The past,present, and future of telemedicine for Parkinson's disease

Travel distance, growing disability, and uneven distribution of doctors limit access to care for most Parkinson's disease (PD) patients worldwide. Telemedicine, the use of telecommunications technology to deliver care at a distance, can help overcome these barriers. In this report, we describe the past, present, and likely future applications of telemedicine to PD. Historically, telemedicine has relied on expensive equipment to connect single patients to a specialist in pilot programs in wealthy nations. As the cost of video conferencing has plummeted, these efforts have expanded in scale and scope, now reaching larger parts of the world and extending the focus from care to training of remote providers. Policy, especially limited reimbursement, currently hinders the growth and adoption of these new care models. As these policies change and technology advances and spreads, the following will likely develop: integrated care networks that connect patients to a wide range of providers; education programs that support patients and health care providers; and new research applications that include remote monitoring and remote visits. Together, these developments will enable more individuals with PD to connect to care, increase access to expertise for patients and providers, and allow more‐extensive, less‐expensive participation in research. © 2014 International Parkinson and Movement Disorder Society     

Frequency‐dependent neural activity in Parkinson's disease

The brainstem and basal ganglia are important in the pathophysiology of Parkinson's disease (PD). Reliable and sensitive detection of neural activity changes in these regions should be helpful in scientific and clinical research on PD. In this study, we used resting state functional MRI and amplitude of low frequency fluctuation (ALFF) methods to examine spontaneous neural activity in 109 patients with PD. We examined activity in two frequency bands, slow‐4 (between 0.027 and 0.073 Hz) and slow‐5 (0.010–0.027 Hz). Patients had decreased ALFF in the striatum and increased ALFF in the midbrain, and changes were more significant in slow‐4. Additionally, changes in slow‐4 in both basal ganglia and midbrain correlated with the severity of the parkinsonism. The ALFF in the caudate nucleus positively correlated with the dose of levodopa, while the ALFF in the putamen negatively correlated with the disease duration in both slow‐4 and slow‐5 bands. In addition, the ALFF in the rostral supplementary motor area negatively correlated with bradykinesia subscale scores. Our findings show that with a large cohort of patients and distinguishing frequency bands, neural modulations in the brainstem and striatum in PD can be detected and may have clinical relevance. The physiological interpretation of these changes needs to be determined. Hum Brain Mapp 35:5815–5833, 2014. © 2014 Wiley Periodicals, Inc.     

茶多酚及其提取物EGCG抑制MPTP致α-突触核蛋白聚集

目的 研究茶多酚及其提取物表没食子儿茶素没食子酸酯(epigallocatechin-3-gallate, EGCG)对帕金森病神经毒素1-甲基-4-苯基-1,2,3,6-四氢吡啶(1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine, MPTP)引起的α-突触核蛋白(α-synuclein, α-syn)聚集的影响。方法 健康雌性食蟹猴(10~12岁),采用数字表法随机分为正常对照组、茶多酚对照组(TP组)、帕金森病模型组(MPTP组)和茶多酚治疗组(MPTP + TP组),每组4只。正常对照组不进行任何处理;茶多酚对照组灌胃给予茶多酚80 d;帕金森病(Parkinson's disease, PD)模型组静脉给予MPTP诱导PD模型;茶多酚治疗组在PD模型建立后给予茶多酚治疗80 d。实验动物经安乐死后,分离脑组织,ELISA法检测不同脑区寡聚化α-syn含量。体外培养MES23.5多巴胺能神经细胞,细胞外添加α-syn单体或寡聚体后,再经MPP⁺和/或EGCG处理,ELISA法检测细胞内α-syn寡聚体的量,MTT法检测各组多巴胺能神经细胞损伤情况。结果 MPTP增加猴脑组织寡聚化α-syn含量,治疗性给予茶多酚减少MPTP引起的α-syn聚集。体外研究表明,MPP⁺可明显增加对照组、α-syn单体和寡聚体处理组细胞的细胞内α-syn寡聚体的量,而茶多酚提取物EGCG可以抑制MPP⁺引起的细胞内α-syn聚集,并缓解MPP⁺所致细胞损伤。结果 茶多酚及其提取物EGCG可以抑制PD神经毒素MPTP引起α-syn聚集和多巴胺能神经元损伤。     

原子力显微镜检测α-突触核蛋白转基因鼠线粒体微观结构的变化

目的 使用原子力显微镜检测α-突触核蛋白（α-synuclein,α-syn）转基因小鼠模型中,皮质线粒体表面微观结构的变化。方法 提取野生型和转基因小鼠皮质细胞线粒体,使用共聚焦显微镜检测其膜电势变化,使用原子力显微镜的敲击模式检测线粒体膜表面的微观结构。结果 JC-1染色法检测线粒体膜电势结果显示,转基因小鼠线粒体膜电势与野生组相比降低20.4%,差异有统计学意义（P<0.01）;原子力显微镜观察结果显示,转基因小鼠线粒体长度与野生组相比增加,表面光滑度减低,线粒体膜孔增多（P<0.05）。结论 α-Syn的转基因小鼠线粒体膜电势减低,线粒体膜完整性受到破坏。在原子力显微镜敲击模式下检测离体线粒体,能反映出转基因小鼠线粒体膜表面微观结构的变化。     

PINK1减轻α-突触核蛋白引起的线粒体损伤

目的 证明PINK1对α-突触核蛋白(α-synuclein, α-syn)引起的线粒体损伤的影响。方法 将携带人源PINK1 和α-syn基因的质粒共转染MN9D多巴胺能神经细胞,流式细胞术检测细胞内活性氧(reactive oxygen species, ROS)、线粒体渗透性转运孔(mitochondrial permeability pore, mPTP)的开放情况及线粒体膜电势(ΔΨ_m)变化;MTT和乳酸脱氢酶法检测细胞活力及细胞损伤情况。结果 PINK1减少α-syn引起的ROS的生成、线粒体膜孔的开放及线粒体膜电势降低,并减轻α-syn所致细胞活力下降及和细胞损伤。结论 PINK1可以减轻α-syn引起的线粒体损伤。     

茶多酚对帕金森病猴多巴胺能神经元保护作用的研究

目的 探索茶多酚对1-甲基-4-苯基-1,2,3,6-四氢吡啶(1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine, MPTP)诱导的帕金森病猴神经元的保护作用及机制。方法 健康雌性食蟹猴年龄10~12岁,采用数字表法随机分为4组:正常对照组、茶多酚对照组(TP组)、帕金森病模型组(MPTP组)和茶多酚治疗组(MPTP + TP组),每组4只。正常对照组不进行任何处理;茶多酚对照组灌胃给予茶多酚80 d;PD模型组静脉注射MPTP诱导PD模型,茶多酚治疗组在PD模型建立后给予茶多酚治疗80 d,每周2次用帕金森病临床行为评价量表评价各组动物运动损伤。实验动物经安乐死后,分离脑组织,高效液相色谱分析纹状体多巴胺及其代谢产物含量,免疫组织化学和体视学分析黑质多巴胺能神经元变化。结果 TP能减少MPTP诱导的食蟹猴黑质多巴胺能神经元的损伤并缓解其运动障碍。结果 首次在灵长类动物体内实验证实茶多酚能有效减少多巴胺能神经元的损伤并改善其运动机能。     

α-突触核蛋白在食蟹猴消化道不同部位的表达

目的 观察α-突触核蛋白(α-synuclein, α-Syn)在正常食蟹猴消化道不同部位的表达。方法 利用免疫组织化学和Western blotting方法检测α-Syn在食蟹猴食道、胃、十二指肠、空肠、回肠及结肠中的表达特点和表达量。结果 α-Syn免疫活性物质主要见于消化道壁内神经的神经纤维和神经节,这些α-Syn免疫阳性神经结构见于消化道的黏膜、黏膜下层和肌层。在消化道的不同部位,α-Syn的表达量不同,其中十二指肠、空肠、回肠和结肠表达量较高,而胃和食道的表达量较低。结论 α-Syn主要存在于食蟹猴消化道的壁内神经,在消化道的不同部位表达量差异有统计学意义。