scholarly journals Introduction to Parkinson disease (PD) and its complications

2016 ◽  
Vol 6 (5) ◽  
pp. 229-235 ◽  
Author(s):  
Marketa Marvanova
Keyword(s):  
Parkinson Disease ◽  
Impulse Control ◽  
Neurodegenerative Disorder ◽  
High Dose ◽  
Motor Symptoms ◽  
Close Monitoring ◽  
Compulsive Sexual Behavior ◽  
High Doses ◽  
Psychiatric Complications ◽  
Deep Brain

Abstract Parkinson disease (PD) is a common neurodegenerative disorder in older adults characterized by motor and nonmotor symptoms and complications. Impulse control disorders (ICDs), such as pathological gambling, compulsive shopping, compulsive sexual behavior (hypersexuality), and binge eating disorder, affect 13.6% of the PD population. Use of dopamine receptor agonists (DRAs) is considered a major risk factor for ICD development. Amantadine and a high dose of levodopa were linked to ICDs to a lesser extent than DRAs. Based on the severity of behavior(s), ICDs can negatively impact social, professional, and familial lives of patients and their families. Ideally, all PD patients taking DRAs, high doses of levodopa, and/or amantadine should be routinely asked about or monitored for ICDs during therapy initiation and continuation. Dose decrease or withdrawal of the offending agent, primarily DRAs, is usually the most effective first step in ICD management. Careful dose adjustment with close monitoring is warranted due to risk for worsening of motor symptoms or emergence of dopamine agonist withdrawal syndrome (DAWS). About 1/3 of PD patients with ICD who decrease or discontinue DRA experienced DAWS. The lowest dose of DRA will need to be continued to balance ICDs and DAWS as it is not alleviated by other dopaminergic or psychotropic medications. Other therapies with low empiric evidence, such as amantadine, naloxone, cognitive behavior therapy, deep brain stimulation, and psychopharmacotherapy showed mixed results for ICD management. It is crucial that clinicians are familiar with the psychiatric complications of PD, including ICDs, beyond mere recognition and management of motor symptoms.

The Utilization of Mobile Applications for Self-Care in People With Parkinson Disease: Systematic Review (Preprint)

2021 ◽  
Author(s):  
JuHee Hee ◽  
Insun Yeom ◽  
Misook Lee Chung ◽  
Yielin Kim ◽  
Subin Yoo ◽  
...  
Keyword(s):  
Parkinson Disease ◽  
Task Performance ◽  
Systematic Reviews ◽  
Mobile Applications ◽  
Symptom Management ◽  
Neurodegenerative Disorder ◽  
Self Care ◽  
Cochrane Library ◽  
Symptom Improvement ◽  
Motor Symptoms

BACKGROUND Self-care is essential for people with Parkinson disease (PD) to minimize their disability and adapt to alterations in physical abilities due to progressive neurodegenerative disorder. With rapid developments in mobile technology, many health-related mobile applications for PD have been developed and utilized. However, insufficient research has investigated mobile application-based self-care in PD. OBJECTIVE This study aimed to explore the features and characteristics of the utilization of mobile applications for self-care in people with PD. METHODS This study was performed sequentially according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. Referred databases are PubMed, Embase, CINAHL, Cochrane Library, Web of Science and PsycINFO in consultation with a librarian on June 8, 2021. We used keywords including ‘Parkinson disease’ and ‘mobile.’ RESULTS A total of 17 studies were selected by the inclusion criteria, including 3 randomized controlled trials and 14 observational studies/quasi-experimental studies. The utilization of mobile applications for self-care in people with PD focused on symptom monitoring, especially tracking motor symptoms. Motor symptoms were objectively measured mainly through the sensors of smartphones or wearable devices and task performance. Non-motor symptoms were monitored through task performance or self-reported questionnaires in mobile applications. Most studies focused on clinical symptom assessment in people with PD, and there was a lack of studies focusing on symptom management. CONCLUSIONS Mobile applications for people with PD have been developed and utilized, but strategies for self-management are insufficient. We recommend the development of mobile applications focused on self-care that can enhance symptom management and health promotion practices. Studies should also evaluate the effects of mobile applications on symptom improvement and quality of life in people with PD. CLINICALTRIAL PROSPERO International Prospective Register of Systematic Reviews CRD42021267374.

Rescuing Suboptimal Outcomes of Subthalamic Deep Brain Stimulation in Parkinson Disease by Surgical Lead Revision

Neurosurgery ◽  
2019 ◽  
Vol 85 (2) ◽  
pp. E314-E321 ◽  
Author(s):  
Robert C Nickl ◽  
Martin M Reich ◽  
Nicoló Gabriele Pozzi ◽  
Patrick Fricke ◽  
Florian Lange ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Parkinson Disease ◽  
Brain Stimulation ◽  
Surgical Revision ◽  
Motor Symptoms ◽  
Optimal Position ◽  
Number Of Patients ◽  
Motor Improvement ◽  
Stn Dbs ◽  
Deep Brain

Abstract BACKGROUND Clinical trials have established subthalamic deep-brain-stimulation (STN-DBS) as a highly effective treatment for motor symptoms of Parkinson disease (PD), but in clinical practice outcomes are variable. Experienced centers are confronted with an increasing number of patients with partially “failed” STN-DBS, in whom motor benefit doesn’t meet expectations. These patients require a complex multidisciplinary and standardized workup to identify the likely cause. OBJECTIVE To describe outcomes in a series of PD patients undergoing lead revision for suboptimal motor benefit after STN-DBS surgery and characterize selection criteria for surgical revision. METHODS We investigated 9 PD patients with STN-DBS, who had unsatisfactory outcomes despite intensive neurological management. Surgical revision was considered if the ratio of DBS vs levodopa-induced improvement of UPDRS-III (DBS-rr) was below 75% and the electrodes were found outside the dorsolateral STN. RESULTS Fifteen electrodes were replaced via stereotactic revision surgery into the dorsolateral STN without any adverse effects. Median displacement distance was 4.1 mm (range 1.6-8.42 mm). Motor symptoms significantly improved (38.2 ± 6.6 to 15.5 ± 7.9 points, P < .001); DBS-rr increased from 64% to 190%. CONCLUSION Patients with persistent OFFmotor symptoms after STN-DBS should be screened for levodopa-responsiveness, which can serve as a benchmark for best achievable motor benefit. Even small horizontal deviations of the lead from the optimal position within the dorsolateral STN can cause stimulation responses, which are markedly inferior to the levodopa response. Patients with an image confirmed lead displacement and preserved levodopa response are candidates for lead revision and can expect significant motor improvement from appropriate lead replacement.

The Benefit of Subthalamic Deep Brain Stimulation for Pain in Parkinson Disease: A 2-Year Follow-up Study

Neurosurgery ◽  
2011 ◽  
Vol 70 (1) ◽  
pp. 18-24 ◽  
Author(s):  
Han-Joon Kim ◽  
Beom S. Jeon ◽  
Jee-Young Lee ◽  
Sun Ha Paek ◽  
Dong Gyu Kim
Keyword(s):  
Deep Brain Stimulation ◽  
Beneficial Effect ◽  
Parkinson Disease ◽  
Brain Stimulation ◽  
Rating Scale ◽  
Motor Disorder ◽  
Motor Symptoms ◽  
Stn Dbs ◽  
Deep Brain

Abstract BACKGROUND Pain is a well-recognized feature of Parkinson disease (PD), which is primarily a motor disorder. In a previous study, we showed that subthalamic deep brain stimulation (STN DBS) improves pain as well as motor symptoms 3 months after surgery in PD patients. OBJECTIVE To determine whether there is a long-term beneficial effect of STN DBS on pain in PD. METHODS We studied 21 patients with PD who underwent STN DBS. Motor symptoms were assessed using the Unified Parkinson's Disease Rating Scale and Hoehn and Yahr staging. Pain was evaluated by asking patients about the quality and severity of pain in each body part. Evaluations were performed at baseline and at 3 and 24 months after surgery. RESULTS At baseline, 18 of the 21 patients (86%) experienced pain. After surgery, most of the pain reported at baseline had improved or disappeared at 3 months and improved further at 24 months. The benefit of STN DBS for pain evaluated at 24 months was comparable to that with medication at baseline. At 24 months, 9 patients (43%) reported new pain that was not present at baseline. Most of the new pain was musculoskeletal in quality. Despite the development of new pain, the mean pain score at follow-up was lower than at baseline. CONCLUSION STN DBS improves pain in PD, and this beneficial effect persists, being observed after a prolonged follow-up of 24 months. In addition, in many of the PD patients new, mainly musculoskeletal pain developed on longer follow-up.

scholarly journals Genotype-Phenotype Correlations in Monogenic Parkinson Disease: A Review on Clinical and Molecular Findings

2021 ◽  
Vol 12 ◽  
Author(s):  
Daniele Guadagnolo ◽  
Maria Piane ◽  
Maria Rosaria Torrisi ◽  
Antonio Pizzuti ◽  
Simona Petrucci
Keyword(s):  
Parkinson Disease ◽  
Movement Disorders ◽  
Sleep Disturbances ◽  
Cell Function ◽  
Neurodegenerative Disorder ◽  
Current Knowledge ◽  
Mendelian Inheritance ◽  
Motor Symptoms ◽  
The Many ◽  
Non Motor Symptoms

Parkinson disease (PD) is a complex neurodegenerative disorder, usually with multifactorial etiology. It is characterized by prominent movement disorders and non-motor symptoms. Movement disorders commonly include bradykinesia, rigidity, and resting tremor. Non-motor symptoms can include behavior disorders, sleep disturbances, hyposmia, cognitive impairment, and depression. A fraction of PD cases instead is due to Parkinsonian conditions with Mendelian inheritance. The study of the genetic causes of these phenotypes has shed light onto common pathogenetic mechanisms underlying Parkinsonian conditions. Monogenic Parkinsonisms can present autosomal dominant, autosomal recessive, or even X-linked inheritance patterns. Clinical presentations vary from forms indistinguishable from idiopathic PD to severe childhood-onset conditions with other neurological signs. We provided a comprehensive description of each condition, discussing current knowledge on genotype-phenotype correlations. Despite the broad clinical spectrum and the many genes involved, the phenotype appears to be related to the disrupted cell function and inheritance pattern, and several assumptions about genotype-phenotype correlations can be made. The interest in these assumptions is not merely speculative, in the light of novel promising targeted therapies currently under development.

Spatial Topographies of Unilateral Subthalamic Nucleus Deep Brain Stimulation Efficacy for Ipsilateral, Contralateral, Midline, and Total Parkinson Disease Motor Symptoms

2015 ◽  
Vol 11 (1) ◽  
pp. 80-88
Author(s):  
Mahesh B Shenai ◽  
Andrew Romeo ◽  
Harrison C Walker ◽  
Stephanie Guthrie ◽  
Ray L Watts ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Parkinson Disease ◽  
Subthalamic Nucleus ◽  
Brain Stimulation ◽  
Rating Scale ◽  
Electrode Placement ◽  
Kriging Interpolation ◽  
Motor Symptoms ◽  
Disease Rating ◽  
Deep Brain

Abstract BACKGROUND Subthalamic nucleus (STN) deep brain stimulation is a successful intervention for medically refractory Parkinson disease, although its efficacy depends on optimal electrode placement. Even though the predominant effect is observed contralaterally, modest improvements in ipsilateral and midline symptoms are also observed. OBJECTIVE To elucidate the role of contact location of unilateral deep brain stimulation on contralateral, ipsilateral, and axial subscores of Parkinson disease motor symptoms. METHODS Eighty-six patients receiving first deep brain stimulation STN electrode placements were identified, yielding 73 patients with 3-month follow-up. Total preoperative and postoperative Unified Parkinson Disease Rating Scale Part III scores were obtained and divided into contralateral, ipsilateral, and midline subscores. Contact location was determined on immediate postoperative magnetic resonance imaging. A 3-dimensional ordinary “kriging” algorithm generated spatial interpolations for total, ipsilateral, contralateral, and midline symptom categories. Interpolative reconstructions were performed in the axial planes (z = −0.5, −1.0, −1.5, −3.5, −4.5, −6.0) and a sagittal plane (x = 12.0). Interpolation error and significance were quantified by use of a cross-validation technique and quantile-quantile analysis. RESULTS There was an overall reduction in Unified Parkinson Disease Rating Scale Part III symptoms: total = 37.0 ± 24.11% (P &lt; .05), ipsilateral = 15.9 ± 51.8%, contralateral = 56.2 ± 26.8% (P &lt; .05), and midline = 26.5 ± 34.7%. Kriging interpolation was performed and cross-validated with quantile-quantile analysis with high correlation (R2 &gt; 0.92) and demonstrated regions of efficacy for each symptom category. Contralateral symptoms demonstrated broad regions of efficacy across the peri-STN area. The ipsilateral and midline regions of efficacy were constrained and located along the dorsal STN and caudal zona incerta. CONCLUSION We provide evidence for a unique functional topographic window in which contralateral, ipsilateral, and midline structures may achieve the best efficacy. Although there are overlapping regions, laterality demonstrates distinct topographies. Surgical optimization should target the intersection of optimal regions for these symptom categories.

Cognitive Changes following Subthalamic Nucleus Stimulation in Two Patients with Parkinson Disease

2002 ◽  
Vol 95 (2) ◽  
pp. 477-486 ◽  
Author(s):  
Rita Moretti ◽  
Paola Torre ◽  
Rodolfo M. Antonello ◽  
Livio Capus ◽  
Manuela Gioulis ◽  
...  
Keyword(s):  
Drug Therapy ◽  
Parkinson Disease ◽  
Subthalamic Nucleus ◽  
Motor Symptoms ◽  
Cognitive Changes ◽  
Subthalamic Nucleus Stimulation ◽  
Subthalamic Stimulation ◽  
Open Debate ◽  
Deep Brain ◽  
Stimulation Of

The limits of a drug therapy in severe forms of Parkinson disease have led to refining neurosurgery on the basal ganglia. Deep brain stimulation of the subthalamic nucleus has been recognized as one of the most promising techniques to decrease “off” motor symptoms and motor fluctuations, allowing a reduction of drug therapy and limiting side effects of the drugs. There is still open debate on the possible consequences of chronic subthalamic stimulation in other ways, apart from motor symptoms, of general cognitive performance. We examined and followed two patients with Parkinson disease for 9 mo. after surgery for deep stimulation, studying their cognitive performances. There is a general amelioration of cognitive performances, in particular as far as linguistic capabilities is concerned. We discuss the possible significance of these results, reminding strenuously that only two patients were involved, so the potential for generalization is seriously limited.

A stroke of silence: tinnitus suppression following placement of a deep brain stimulation electrode with infarction in area LC

2013 ◽  
Vol 118 (1) ◽  
pp. 192-194 ◽  
Author(s):  
Paul S. Larson ◽  
Steven W. Cheung
Keyword(s):  
Deep Brain Stimulation ◽  
Parkinson Disease ◽  
Vascular Injury ◽  
Brain Stimulation ◽  
Motor Symptoms ◽  
Postoperative Mri ◽  
Deep Brain Stimulation Electrode ◽  
Contralateral Ear ◽  
Stimulation Electrode ◽  
Deep Brain

The authors report on a case of tinnitus suppression following deep brain stimulation (DBS) for Parkinson disease. A perioperative focal vascular injury to area LC, a locus of the caudate at the junction of the head and body of the caudate nucleus, is believed to be the neuroanatomical correlate. A 56-year-old woman underwent surgery for implantation of a DBS lead in the subthalamic nucleus to treat medically refractory motor symptoms. She had comorbid tinnitus localized to both ears. The lead trajectory was adjacent to area LC. Shortly after surgery, she reported tinnitus suppression in both ears. Postoperative MRI showed focal hyperintensity of area LC on T2-weighted images. At 18 months, tinnitus localized to the ipsilateral ear remained completely silenced, and tinnitus localized to the contralateral ear was substantially suppressed due to left area LC injury. To the authors' knowledge, this is the first report of a discrete injury to area LC that resulted in bilateral tinnitus suppression. Clinicians treating patients with DBS may wish to include auditory phantom assessment as part of the neurological evaluation.

scholarly journals Alpha-Synuclein and Cognitive Decline in Parkinson Disease

Life ◽  
2021 ◽  
Vol 11 (11) ◽  
pp. 1239
Author(s):  
Tian-Sin Fan ◽  
Sam Chi-Hao Liu ◽  
Ruey-Meei Wu
Keyword(s):  
Nervous System ◽  
Cognitive Impairment ◽  
Parkinson Disease ◽  
Cognitive Decline ◽  
Elderly People ◽  
Neurodegenerative Disorder ◽  
Alpha Synuclein ◽  
Motor Symptoms ◽  
Non Motor Symptoms ◽  
Common Neurodegenerative Disorder

Parkinson disease (PD) is the second most common neurodegenerative disorder in elderly people. It is characterized by the aggregation of misfolded alpha-synuclein throughout the nervous system. Aside from cardinal motor symptoms, cognitive impairment is one of the most disabling non-motor symptoms that occurs during the progression of the disease. The accumulation and spreading of alpha-synuclein pathology from the brainstem to limbic and neocortical structures is correlated with emerging cognitive decline in PD. This review summarizes the genetic and pathophysiologic relationship between alpha-synuclein and cognitive impairment in PD, together with potential areas of biomarker advancement.

Patient Selection Criteria for Deep Brain Stimulation for Parkinson Disease

2020 ◽  
pp. 43-48
Author(s):  
Laura S. Surillo Dahdah ◽  
Padraig O’Suilleabhain ◽  
Hrishikesh Dadhich ◽  
Mazen Elkurd ◽  
Shilpa Chitnis ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Parkinson Disease ◽  
Patient Selection ◽  
Brain Stimulation ◽  
Selection Criteria ◽  
Cerebral Atrophy ◽  
Motor Symptoms ◽  
Patient Selection Criteria ◽  
Treatment Medication ◽  
Deep Brain

Patient selection is critical for optimizing clinical outcomes after deep brain stimulation (DBS) surgery. Patient expectations need to be addressed before DBS surgery to avoid disappointment. There are generally accepted criteria for DBS candidacy for treatment of Parkinson disease (PD), essential tremor (ET), and dystonia. For PD, selection criteria include a diagnosis of idiopathic PD and the presence of disabling or troubling motor symptoms such as motor fluctuations or dyskinesia (despite optimized pharmacologic treatment). Medication-resistant tremor is also an indication. The response of problematic motor symptoms to dopaminergic drugs is an important predictor of DBS response, favoring selection of patients for whom levodopa substantially improves tremor, bradykinesia, and rigidity. Rarely, gait is improved with DBS, and in some cases freezing can improve, although this is not a predictable post-DBS feature. Exclusion criteria include serious medical comorbidities, uncontrolled psychiatric illness (thought and mood disorders), and dementia. Preoperative magnetic resonance imaging with extensive white matter changes, vascular malformations, severe cerebral atrophy, or hydrocephalus can also be exclusions. The patient should clearly understand the risks and benefits of DBS, which should be assessed using a preoperative multidisciplinary evaluation (neurology, neurosurgery, neuropsychology, psychiatry, and rehabilitation). Use of a social worker and/or nutritionist can also be helpful in select cases.

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