依达拉奉治疗帕金森病的疗效观察

目的 探讨依达拉奉治疗帕金森病(PD)的临床疗效.方法 对18例早期PD(病程≤3.5年)和12例晚期PD(病程≥4年)患者,应用依达拉奉30 mg加入生理盐水中静脉滴注,每天2次,连续14 d.在治疗前和治疗后14 d、1个月、3个月进行PD统一评分量表(UPDRS)评分,并观察治疗期间的不良反应.结果 早期PD组在治疗后14 d、1个月、3个月精神活动、行为和精神评分、日常生活活动评分和运动检查评分较治疗前有显著降低(P<0.05～0.01);晚期PD组治疗前后UPDRS评分的差异无统计学意义(均P＞0.05).1例出现轻度恶心、食欲下降;1例出现天冬氨酸转氨酶升高;无其他不良反应.结论 依达拉奉能改善早期PD患者的病情,对晚期PD患者无明显效果.     

还原型谷胱甘肽治疗帕金森病的临床研究

目的探讨还原型谷胱甘肽(GSH)治疗帕金森病(PD)患者的临床疗效。方法 63例帕金森病患者随机分为2组,治疗组32例,对照组31例,均予抗PD药物治疗,其中治疗组加用0.9%氯化钠注射液100 mL+还原型谷胱甘肽1.2～2.4 g静滴,1次/d,共21 d。治疗前后分别采用PD统一评分量表(UPDRS)、Hoehn-Yahr分级量表进行临床评价,行血清谷胱甘肽过氧化物酶(GSH-Px)、超氧化物歧化酶(SOD)测定。结果与对照组比较,GSH组UPDRS评分、Hoehn-Yahr分级有显著改善(P0.05或0.01),GSH-Px、SOD值较治疗前明显升高(P0.01),而对照组改变不明显。结论 GSH治疗帕金森病疗效显著。     

微电极引导立体定向核团毁损和脑深部电刺激治疗帕金森病

目的研究微电极引导立体定向颅内核团毁损和脑深部电刺激手术(deep brain stimulation,DBS)治疗帕金森病的临床疗效。方法分析我院116例应用微电极引导立体定向核团毁损术和85例应用脑深部电刺激术治疗的帕金森病患者的临床资料,获得术前、术后和DBS开启后6个月、1年、3年及5年的不同服药状态下帕金森病联合评分量表(UPDRS)的评分,比较手术前后UPDRS运动评分的差异。结果核团毁损术和DBS在术后6个月、1年和3年的随访中均能显著改善患者术前UPDRS运动评分,在第5年仅DBS组UPDRS运动评分较术前有改善,同时DBS组患者术后抗帕金森病药物用量较术前减少。结论核团毁损和脑深部电刺激手术均能显著改善帕金森病患者的UPDRS运动评分,DBS疗效更为长久。     

司来吉兰联合复合多巴治疗帕金森病的有效性和安全性

目的 探讨司来吉兰联合复合多巴治疗帕金森病的疗效和安全性.方法 将89例帕金森病患者随机分为对照组(45例)和治疗组(44例),对照组患者采用复合多巴等药物治疗,治疗组患者加用司来吉兰治疗,6个月为1个观察周期.于用药前及用药后1、3、6个月采用PD统一评分量表(UPDRS)对两组患者进行疗效评定,并观察其不良反应.结果 治疗组患者治疗1个月时与治疗前相比,除UPDRSⅢ评分降低外(P＜0.01),UPDRSⅠ、Ⅱ、Ⅳ评分变化均无统计学差异(均P＞0.05)；治疗3、6个月时与治疗前比较,其UPDRSⅠ～Ⅳ评分均下降(P＜0.01)；治疗3、6个月时与治疗1个月时比较,UPDRS Ⅰ、Ⅲ、Ⅳ评分降低均降低(P＜0.01,P＜0.05)；治疗6个月时与治疗3个月时相比,其UPDRS Ⅰ～Ⅳ评分均无统计学差异(P＞0.05).治疗3、6个月时,治疗组UPDRSⅠ～Ⅳ评分均明显低于对照组(P＜0.01,P＜0.05).观察期内,两组患者未出现严重不良反应.结论 司来吉兰联用复合多巴可有效改善帕金森病症状,且耐受性好,不良反应少.     

神经干细胞移植治疗帕金森病的效果观察

目的探讨神经干细胞移植术治疗帕金森病的临床效果。方法选择2014-05—2015-05驻马店市中心医院收治的帕金森病患者27例,均采用神经干细胞移植手术治疗。分别记录患者治疗前、治疗后12个月的统一帕金森病评分量表(UPDRS)评分,并观察患者随访12个月的治疗效果。结果治疗后12个月,患者UPDRS量表中的行为和心理评分、日常生活质量评分、运动功能评分、并发症评分均明显低于治疗前(P0.05),且治疗后12个月UPDRS量表总评分也低于治疗前(P0.05)。27例患者平均随访12个月,治疗总有效率为81.48%。结论神经干细胞移植手术治疗帕金森病疗效确切,可明显改善患者UPDRS评分,提升生活质量,值得推广。     

定振汤治疗帕金森病的临床观察

目的 观察定振汤治疗帕金森病(PD)的临床疗效.方法 选择2006年3月～2008年9月我院PD患者65例,将其随机分为治疗组和对照组,对照组根据"国际帕金森病治疗指南"用药原则进行治疗,治疗组在此基础上予以定振汤,连续服用6月.在治疗前、治疗后3月和6月分别进行帕金森病统一评分量表(UPDRS)评分、观察两组在治疗前、治疗后3月及6月自主神经症状发生率.结果 治疗后两组患者UPDRS评分均呈上升趋势,治疗组较对照组UPDRS评分上升明显减慢,在治疗后第6月时,两组UPDRS评分比较差异有显著性(P＜0.05).治疗后3月时,治疗组便秘的发生率明显低于对照组(P＜0.05),治疗6月时,治疗组泌尿障碍的发生率明显低于对照组(P＜0.05).结论 定振汤能有效减慢PD患者的UPDRS评分的上升速度,延缓病情进展,改善便秘、泌尿障碍等自主神经症状.     

重复经颅磁刺激治疗帕金森病

目的探讨重复经颅磁刺激对帕金森病患者的治疗作用。方法采用重复经颅磁刺激方法对8例帕金森病患者进行治疗,另选择7例帕金森病患者作为对照。采用改进的H&Y(HoehnandYahr)评分标准、SchwabandEngland日常生活能力评分量表以及帕金森病症状评分量表(UPDRS)进行疗效评估。结果8例接受重复经颅磁刺激治疗的患者,于治疗第3、6和9个月时进行H&Y评分和UPDRS评分,与治疗前相比,这两种评分均明显下降(P<0.05),而SchwabandEngland日常生活能力评分则明显提高,治疗前后相比差异具有显著性意义(P<0.05);对照组治疗前后相比差异无显著性意义(P>0.05)。结论重复经颅磁刺激有助于缓解帕金森病患者的症状。     

微电极引导立体定向脑内核团毁损术治疗帕金森病临床观察

目的研究微电极引导下立体定向核团毁损术治疗帕金森病的临床效果分析。方法我院106例微创外科手术治疗帕金森病患者的临床资料,显效(含显效及特别显效)90例(84.9%),有效16例(15.1%),总有效率100%。分别获得微创治疗术前、术后不同服药状态下帕金森病联合评分量表(UPDRS)的评分,比较微创手术治疗前后UPDRS运动评分之间的差异。结果颅内核团毁损术在术后3个月、6个月及1a的随访中均能有效改善帕金森患者术后UPDRS运动评分,同时患者术后口服抗帕金森病类药物用量较术前可见不同程度的减少。结论微电极引导立体定向脑内核团毁损治疗帕金森病疗效满意,能显著改善帕金森病患者的UPDRS运动评分,精确定位是手术成功的关键,微电极记录可提高手术的准确性。     

脐带间充质干细胞移植治疗帕金森病效果分析

目的 探讨脐带间充质干细胞移植治疗帕金森病的临床效果.方法 选择我院收治的38例帕金森病为研究对象,采用足月妊娠产妇脐带处理后干细胞,于第2周期进行鞘内注射移植治疗.分析治疗后临床症状及体征改善情况.治疗前及治疗后1个月,采用帕金森病统一评分量表（UPDRS）对患者精神、行为、情绪、日常活动、运动功能、并发症进行评价.结果 所有患者的静止性震颤、运动迟缓、肌强直、姿势步态障碍均不同程度缓解,治疗过程中及治疗后患者各项生命体征均较平稳.38例患者移植后UPDRS评分显著低于移植前,差异有统计学意义（P＜0.05）.治疗过程中患者有低热、头痛、腰痛、兴奋症状出现,给予对症处理后均完全缓解.均未见抗移植物宿主病.结论 脐带间充质干细胞移植可显著改善帕金森病患者的临床症状.     

川芎嗪添加治疗帕金森病的临床疗效观察

目的研究川芎嗪添加治疗帕金森病(PD)的临床疗效。方法将46例PD患者随机分为对照组和观察组;2组均给予美多巴基础治疗,观察组在对照组治疗基础上添加川芎嗪治疗;在治疗前后对2组患者进行统一帕金森病评分量表(UPDRS)各部分评分,并计算2组患者治疗有效率。结果对照组患者治疗后日常生活活动评分和运动检查评分较治疗前显著降低(P<0.05)。观察组患者治疗后精神、行为、情绪评分、日常生活活动评分和运动检查评分较治疗前显著降低(P<0.05)。与对照组治疗后比较,观察组治疗后精神、行为、情绪评分、日常生活活动评分和运动检查评分显著降低(P<0.05)。与对照组比较,观察组治疗有效率显著增高(P<0....     

Effect of therapy on motor cortical excitability in Parkinson's disease

OBJECTIVE: To assess the impact of the disease stage and therapy on motor cortical excitability in Parkinson's disease (PD). METHODS: Twenty newly diagnosed and medication-free, early stage patients, 20 late stage patients under antiparkinsonian therapy and 20 normal healthy controls were included. Motor threshold (MT), amplitudes of motor evoked potential (MEP), motor evoked potential amplitude/compound muscle action potential amplitude (MEP/CMAP) ratio, central motor conduction time (CMCT) and cortical silent period (CSP) were measured by stimulation of the motor cortex using a 13.5 cm circular coil and recordings from abductor digiti minimi muscle. Following the first study protocol, early stage patients were given therapy and the same protocol was repeated three months later. RESULTS: Motor threshold was lower; and the MEP/CMAP ratio was higher in early and late stage patients than normals. In early stage patients after proper therapy, the MTs became higher than before therapy, but still remained lower than normals. In late stage patients, the CMCTs were shorter than the early stage patients before therapy and normals, but there was no difference between the early stage patients and normals. In early stage patients after therapy, the CMCT became longer than before therapy and this difference was significant in both late stage patients and normals. Although more prominent in late stage patients, the CSP duration in both PD groups was found shorter than normals. In early stage patients, after therapy, the CSP durations became significantly longer compared with before therapy. CONCLUSION: These findings suggest that the motor cortical excitability increases in PD because of the impairment of the corticomotoneuronal inhibitory system.     

A responsive outcome for Parkinson's disease neuroprotection futility studies

Futility studies are designed to test new treatments over a short period in a small number of subjects to determine if those treatments are worthy of larger and longer term studies, or if they should be abandoned. An appropriate outcome measure for a neuroprotection futility study in Parkinson's disease (sensitive to tracking disease progression in the short-term) has not been determined. Data sets from three clinical trials were used to compare Parkinson's disease outcome measures. Total Unified Parkinson's Disease Rating Scale (UPDRS; Mentation + Activities of Daily Living + Motor) change and Motor plus Activities of Daily Living UPDRS change, measured in untreated patients, required the smallest sample sizes of all the outcome measures explored. Other outcomes (UPDRS Motor, UPDRS Activities of Daily Living, and time to need levodopa) required somewhat larger sample sizes. Futility designs in Parkinson's disease are feasible in terms of short duration and small sample size requirements, and this design is being applied in two ongoing Parkinson's disease studies to select agents for future larger and longer term neuroprotection studies.     

Metric attributes of the unified Parkinson's disease rating scale 3.0 battery: part II, construct and content validity.

This article is the second of a two-part series concerning the metric properties of the following three Parkinson's disease (PD) scales: modified Hoehn and Yahr staging (H&Y), Schwab and England (S&E), and Unified Parkinson's Disease Rating Scale (UPDRS) 3.0. Part II focuses on construct and content validity. To assess construct validity, a sample of 1,136 PD patients completed the above-mentioned PD scales. Correlation coefficients between measures of disability and dysfunction [S&E, UPDRS Activities of Daily Living (ADL), and UPDRS Motor Examination] were |r| = 0.69-0.77, indicating good convergent validity. Results showed that the S&E (F(5,945) = 193.47; P < 0.0001) and UPDRS subscales discriminated between modified H&Y stages (F(20,2784) = 25.28; P < 0.001). A panel of 12 to 13 international experts rated the relevance of the scales and items. This enabled the scales' content validity index to be calculated, which ranged from 41.7% (UPDRS Mentation) to 83.3% (UPDRS Motor Examination). In conclusion, while the modified H&Y, S&E, and UPDRS displayed satisfactory construct validity, the content validity of all scales except UPDRS Motor Examination failed to attain adequate standards.     

帕金森病患者自主神经功能障碍评估

目的：评估帕金森病（PD）患者中自主神经功能障碍症状发生比例、各症状分布的差异，及其与PD临床特点之间的关系。方法：应用SCOPA-AUT量表、统一帕金森病评分量表（UPDRS）、日常生活能力量表（ADL）、Hamilton抑郁量表和简易智能量表（MMSE）对116例原发性PD患者进行评估。结果：SCOPA-AUT总分和消化系统（GI）症状、排尿（UR）症状、体温调节（TH）症状、性功能（SX）症状评分均高于对照组，差异有极显著统计学意义（P=0．0001）。SCOPA-AUT总分与UPDRS评分、Hamilton抑郁量表评分呈正相关（P〈0．001），与生活质量ADL评分呈负相关（P〈0．001）。结论：自主神经功能障碍在PD早期就会出现，并随着疾病进展而加重，影响患者的生活质量。     

Impact of the motor complications of Parkinson's disease on the quality of life.

The impact of motor complications of Parkinson's disease (PD), especially levodopa-induced dyskinesias, on quality of life (QL) was studied in 143 patients with PD. All were evaluated on the Hoehn and Yahr (H&Y) scale, and the Motor part of the Unified Parkinson's Disease Rating Scale (UPDRS). Motor complications were analyzed using the UPDRS Parts IV(A) and IV(B) and the Abnormal Involuntary Movement Scale. A specific Parkinson's disease quality of life questionnaire (39-item version, PDQ-39) was used. Motor complications significantly worsened the PDQ-39 Summary Index (PDQ-SI) of patients with PD. The dimensions of Mobility, Activities of Daily Living, Stigma, and Communication were the most strongly affected. "Peak dose" dyskinesia decreased Mobility, Emotional Well-Being, and Cognition, whereas biphasic dyskinesia affected Mobility, Stigma, Communication, and Activities of Daily Living. Morning akinesia, end-of-dose fluctuations, and "unpredictable offs" decreased QL on the dimensions of Mobility, Activities of Daily Living, Stigma, and Communication. Nocturnal akinesia led to a deterioration of all dimensions of the PDQ-39. Thus, motor complications and especially nocturnal akinesia and biphasic dyskinesias worsened the QL of PD patients.     

早期帕金森病患者健康相关生活质量

目的 研究中国早期帕金森病(PD)患者健康相关生活质量(health related quality of life,HR-QOL)的特点;探讨运动症状和非运动症状对早期PD患者HR-QOL的影响.方法 在全国范围内共筛选出391例早期PD患者入组.采用统一帕金森病评分表(UPDRS)和Hoehn-Yahr评价运动症状,采用流行病学研究中心编制的抑郁量表(CES-D)、匹兹堡睡眠质量指数(PSQI)、疲劳量表(FSS)、阿尔茨海默病评定量表的认知部分(ADAS-Cog)和便秘量表分别对抑郁、睡眠障碍、疲劳、认知功能和便秘等非运动症状进行评价;采用36条目简化医疗结局调查问卷(SF-36)评价HR-QOL.比较PD患者与同龄健康老年人SF-36分值的差异.采用逐步多元线性回归分析深入探讨各种运动及非运动症状变量对HR-QOL的影响.结果 早期PD患者除SF-36躯体疼痛维度外,其余各维度分值较同龄健康老年人均下降.UPDRS第3部分分值(23.8±11.8)、Hoehn-Yahr分期(2.0±0.7)和强直分值(4.4±3.1)仅能解释SF-36总分变化的18.9%(R2=0.189).CES-D、FSS和PSQI分值等非运动症状变量引入回归方程后,SF-36总分可被解释的部分由18.9%增加至61.7%(R2=0.617).并且,引入CES-D分值后,SF-36总分可被解释的部分增加了43.3%(R2=0.433).结论 PD症状严重影响早期患者的HR-QOL.运动症状对HR-QOL存在影响,但影响作用有限.抑郁、疲劳和睡眠障碍这3个非运动症状是导致早期PD患者HR-QOL恶化的主要原因.其中,抑郁症状是HR-QOL恶化的最强预测因素.临床上,应重视非运动症状,运动和非运动症状兼治,才能真正提高疗效显著改善患者的HR-QOL.     

Dilemma in Parkinson’s Treatment; Levodopa Monotherapy May be the Best Choice

IntroductionSeveral treatment strategies have been claimed for Parkinson's disease (PD) so far. However, there remains controversies over the best possible treatment. The aim of this study is to compare Levodopa monotherapy versus Pramipexole in combination with Levodopa L in patients with PD with regards to the efficacy and side effects.MethodsPatients being treated with levodopa alone and Pramipexole add-on therapy to Levodopa were enrolled in the study. Factors regarding efficacy and side effects were assessed and analyzed between both groups by appropriate tests.Results176 Patients were enrolled in the study. Results showed significant higher total MDS-UPDRS (worse total disease severity score) among patients being treated with Pramipexole add-on therapy which was particularly higher in parts 1 (Mentation, behavior and mood), 2 (Activity of daily living) and 3 (Motor examination) (P-values < 0.05). Psychosis global score with significantly higher frequency of hallucination and depression, statistically higher in combination therapy group compared to Levodopa monotherapy group (P-value < 0.05). Patients in the Pramipexole add-on group reported lower scores of Health-related quality of life (HRQoL) (P-value < 0.05). Significant correlation was between disease duration and psychosis score among Levodopa monotherapy group (P-value < 0.05).ConclusionsCompared to Levodopa monotherapy, Add-on therapy with Pramipexole shows less efficiency yet more side effects. This indicates that single administration of Levodopa still remains the best available treatment for Parkinson's disease.     

The rate of cognitive decline in Parkinson disease

OBJECTIVES: To measure the rate and predictors of change on the Mini-Mental State Examination in patients with Parkinson disease (PD) and to compare that change with the Mini-Mental State Examination changes of patients with Alzheimer disease and nondemented subjects. PATIENTS: Patients with PD were drawn from a community-based cohort in Rogaland County, Norway. Those who were without cognitive impairment at disease onset and participated in 1 or more assessments after visit 1 were included and examined after 4 years (visit 2) and 8 years (visit 3). Motor, cognitive, and psychiatric symptoms were rated using standardized scales at visit 1. Two population-based cohorts of patients with Alzheimer disease and nondemented control subjects were included for comparison. Data were analyzed using a mixed-effects model. RESULTS: One hundred twenty-nine PD patients (57% women) were included. The mean (SD) Mini-Mental State Examination score at visit 1 was 27.3 (5.7). The mean annual decline in score from visit 1 to visit 3 was 1.1 (95% confidence interval, 0.8 to 1.3; 3.9% change from visit 1). Patients with PD and dementia (n = 49) had an annual decline from visit 1 to visit 2 of 2.3 (95% confidence interval, 2.1 to 2.5; 9.1% change from visit 1), compared with 2.6 (95% confidence interval, 2.3 to 2.8; 10.6% change from visit 1) in the patients with Alzheimer disease (n = 34) (mean annual decline among patients with PD and dementia vs patients with Alzheimer disease, not significant). The change in score for nondemented PD patients (n = 80) was small and similar to that for nondemented control subjects (n = 1621). Old age, hallucinations, and more severe motor symptoms (rigidity and motor scores mediated by nondopaminergic lesions) at visit 1 were significantly associated with a more rapid cognitive decline in patients with PD. CONCLUSIONS: The mean annual decline on the Mini-Mental State Examination for PD patients was 1 point. However, a marked variation was found. In patients with PD and dementia, the mean annual decline was 2.3, which was similar to the decline observed in patients with Alzheimer disease.     

Pallidotomy effect on the cortical excitability in patients with severe Parkinson's disease.

Surgical lesions in the medial pallidum have been shown to ameliorate motor deficits in patients with Parkinson's disease (PD). It is believed that interruption of the pallidothalamocortical projections to the motor cortex is required for the satisfactory results. In this report, we adopt cortico-cortical inhibition as the tool to assess the pallidotomy effect on cortical excitability in PD. Interstimulus interval between 1 and 15 msec were investigated. The average peak-to-peak amplitude was measured and calculated at each delay. A total of 8 patients (M:F = 4:4) 54.9 years of age (SD = 9.6) and 10 controls were recruited for the study. In the controls, the inhibitory phenomenon was observed from the 1-msec to the 4-msec delay points and the maximal inhibition was at the 3-msec delay point (33.69% +/- 6.50% of the control response). Mild facilitation was noticed since the 5-msec delay point and thereafter. In patients before operation, a similar trend of inhibition was also observed in the initial 4 msec with the maximal inhibition also at the 3-msec delay point (64.66 +/- 6.77% of the control response). In the postoperative group, the short interstimulus interval inhibition can no longer be observed and the conditioned response was 95.06 +/- 23.68% of the control at the 3-msec delay point. The suppression was gone at and after the 7-msec delay point. Results of repeated-measures analysis of variance show a significant difference among the controls and PD patients before and 3 months after pallidotomy (F = 3.40, P = 0.05). Post hoc examination revealed a significant difference between the controls and PD patients 3 months after pallidotomy at the 3-msec delay point (P = 0.004). However, no correlation was observed between the 3-msec inhibition and the Unified Parkinson's Disease Rating Scale Motor score or the dyskinesia score. The results suggest that pallidotomy can modulate the cortical inhibitory circuitry in patients with PD.     

Challenging the serotonergic system in Parkinson disease patients: effects on cognition, mood, and motor performance

BACKGROUND: Parkinson disease (PD) is a neuropsychiatric disease that is characterized by motor and neuropsychiatric symptoms. Multiple neurotransmitter systems, including the serotonergic system, are involved in the pathophysiology of this disease. The exact role of the serotonergic system in PD is still unclear. OBJECTIVE: To investigate the role of serotonin on specific aspects of cognition, mood, and motor performance in PD. METHODS: In a double-blind, randomized, placebo-controlled, crossover design, the effects of a nonspecific serotonergic challenge with citalopram, a selective serotonin reuptake inhibitor, and a 5-HT1a receptor-specific challenge with buspirone on the Visual Verbal Learning Task, Concept Shifting Task, Profile of Mood State Questionnaire, motor section of the Unified Parkinson Disease Rating Scale (section 3), Simple Reaction Time Task, and Finger Precuing Task were studied in 21 PD patients in early stages of their disease and 21 age-, sex-, and education-matched healthy volunteers. RESULTS: The serotonergic challenges resulted in similar effects for both groups. No changes of scores on the cognitive tasks (Visual Verbal Learning Task and Concept Shifting Task) were observed. Results of the Profile of Moods State Questionnaire indicated that, at baseline, PD patients scored less than controls on all 5 subscales. Motor performance (measured by reaction time) was negatively affected by the interventions. CONCLUSIONS: The effects of nonspecific and 5-HT1a receptor-specific challenging of the serotonergic neurotransmitter system had similar effects in both PD patients and healthy control subjects. These findings indicate that serotonergic function is not impaired in early PD and that serotonin, although involved in the pathophysiology of PD, does not seem to play a direct role in cognition, mood, and motor performance in PD patients, but may be involved in hypokinesia.