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目的 :探讨氯氮平治疗帕金森病 (PD)患者中左旋多巴诱导的异动症 (LID)的疗效、合适剂量、不良反应。方法 :对 12例出现LID的PD患者添加氯氮平治疗 ,治疗前后进行UPDRS的异动症评分、运动功能评分和血白细胞的计数。结果 :氯氮平 (5 0± 5 1)mg显著改善了 91 7% (11/12 )PD患者的异动症状 ,治疗前异动症评分为 3 4± 0 7,治疗后为 1 6± 1 3 ,差异显著 (P <0 0 1)。治疗过程中无患者出现运动功能的恶化和血白细胞的减少。结论 :小剂量 (5 0mg)氯氮平能有效改善PD患者的LID ,安全性好 相似文献
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Valtteri Kaasinen MD Sheng Luo PhD Pablo Martinez-Martin MD PhD Christopher G. Goetz MD Glenn T. Stebbins PhD 《Movement disorders》2023,38(4):688-692
Background
The prevalence of levodopa-induced dyskinesia (LID) in Parkinson's disease (PD) varies among geographical regions. Cultural differences in patient-based perceptions of LID have not been studied.Objective
We compared patient and clinician evaluations of LID severity across multiple cultures in patients with PD.Methods
The data set included the Unified Dyskinesia Rating (UDysRS) scores from 16 language translation programs (3566 patients). We defined the Perception Severity Index (PSI) as the ratio between normalized patient-based subjective ratings (UDysRS Part 1B) and normalized clinician examination (Parts 3 and 4) scores (Part 1B/Parts 3 + 4) and compared the PSI across languages.Results
The mean PSI for the Chinese language (2.16) was higher than those of all other languages, whereas the ratio for the Korean language (0.73) was lower than those for Japanese, German, Turkish, Greek, Polish, and Finnish languages (corrected P values <0.05).Conclusions
Culture, as represented by language, affects the subjective perception of LID and needs to be considered in multinational clinical PD trials on dyskinesia. © 2023 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society. 相似文献4.
Takashi Tsuboi MD PhD Marc Charbel PhD David T. Peterside BS Mohit Rana PhD Ahmad Elkouzi MD Wissam Deeb MD Adolfo Ramirez-Zamora MD Janine Lemos Melo Lobo Jofili Lopes MD Leonardo Almeida MD Pamela R. Zeilman APRN Robert S. Eisinger PhD Kelly D. Foote MD Lela Okromelidze MD Sanjeet S. Grewal MD Michael S. Okun MD Erik H. Middlebrooks MD 《Movement disorders》2021,36(2):380-388
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Ai Huey Tan MD Shen-Yang Lim MD Sanjiv Mahadeva MD Mun Fai Loke PhD Jiun Yan Tan MBBS Ban Hong Ang MBBS Kok Ping Chin MBBS Amni Fatihah Mohammad Adnan MBBS Shawna Mei Chien Ong MBBS Aimi Izzah Ibrahim MBBS Nusyaibah Zulkifli MBBS Jing Kun Lee MBBS Wan Ting Lim MBBS Yong Teck Teo MBBS Yong Leng Kok MBBS Tze Ying Ng MBBS Aaron Guan Siang Tan MBBS Intan Maisara Zulkifle MBBS Chin Khoon Ng MBBS Soon Sean Ee MBBS Shuhaina Arafin MBBS Khairunnisa Mohamad Shukori MBBS Jamunarani S. Vadivelu PhD Connie Marras PhD Susan H. Fox PhD Anthony E. Lang MD 《Movement disorders》2020,35(12):2250-2260
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Dongning Su MD MS Yawen Gan BS Zhe Zhang PhD Yusha Cui Zhijin Zhang BS Zhu Liu MD PhD Zhan Wang MD PhD Junhong Zhou PhD Vesna Sossi PhD A. Jon Stoessl MD Tao Wu MD PhD Jing Jing MD PhD Tao Feng MD PhD 《Movement disorders》2023,38(4):616-625
Background
Degeneration of the substantia nigra (SN) may contribute to levodopa-induced dyskinesia (LID) in Parkinson's disease (PD), but the exact characteristics of SN in LID remain unclear.Objective
To further understand the pathogenesis of patients with PD with LID (PD-LID), we explored the structural and functional characteristics of SN in PD-LID using multimodal magnetic resonance imaging (MRI).Methods
Twenty-nine patients with PD-LID, 37 patients with PD without LID (PD-nLID), and 28 healthy control subjects underwent T1-weighted MRI, quantitative susceptibility mapping, neuromelanin-sensitive MRI, multishell diffusion MRI, and resting-state functional MRI. Different measures characterizing the SN were obtained using a region of interest–based approach.Results
Compared with patients with PD-nLID and healthy control subjects, the quantitative susceptibility mapping values of SN pars compacta (SNpc) were significantly higher (P = 0.049 and P = 0.00002), and the neuromelanin contrast-to-noise ratio values in SNpc were significantly lower (P = 0.012 and P = 0.000002) in PD-LID. The intracellular volume fraction of the posterior SN in PD-LID was significantly higher compared with PD-nLID (P = 0.037). Resting-state fMRI indicated that PD-LID in the medication off state showed higher functional connectivity between the SNpc and putamen compared with PD-nLID (P = 0.031), and the functional connectivity changes in PD-LID were positively correlated with Unified Dyskinesia Rating Scale total scores (R = 0.427, P = 0.042).Conclusions
Our multimodal imaging findings highlight greater neurodegeneration in SN and the altered nigrostriatal connectivity in PD-LID. These characteristics provide a new perspective into the role of SN in the pathophysiological mechanisms underlying PD-LID. © 2023 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society. 相似文献7.
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Michelle S. Troche PhD CCC-SLP James A. Curtis PhD CCC-SLP Jordanna S. Sevitz MS CCC-SLP Avery E. Dakin MS CCC-SLP Sarah E. Perry PhD CCC-SLP James C. Borders MS CCC-SLP Alessandro A. Grande MPhil Yuhan Mou MA CCC-SLP Nora Vanegas-Arroyave MD Karen W. Hegland PhD CCC-SLP 《Movement disorders》2023,38(2):201-211
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Beata Lindholm Frida Eek
rjan Skogar Eva E. Hansson 《Acta neurologica Scandinavica》2019,139(6):512-518
A growing body of research highlights the importance of cognition for prediction of falls in Parkinson's disease (PD). However, a previously proposed prediction model for future near falls and falls in PD, which includes history of near falls, tandem gait, and retropulsion, was developed without considering cognitive impairment. Therefore, by using a sample of 64 individuals with relatively mild PD and not excluding those with impaired cognition we aimed to externally validate the previously proposed model as well as to explore the value of additional predictors that also consider cognitive impairment. Since this validation study failed to support the proposed model in a PD sample including individuals with impaired global cognition, extended analyses generated a new model including dyskinesia (item 32 of Unified PD Rating Scale) and frontal lobe impairment (Frontal Assessment Battery—FAB) as significant independent predictors for future near falls and falls in PD. The discriminant ability of this new model was acceptable (AUC, 0. 80; 95% CI 0.68‐0.91). Replacing the continuous FAB scores by a dichotomized version of FAB with a cut‐off score ≤14 yielded slightly lower but still acceptable discriminant ability (AUC, 0. 79; 95% CI 0.68‐0.91). Further studies are needed to test our new model and the proposed cut‐off score of FAB in additional samples. Taken together, our observations suggest potentially important additions to the evidence base for clinical fall prediction in PD with concomitant cognitive impairment. 相似文献
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Lateralized Subthalamic Stimulation for Axial Dysfunction in Parkinson's Disease: A Randomized Trial
Karlo J. Lizárraga MD MSc Bhairavei Gnanamanogaran BS Tameem M. Al-Ozzi MS Melanie Cohn PhD George Tomlinson PhD Alexandre Boutet MD PhD Gavin J.B. Elias BA Jürgen Germann PhD Derrick Soh MD Suneil K. Kalia MD PhD Mojgan Hodaie MD PhD Renato P. Munhoz MD PhD Connie Marras MD PhD William D. Hutchison PhD Andres M. Lozano MD PhD Anthony E. Lang MD Alfonso Fasano MD PhD 《Movement disorders》2022,37(5):1079-1087
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Tardive dyskinesia (TD) is an adverse effect of long-term neuroleptic use. An effective treatment for TD is needed, especially if chronic neuroleptic therapy is indicated. The treatment of TD in the elderly is not well established. We present here the case of an 81-year-old male with TD who had a significant reduction in dyskinetic and dystonic movements when treated with clonazenam. 相似文献
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Cigdem Aydemir Erol Goka Cebrail Kisa Aydin Kurt Fatih Volkan Yuksel 《International journal of psychiatry in clinical practice》2013,17(4):238-243
Objective. Several neurological abnormalities can be found at a greater frequency in patients with schizophrenia, including neurological soft signs (NSS) and signs of the “pyramidal” and “extrapyramidal” systems. We aimed to explore the frequency of movement disorders in patients with antipsychotic naïve schizophrenia and to compare and contrast with antipsychotic-treated patients and healthy controls. Methods. Twenty-two antipsychotic naive schizophrenic patients, 22 antipsychotic treated patients and 22 healthy control subjects were assessed by Neurological Evaluation (NES), Abnormal Involuntary Movements (AIMS), and Positive and Negative Syndrome (PANSS) Scales. Results. The NES scores of the never-medicated schizophrenic group were significantly higher than those of normal controls but did not differ significantly from the medicated group. Dyskinesia rates in the both schizophrenic groups were higher than in healthy controls. Medicated and non-medicated schizophrenic patient scores did not differ in AIMS with regard to facial and oral movements, but medicated patients scored higher than non-medicated subjects with respect to extremity movements. Conclusion. Our data suggest that: soft neurological signs and abnormal involuntary movements in the facial region are more prevalent in patients with schizophrenia, whether they are medicated or antipsychotic naïve. On the contrary, abnormal involuntary movements in the trunk and the extremities seem to be associated with medication. 相似文献
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Sara Bech MD PhD Annemette Løkkegaard MD PhD Troels T. Nielsen MSc PhD Anne Nørremølle MSc PhD Sabine Grønborg MD Lis Hasholt DMSc Gudrun K. Steffensen MD Gabor Graehn MD Jess H. Olesen MSc Niels Tommerup DMSc Yuan Mang PhD Mads Bak MSc PhD Jørgen E. Nielsen MD PhD Hans Eiberg MSc Lena E. Hjermind MD PhD 《Movement disorders》2020,35(12):2343-2347