του κεντρικού νευρικού συστήματος, το φύλο, την ηλικία και, κυρίως, η επιμόλυνση του ΕΝΥ από αίμα), στις διαφορετικές μεθόδους ELISA και στη μέτρηση διαφορετικών τύπων της α-Syn στο ΕΝΥ και το πλάσμα. Σκοπός: Έτσι, λαμβάνοντας υπόψη τις αδυναμίες των προηγούμενων ερευνών, η παρούσα διατριβή στοχεύει να ελέγξει για πιθανή διαφορά των επιπέδων της α-Syn στο ΕΝΥ, τον ορό και το πλάσμα ανάμεσα σε ασθενείς με νόσο PD, PDD, DLB και υγιείς μάρτυρες και τη διαγνωστική της αξία χρησιμοποιώντας βέλτιστες δυνατές μεθόδους και αυστηρή τήρηση των προαναλυτικών και αναλυτικών κατευθυντήριων οδηγιών.Μεθοδολογία: Στη μελέτη συμμετείχαν 77 ασθενείς (30 με PD, 18 με PDD και 29 με DLB) οι οποίοι νοσηλευτηκαν στην Α΄ Νευρολογική κλινική του Αιγινητείου Νοσοκομείου της Ιατρικής Σχολής του Πανεπιστημίου Αθηνών. Η διάγνωση ετέθη βάσει των πλέον πρόσφατων διαγνωστικών κλινικών κριτηρίων. Σε όλους τους ασθενείς ελήφθη πλήρες ιστορικό και διενεργήθηκε ενδελεχής αντικειμενική νευρολογική εξέταση. Επίσης υποβλήθησαν σε πλήρη κλινικοεργαστηριακό και απεικονιστικό έλεγχο, συμπεριλαμβανομένου τομοσπινθηρογραφήματος βασικών γαγγλίων με 123Ι-ioflupane (SPECT). Επίσης διενεργήθηκε νευροψυχολογικός έλεγχος με τις κάτωθι δοκιμασίες: Mini Mental State Examination (MMSE), CLOX 1-2, Frontal Assessment Battery (FAB), Clinical Dementia Rating (CDR), Neuropsychiatric Inventory (NPI),Questionnaire for Impulsive-Compulsive Disorder in Parkinson's Disease-Rating Scale (QUIP) και Instrumental Activities of Daily Living (IADL). Η κινητική αναπηρία των παρκινσονικών ασθενών αξιολογήθηκε με βάση την κλίμακα Unified Parkinson's Disease Rating Scale (UPDRS Ι-ΙV), η σταδιοποίησή τους με τις κλίμακες των Hoehn και Yahrκαι των Schwab και England. Η ομάδα ελέγχου αποτελείται από 30 υγιή άτομα χωρίς ιστορικό νευρολογικής ή ψυχιατρικής νόσου και φυσιολογική βαθμολογία στις ανωτέρω δοκιμασίες και κλίμακες. Όλοι οι συμμετέχοντες υποβλήθηκαν σε οσφυϊκή παρακέντηση μεταξύ 9-12 π.μ. μετά από ολονύκτια νηστεία. Δείγματα ΕΝΥ και πλάσματος/ ορού ελήφθησαν σε σωληνάρια από πολυπροπυλένιο, φυγοκεντρήθηκαν σε 2000xg για 10 λεπτά και αποθηκεύτηκαν στους -80 ° C μέχρι την ανάλυση. Δείγματα ΕΝΥ με περισσότερα από 50 ερυθρά αιμοσφαίρια απορρίφθηκαν. Αποτελέσματα: Η ηλικία κατά την έναρξη της νόσου ήταν μεγαλύτερη στους ασθενείς με DLB και οι βαθμολογίες MMSE ήταν υψηλότερες σε ασθενείς με PD. Μεγαλύτερες μέσες τιμές UPDRS-III καταγράφηκαν στους PDD και χαμηλότερες σε ασθενείς με PD. Μετά τη διόρθωση του Bonferroni διαπιστώθηκαν σημαντικά χαμηλότερες τιμές του Αβ42 σε ασθενείς με DLB σε σύγκριση με μάρτυρες (p = 0,002), ασθενείς με PD (p <0,001) και ασθενείς με PDD (p = 0,021). Επιπλέον, ηΤΡ-181 είχε σημαντικά χαμηλότερες τιμές σε ασθενείς με PD σε σύγκριση με ασθενείς με DLB (p = 0,028). Μεγαλύτερες τιμές α-Syn στο ΕΝΥ βρέθηκαν σε ασθενείς με DLB σε σύγκριση με τους μάρτυρες (p <0,001), ασθενείς με PD (p <0,001) και με PDD (p <0,001). Η ομάδα έλεγχου είχε σημαντικά χαμηλότερες τιμές α-Syn ορού σε σύγκριση με τους ασθενείς με PD (p <0,001), με PDD (p <0,001) και με DLB (p <0,001). Επιπλέον, οι ασθενείς με PDD είχαν σημαντικά υψηλότερες τιμές του πλάσματος α-Syn σε σύγκριση με τους μάρτυρες (p= 0,023). Ανεξαρτήτως ομάδας ασθενών, τα επίπεδα της α-Syn στο ΕΝΥ συσχετίζονταν σημαντικά με την Aβ42, ενώ τα επίπεδα της α-Syn στο πλάσμα συσχετίζονταν με την Τp-181. Αφαιρώντας τους 7 ασθενείς με DLB με προφιλ ΕΝΥ παθολογίας τύπου Alzheimer (Τt≥ 376, Aβ42≤580 and ΤP-181≥ 62.5 pg/ml) ανεύρεθηκαν σημαντικά υψηλότερες τιμές για την α-Syn ορού και πλάσματος αλλά οριακά για την πρωτεϊνη ΤP-181 στην ομάδα των LBDs συγκριτικά με την ομάδα ελέγχου. Η ανάλυση ROC έδειξε ότι οι α-Syn και Αβ42 στο ΕΝΥ είχαν την καλύτερη διακριτική ικανότητα μεταξύ PD και DLB. Επιπλέον, η διακριτική ικανότητα μεταξύ PDD και DLB ήταν παρόμοια για τις α-Syn και Αβ42 στο ΕΝΥ. Η α-Syn στον ορό έδειξε την καλύτερη διακριτική ικανότητα μεταξύ των PD και μαρτύρων ή μεταξύ PDD και μαρτύρων. Προέκυψαν τέλος οριακές συσχετίσεις μεταξύ βιοδεικτών της α-Syn και της Τp-181 και συγκεκριμένων νευροψυχολογικών/συμπεριφορικών κλιμάκων. Συμπεράσματα: Η α-Syn και η Αβ42 στο ΕΝΥ και τον ορο θα μπορούσαν να θεωρηθουν εν δυναμει βιοδεικτες για την διαφοροδιαγνωση των ασθενών στο φάσμα της LBD αφού έδειξαν την καλύτερη διακριτική ικανότητα μεταξύ των ομάδων PD- PDD και DLB. Εφ’ όσον επιβεβαιωθούν τα αποτελέσματα, η α-Syn του ορού, και, σε μικρότερο βαθμό, του πλάσματος, θα μπορούσαν να θεωρηθούν βιοδείκτες διάγνωσης των LBDs, καθώς εμφανίζουν υψηλότερες τιμές σε σχέση με άτομα ελέγχου.


2009 ◽  
Vol 31 (1) ◽  
pp. 39-42 ◽  
Author(s):  
Beatriz Azevedo dos Anjos Godke Veiga ◽  
Vanderci Borges ◽  
Sonia Maria César de Azevedo Silva ◽  
Fabrício de Oliveira Goulart ◽  
Maysa Seabra Cendoroglo ◽  
...  

OBJECTIVE: To evaluate and compare the frequency and severity of major depression in patients with Parkinson's disease and in individuals older than 60 years without neurological, rheumatological and/or oncological comorbidities. METHOD: We studied 50 patients with Parkinson's disease older than 60 years and 50 geriatric patients. Subjects with scores of Mini Mental State Examination indicating cognitive impairment were excluded. We used Diagnostic Statistical Manual of Mental Diseases-IV criteria to diagnose major depression and the Hamilton Depression Scale and the Beck Depression Inventory to rate it. The Unified Parkinson's Disease Rating Scale part 3 and the Hoehn and Yahr Scale were used to evaluate the motor severity of Parkinson's disease. RESULTS: Major depression was found in 42% of Parkinson's disease patients and in 10% of the geriatric patients (p < 0.001). The scores of the Hamilton Depression Scale and the Beck Depression Inventory were higher in Parkinson's disease patients (p < 0.001). Depressed Parkinson's disease patients had longer duration of Parkinson's disease (p = 0.020) and higher scores on the Unified Parkinson's Disease Rating Scale part 3 (p = 0.029) and the Yahr Scale (p = 0.027). CONCLUSIONS: The frequency (42%) and severity of major depression were higher in Parkinson's disease patients. Longer duration of Parkinson's disease, higher scores on the Unified Parkinson's Disease Rating Scale part 3 and the Hoehn and Yahr Scale were significantly associated with major depression.


2009 ◽  
Vol 67 (3a) ◽  
pp. 585-590 ◽  
Author(s):  
Ariane Haydée Estrada Gamarra ◽  
Cibele Silva Molski ◽  
Arlete Hilbig ◽  
Cristina Kern Valentini ◽  
Vera Lúcia Widniczck Striebel ◽  
...  

OBJECTIVE: To identify characteristics of body image and self-concept in individuals over fifty years of age with Parkinson's disease (PD). The secondary objectives are to analyze whether body image and self-concept are influenced by the severity of PD and to verify if there is correlation between depression, self-concept and body image in cases of PD. METHOD: Participating in the study were 48 individuals, being 26 with PD and 22 Controls. The instruments used were: The Mini Exam of Mental State, The My Body Image Test, The Factorial Self-concept Test, The Beck Depression Inventory, the motor section of The Unified Parkinson's Disease Rating Scale and The Modified Hoehn and Yahr Scale. RESULTS: In PD the perception of body image and self-concept demonstrated significantly reduced values p<0.001 and p=0.012 respectively, and the presence of depression symptomatology was significantly more (p=0.002). CONCLUSION: Individuals with PD present alteration of body image and self-concept and also present lower personal confidence and lower social receptivity, correlated with depressive symptoms.


2017 ◽  
Vol 32 (5) ◽  
pp. 789-793 ◽  
Author(s):  
Krisztina Horváth ◽  
Zsuzsanna Aschermann ◽  
Márton Kovács ◽  
Attila Makkos ◽  
Márk Harmat ◽  
...  

Neurosurgery ◽  
2008 ◽  
Vol 62 (2) ◽  
pp. 347-359 ◽  
Author(s):  
Josè D. Carrillo-Ruiz ◽  
Francisco Velasco ◽  
Fiacro Jimènez ◽  
Guillermo Castro ◽  
Ana L. Velasco ◽  
...  

Abstract OBJECTIVE Tremor and rigidity have been efficiently controlled by electrical stimulation of contralateral prelemniscal radiations (Raprl) in patients with unilateral Parkinson's disease. The present study determines the effect of bilateral Raprl electrical stimulation in a group of patients with severe bilateral tremor, rigidity, and bradykinesia. METHODS Five patients with Parkinson's disease (Hoehn and Yahr scale, Stage V) underwent bilateral stereotactic electrode implantation. Postoperative magnetic resonance imaging studies confirmed their position. Bipolar chronic electrical stimulation was performed through contiguous contacts of each electrode, which were selected by means of a screening test that explored multiple combinations. Preoperative and 3-, 6-, 9-, and 12-month postoperative evaluations were performed using international rating scales. Postoperative evaluations were performed with 24 hours off medication-on stimulation. RESULTS Contralateral tremor and rigidity were significantly decreased by simple insertion of electrodes in Raprl and returned hours to days later. Contacts for chronic stimulation were located in the area between the red and subthalamic nuclei, including Raprl, zona incerta, and substantia Q. Efficient stimulation had at least one contact in Raprl and in four cases, both contacts were only in Raprl. Stimulation parameters were 90 to 130 Hz, 90 to 330 μs, and 1.5 to 3.5 V. Unified Parkinson's Disease Rating Scale (motor, Part III) scores decreased 65% (P &lt; 0.001), with improvements of 90% in tremor (P &lt; 0.001), 94% in rigidity (P &lt; 0.001), 75% in bradykinesia (P &lt; 0.001), 40% in gait, and 35% in postural stability (P &lt; 0.05) at 1 year. CONCLUSION Raprl electrical stimulation is safe and efficient to treat patients with the Parkinson's disease symptomatic triad. By use of Raprl stereotactic coordinates, electrodes were placed behind the subthalamic nucleus.


2020 ◽  
Vol 10 (2) ◽  
pp. 81-93
Author(s):  
Cyprian Popescu

Aim: Previous studies have revealed uncertainties concerning the utility of sudoscan in identifying small fiber neuropathy in Parkinson’s disease (PD). Patients & methods: We searched for a significant reduction of electrochemical skin conductance (ESC) in 67 PD patients versus 66 controls with similar characteristics. We conducted analysis of the subgroups of PD patients without diabetes using sudoscan technology. Results: There is no discrimination between patients and controls relative to feet ESC, the modified Hoehn and Yahr Scale and/or Unified Parkinson's Disease Rating Scale. ESC in patients did not differ significantly according to the Unified Parkinson's Disease Rating Scale score. The oldest PD patients with cardiovascular risk factors have more marked small fibers dysfunction. Conclusion: The sudoscan procedure did not show advantage in the diagnosis of small fiber neuropathy. Its diagnostic value increases in some subgroups of patients with cardiovascular co-morbidity.


2021 ◽  
Vol 93 (3) ◽  
pp. 336-340
Author(s):  
Erdal Benli ◽  
Fahriye Feriha Ozer ◽  
Nesrin Helvacı Yılmaz ◽  
Ozge Arici Duz ◽  
Ahmet Yuce ◽  
...  

Objectives: Parkinson's disease (PD) often presents with movement disorder. However, besides motor complaints, there are many complaints such as anxiety, depression, urinary complaints and constipation. The aim of this study was to investigate whether neurogenic lower urinary dysfunction (NLUD), which is frequently seen in PD, has an effect on the development of anxiety and depression in these patients. Materials and methods: The study included 32 males (66.6%) and 16 females (33.3%); in total 48 subjects were registered. For the diagnosis and severity of PD, the UK Parkinson's Disease Society Brain Bank Criteria, Unified Parkinson's Disease Rating Scale (UPDRS) and the Hoehn-Yahr scale were used. Urological evaluation was performed using history, physical examination, laboratory tests and standard forms such as IPSS and OAB-V8. Results: There was no difference between the genders in terms of duration, severity and NLUD (p > 0.05). The incidence of anxiety and depression in PD patients was 62.8% and 72.1%, respectively. The prevalence of NLUD was 67.4% and depression and anxiety was found to increase (1.06 and 1.28 times, respectively) in relation to NLUD. In particular, there was a relationship between storage lower urinary tract symptoms and anxiety and depression development (p < 0.05). Conclusions: As expected, it was found that the incidence of NLUD, anxiety and depression was increased in PD. In addition, NLUD was found to be a risk factor for the development of anxiety and depression. Therefore, it is concluded that NLUD, which can potentially cause important complications, as well as motor complaints, should be closely monitored and treated in PD patients.


2017 ◽  
Vol 75 (8) ◽  
pp. 497-502 ◽  
Author(s):  
Raissa Carla Moreira ◽  
Marise Bueno Zonta ◽  
Ana Paula Serra de Araújo ◽  
Vera Lúcia Israel ◽  
Hélio A. G. Teive

ABSTRACT Objective To investigate which factors are associated with the quality of life decline in Parkinson’s disease patients from mild to moderate stages. Methods The Unified Parkinson’s Disease Rating Scale and Parkinson’s Disease Questionnaire-39 were used to evaluate clinical/functional data and the quality of life. Results The markers of clinical/functional worsening were drooling (p < 0.004), need for assistance with hygiene (p = 0.02), greater freezing frequency (p = 0.042), bradykinesia (p = 0.031), greater intensity of the resting tremor (p = 0.035) and “pill rolling” (p = 0.001). The decline in quality of life was related to stigma (p = 0.043), greater impairment in cognition (p = 0.002), mobility (p = 0.013) and for daily living activities (p = 0.05), and was considered more significant in men, married, older individuals, and those with a longer time of disease. Conclusions The quality of life worsening markers at the moderate stage were related to stigma, worsening of cognition, and to greater impairment in mobility and daily living activities.


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