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Journal of Neurology - 相似文献
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BackgroundLevodopa/carbidopa intestinal gel infusion (LCIG) and subthalamic nucleus deep brain stimulation (STN-DBS) are approved therapies for advanced Parkinson’s disease (PD) whose long-term comparability remains unclear. MethodsWe reviewed the 5-year data on activities of daily living (ADL) and motor complications (OFF time, dyskinesia duration, and dyskinesia severity), as measured by the Unified Parkinson Disease Rating Scale (UPDRS) section-II and section-IV (items 39, 32, and 33, respectively) in 60 PD patients exposed to STN-DBS (n = 20), LCIG (n = 20), and oral medical therapy (OMT) (n = 20) at similar baseline disability and cognitive state. ResultsSTN-DBS and LCIG showed a similar magnitude of deterioration in ADL (+6.1 vs. +5.7 UPDRS-II; p = 0.709), but lesser than with OMT (+13.7 UPDRS-II; p = 0.005). OFF time also improved to the same extent in STN-DBS and LCIG (−62% vs. −54.5%; p = 0.830), while worsened with OMT (+78.6%; p < 0.001). STN-DBS and LCIG yielded greater improvement on dyskinesia compared to OMT (dyskinesia duration: −66.1% vs. −9.0% vs. +24.2% [ p = 0.001]; dyskinesia severity: −68.8% vs. −18.0% vs. +16.2% [ p = 0.002]), with relative superiority of STN-DBS over LCIG ( p = 0.004 for duration; p = 0.014 for severity). The annualized rate of complication was lower in STN-DBS vs. LCIG (0.13 vs. 0.68; p < 0.001) but not different between STN-DBS and OMT (0.13 vs. 0.10; p = 0.795). ConclusionsSTN-DBS and LCIG showed comparable efficacy in ADL and OFF time, superior to OMT. STN-DBS yielded greater improvement in dyskinesia and lower long-term rate of complications than LCIG. 相似文献
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Continuous apomorphine infusion (APO) is one of the treatments available for advanced Parkinson disease (PD). Over 10 years, we have treated 230 patients with APO. Mean age was 66.8 and average evolution time at APO onset was 13.0 years. Mean duration of the treatment was 26.3 months. As of June 2016, 93 remained on the medication (active group), while 137 had stopped. This active group had mean age 67.3 at recruitment and mean evolution 14.2 years. The main indication for APO was lack of deep brain stimulation criteria (DBS). Twelve patients were on waiting list for DBS. Average time since APO onset was 40.0 months. In the active group, APO decreased off-state in 4 h and allowed reducing levodopa and dopamine agonists. Dyskinesia and balance did not worsen. Cognitive decline did not change within the first 15 months. Hallucinations were the same within the first 39 months. The presence of subcutaneous nodules was the most frequent adverse event in this group. The main reason for discontinuation was side effects, being psychosis the most common. Within the first year, 82 patients stopped APO. Eighteen of these patients eventually got DBS. APO is a good option for advanced PD, since it permits a significant reduction in off-time and other antiparkinsonian drugs. This effect is sustained over time. We have treated 132 patients for over a year. Dyskinesia seems not to worsen. Combining APO with DBS simultaneously or alternatively provides good results. 相似文献
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Drooling is a well known problem in patients with Parkinson's disease (PD). The aim of this study was to investigate the severity and consequences of drooling in PD. A comprehensive drooling questionnaire was sent to 105 PD outpatients, who had volunteered drooling during a previous questionnaire (n = 216). Among 63 patients who responded and confirmed drooling, 27% experienced severe saliva loss. Social and emotional consequences were reported by 17% to 77% of patients, and significantly more often by those with severe drooling. We conclude that drooling is a frequent, disabling and apparently undertreated symptom of PD. History taking ought to be detailed and specific to understand the full impact of drooling for an individual patient. Therapeutic options should be evaluated more intensively. 相似文献
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Treatment standards
or guidelines have been developed
for most features of Parkinson’s
disease (PD). However, data on the
actual treatment that is put into
practice are scarce. In 2000, a nationwide
survey on the topic of
sudden onset of sleep (SOS) in PD
was initiated among the members
of the German patient support
group (deutsche Parkinson–Vereinigung,
dPV). A part of this
mailed questionnaire survey covering
the antiparkinsonian and concomitant
medication of the participants
is presented here. This study
analyses data sets from more than
6,500 PD patients. The mean
dopaminergic dose was equivalent
to 599 ± 387 mg levodopa/die. The
most frequently administered
drugs were levodopa (94.2 %),
dopamine agonists (DA) (71.7 %),
amantadine (40.1 %), selegiline
(27.6 %), entacapone (20.4 %),
budipine (12.3 %), and anticholinergics
(11.8 %). Costs of pharmacotherapy
were estimated to be
approximately € 399 million/year
in Germany. PD drug therapy in
general strongly depended on age,
disease duration, and the level of
care. The treatment guidelines were
apparently not consistently followed
underlining the need for
their continuous propagation
throughout the medical community.
In addition our data suggest
that non–motor symptoms in PD
are not adequately treated and that
concomitant sedative medication
contributes to the occurrence of
SOS. 相似文献
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In this review, the potential role of positron emission tomography and single photon emission computed tomography as biological
markers for diagnosing and following the progression of Parkinson’s disease (PD) is discussed. Their value for assessing the
efficacy of putative neuroprotective agents in PD and for revealing the pharmacological changes underlying the symptomatology
and complications of this disorder is also considered. It is concluded that in the future functional imaging will provide
a valuable adjunct to clinical assessment when judging the efficacy of putative neuroprotective approaches to PD. 相似文献
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Among the recently well appreciated non-motor symptoms in Parkinson’s disease (PD), depression plays a prominent role due to its frequency and impact on quality of life. However, depression may be confounded by motor symptoms, especially akinesia and other non-motor symptoms such as apathy, anxiety and dementia. Data on specific diagnostic tools or treatment for depressive symptoms in PD patients are still sparse. Here we summarize an expert opinion based on available data and clinical experience. 相似文献
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Abstract.
Fatigue is a recognized problem in Parkinsons disease and
other clinical conditions. We characterized this symptom in 19
patients and 19 age- and sex-matched controls, using the
Multidimensional Fatigue Inventory (MFI) and the Geriatric
Depression Scale. Fatigue may be an independent symptom in
Parkinsons disease, frequently associated with depression. Our
analysis showed the usefulness of the MFI in discriminating
between different dimensions of fatigue for a better therapeutic
approach. 相似文献
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Abstract
Objectives
The pathophysiology of depression and anxiety in Parkinson's disease remains obscure. We aimed to compare the fractional anisotropy
(FA) values of Parkinson's disease (PD) patients with and without depression to investigate the nature of depression in PD.
Methods
Twenty-eight patients were divided into two groups: those with depression and those without. Diagnosis of depression was made
using the DSM-IV criteria. Patients in the two groups were matched for Hoehn Yahr stage.
Results
There were significant reductions in FA values in the bilateral frontal ROIs possibly representing anterior cingulate bundles.
Conclusions
The anterior cingulate bundles play an important role in depression in PD, and some aspects of depression in PD have pathological
processes in common with de novo depression. 相似文献
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INTRODUCTIONWe examined the prevalence of cancer in patients with Parkinson’s disease (PD) and controls evaluated at the Mayo Clinic in Jacksonville, Florida, between 2003 and 2014. METHODSWe retrospectively collected information regarding cancer diagnoses and diagnosis of PD from 971 unrelated PD patients and 478 controls, and all were white. For PD patients, we examined cancers diagnosed before and after PD diagnosis separately in addition to considering all cancer diagnoses. RESULTSTwenty different cancers were identified. In PD patients, the most common types of cancer were skin cancer (17.3% overall; 10.6% before PD), followed by nonmelanoma skin cancer (16.0% overall; 9.7% before PD), prostate cancer in men (12.8% overall; 9.2% before PD), breast cancer in women (10.6% overall; 6.3% before PD), and melanoma (2.4% overall; 1.1% before PD). Compared to controls, a significantly lower frequency of nonmelanoma skin cancer (odds ratio [OR]: 0.62, P = 0.0024) and any skin cancer (OR: 0.57, P = 0.0002) was observed in PD patients. These differences were greater when considering only cases with cancers that occurred before PD diagnosis (OR: 0.49, P < 0.0001; OR: 0.45, P < 0.0001, respectively), and there was a lower frequency of melanoma and any cancer preceding PD diagnosis compared to controls (OR: 0.31, P = 0.003; OR: 0.36, P < 0.0001). There was no evidence of a frequency difference for any other cancer. CONCLUSIONSPD patients had a lower frequency of skin cancers or any cancer prior to PD diagnosis compared to controls, suggesting that cancer may have a protective effect on PD risk. 相似文献
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Depression is common in Parkinson’s disease (PD), and its identification and treatment are critically important in disease
management. Despite depression’s high prevalence and major impact on patient quality of life, questions remain regarding its
epidemiology and preferred treatment. The authors of this paper summarize available information on the epidemiology of depression
in PD, review treatment options, and discuss possible interactions between antidepressants and other agents. This information
may help guide clinical treatment and define the need for further studies. 相似文献
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Parkinson’s disease (PD) is characterised both clinically and pathologically by features that distinguish it from other parkinsonian disorders including, for instance, multiple system atrophy and progressive supranuclear palsy. The aetiologies of PD includes both genetic and environmental influences. Several single gene causes of autosomal dominant and recessive PD have been described. Recent genome-wide association (GWA) studies have identified a number of risk alleles for PD. No specific environmental cause has been defined but several factors have been described which influence the risk for PD. Mitochondrial dysfunction, free radical mediated damage, inflammatory change and proteasomal dysfunction have been thought to play a role in PD pathogenesis. Autophagy is now recognised as an important component of the cell’s mechanism for protein turnover and has relevance for PD. There is some convergence and overlap of pathogenetic pathways between environmental and genetic factors. The importance of identifying the molecular and biochemical events that lead to PD lies in the prospect that novel drug targets will emerge and that new compounds will be developed that slow the progression of the disease. 相似文献
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Whether patients with genetically defined Parkinson’s disease (PD) may be particularly eligible to benefit from deep brain
stimulation of the nucleus subthalamicus (STN-DBS) is currently the subject of debate. We report on a patient with advanced
PD due to R793M missense mutation in the LRRK2 gene successfully treated by STN-DBS. Disease onset was at age 42 with bradykinesia,
rigidity and rest tremor. During the course of the disease he developed severe motor fluctuations, dyskinesias, postural instability
with falls, but preserved levodopa responsiveness. At age 60 the patient was treated by bilateral DBS of the STN. At one year
after surgery a 66% improvement of the UPDRS motor score in the off-medication state was determined. During the long-term
follow-up there was sustained benefit with 56% improvement of motor score after 8 years. Our report adds evidence that patients
with LRRK2 monogenetic Parkinsonism are well suited candidates for DBS treatment and may indicate a potential genetic predictor
for positive long-term effect of STN-DBS treatment. 相似文献
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Parkinson’s disease is a widespread degenerative illness affecting the human central, peripheral, and enteric nervous systems. The underlying pathological process progresses slowly but relentlessly and involves multiple neuronal systems. The disease is the consequence of changes in the neuronal cytoskeleton developing in only a few susceptible types of nerve cells. Afflicted neurons eventually produce Lewy bodies in their perikarya and Lewy neurites in their neuronal processes. Immunoreactions against the presynaptic protein α-synuclein have revealed many kinds of inclusion bodies ranging from inconspicuous dot- or thread-like forms to particularly voluminous types. The selective vulnerability of nerve cells induces a distinctive distribution pattern of lesions which remains remarkably consistent across cases. Components of the limbic system and the motor system have been shown to be particularly vulnerable to severe destruction. Some subnuclei of the substantia nigra also undergo major changes. This damage is consistently accompanied by extranigral alterations, with predilection sites including the entorhinal region, the second sector of the Ammon’s horn, and important subnuclei of the amygdala. In addition, the nucleus of the stria terminalis, components of the hypothalamus, all of the non-thalamic nuclei with diffuse projections to the cerebral cortex, and most of the centers regulating autonomic functions exhibit severe lesions. 相似文献
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Pain occurring in Parkinson’s disease (PD) may affect a large proportion of patients. Based on the results of the methodologically more robust case–control studies that detected a significantly greater frequency of pain in PD patients than in control subjects, pain should now be considered as a non-motor symptom of PD. The heterogeneous quality of pain, the variable relationship of pain with parkinsonian motor signs, and the mixed response of pain to dopaminergic drugs suggest complex mechanisms for pain in PD. Some evidence raises the possibility of common mechanisms shared by pain patients, regardless of the clinical heterogeneity of pain and its variable relationship with motor signs. 相似文献
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