Autonomic dysfunction in Parkinson's disease: A prospective cohort study

Background : Dysautonomia is a frequent and disabling complication of PD, with an estimated prevalence of 30‐40% and a significant impact on the quality of life. Objectives : To evaluate the rate of progression of dysautonomia and, in particular, orthostatic hypotension, in a cohort of unselected PD patients, and assess the extent to which the progression of dysautonomia affects activities of daily living, health‐related quality of life, and health care utilization in PD. Methods : We recruited 131 consecutive patients into a 12‐month, prospective, observational cohort study. Clinical measures included the International Parkinson and Movement Disorder Society/UPDRS, the Scale for Outcomes in Parkinson Disease‐Autonomic, the Orthostatic Hypotension Symptoms Assessment, and orthostatic blood pressure measurements. Health care utilization was quantified as the number of hospitalizations, emergency room visits, and outpatient clinic evaluations. Results : The overall severity of autonomic symptoms, as measured by the the Orthostatic Hypotension Symptoms Assessment total score, worsened by 20% over 12 months (P < 0.001), with an overall increase in orthostatic hypotension prevalence from 31.1% to 46.7% (P < 0.001). Worsening of autonomic symptoms was independently associated with deterioration in daily living activities (P = 0.021) and health‐related quality of life (P = 0.025) adjusting for disease duration, cognitive impairment, and motor severity. Regardless of symptomatic status, orthostatic hypotension was associated with greater deterioration in daily living activities, health care utilization, and falls (P ≤ 0.009) compared to patients without orthostatic hypotension. Conclusions : The severity of autonomic symptoms progressed by 20% over 1 year and was independently associated with impairments in daily living activities and health‐related quality of life. Symptomatic and asymptomatic orthostatic hypotension were both associated with increased prevalence of falls and health care utilization. © 2017 International Parkinson and Movement Disorder Society     

A multinational consensus on dysphagia in Parkinson's disease: screening,diagnosis and prognostic value

Journal of Neurology - Parkinson’s disease (PD) is a neurodegenerative disorder characterized by a combination of motor and non-motor dysfunction. Dysphagia is a common symptom in PD, though...     

Anxiety,depression, and worries in advanced Parkinson disease during COVID-19 pandemic

Neurological Sciences - The psychological impact of the COVID-19 outbreak and lockdown on frail populations with advanced Parkinson disease (APD) and their caregivers may present with peculiar...     

Management of skin erosion following deep brain stimulation

Skin erosion is a hardware-related complication commonly described after deep brain stimulation (DBS). Despite the considerable incidence reported in literature, little is written about the management of this complication. In this report, we describe a case of noninfected device extrusion through the skin; in order to prevent infection and system removal, we performed a scalp reconstruction over the area of system exposure. During the follow-up, no signs of infection or fistula occurred and DBS efficacy was preserved. The paper shows the possibility to treat, in noninfectious cases, this frequent complication avoiding the psychological and clinical consequences related to implant removal.     

COMT inhibition with tolcapone in the treatment algorithm of patients with Parkinson's disease (PD): relevance for motor and non-motor features

Levodopa is the most effective treatment in Parkinson's disease and the association with COMT inhibitors widens its plasma bioavailability and effectiveness. Tolcapone is a potent COMT inhibitor whose utilization in PD is limited due to safety concerns on liver toxicity. However, recent data indicate that if liver function is actively monitored, tolerability is no worse than other currently available therapies. By contrast, administration of tolcapone is associated with significant clinical improvement and benefit involves also non-motor features. In this review we discuss the rationale for the use of tolcapone in association with levodopa and other treatments in PD, and we provide an indirect comparison of current strategies to reduce "off" time. We propose that future guidelines include a trial with tolcapone in all PD patients who continue to complain about motor fluctuations despite treatment with entacapone and/or MAO-B inhibitors. Moreover, we suggest that tolcapone should be considered before surgical or infusional strategies are applied.