scholarly journals Intensive Rehabilitation Treatment in Parkinsonian Patients with Dyskinesias: A Preliminary Study with 6-Month Followup

2012 ◽  
Vol 2012 ◽  
pp. 1-4 ◽  
Author(s):  
Giuseppe Frazzitta ◽  
Micaela Morelli ◽  
Gabriella Bertotti ◽  
Guido Felicetti ◽  
Gianni Pezzoli ◽  
...  
Keyword(s):  
Rating Scale ◽  
Involuntary Movement ◽  
Rehabilitation Treatment ◽  
Beneficial Effects ◽  
Levodopa Dosage ◽  
Rehabilitation Protocols ◽  
Disease Rating ◽  
Preliminary Study ◽  
Intensive Rehabilitation ◽  
Over Time

A major adverse effect of levodopa therapy is the development of dyskinesia, which affects 30–40% of chronically treated Parkinsonian patients. We hypothesized that our rehabilitation protocol might allow a reduction in levodopa dosage without worsening motor performances, thus reducing frequency and severity of dyskinesias. Ten Parkinsonian patients underwent a 4-week intensive rehabilitation treatment (IRT). Patients were evaluated at baseline, at the end of the rehabilitation treatment and at 6-month followup. Outcome measures were the Unified Parkinson’s Disease Rating Scale Sections II, III, and IV (UPDRS II, III, IV) and the Abnormal Involuntary Movement Scale (AIMS). At the end of the IRT, levodopa dosage was significantly reduced (P=0.0035), passing from1016±327to777±333 mg/day. All outcome variables improved significantly (P<0.0005all) by the end of IRT. At followup, all variables still maintained better values with respect to admission (P<0.02all). In particular AIMS score improved passing from11.90±6.5at admission to3.10±2.3at discharge and to4.20±2.7at followup. Our results suggest that it is possible to act on dyskinesias in Parkinsonian patients with properly designed rehabilitation protocols. Intensive rehabilitation treatment, whose acute beneficial effects are maintained over time, might be considered a valid noninvasive therapeutic support for Parkinsonian patients suffering from diskinesia, allowing a reduction in drugs dosage and related adverse effects.

Pedunculopontine Nucleus Stimulation Improves Gait Freezing in Parkinson Disease

Neurosurgery ◽  
2011 ◽  
Vol 69 (6) ◽  
pp. 1248-1254 ◽  
Author(s):  
Wesley Thevathasan ◽  
Terry J. Coyne ◽  
Jonathan A. Hyam ◽  
Graham Kerr ◽  
Ned Jenkinson ◽  
...  
Keyword(s):  
Parkinson Disease ◽  
Clinical Application ◽  
Rating Scale ◽  
Pedunculopontine Nucleus ◽  
Postural Instability ◽  
Bilateral Stimulation ◽  
Novel Therapy ◽  
Beneficial Effects ◽  
Disease Rating ◽  
Stimulation Of

Abstract BACKGROUND Pedunculopontine nucleus (PPN) stimulation is a novel therapy for Parkinson disease. However, controversies remain regarding the clinical application of this new therapy, including patient selection, electrode positioning, and how best to assess outcomes. OBJECTIVE To clarify the clinical application of PPN stimulation in Parkinson disease. METHODS Five consecutive patients with Parkinson disease complicated by severe gait freezing, postural instability, and frequent falls (all persisting even while the patient was on medication) received bilateral stimulation of the mid-lower PPN without costimulation of other brain targets. Outcomes were assessed prospectively over 2 years with gait-specific questionnaires and the Unified Parkinson Disease Rating Scale (part III). RESULTS The primary outcome, the Gait and Falls Questionnaire score, improved significantly with stimulation. Benefits were maintained over 2 years. Unified Parkinson Disease Rating Scale (part III) items assessing gait and posture were relatively insensitive to these treatment effects. Beneficial effects often appeared to outlast stimulation for hours or longer. Thus, single-session on- vs off-stimulation assessments may be susceptible to “delayed washout effects.” Stimulation of the PPN did not change akinesia scores or dopaminergic medication requirements. CONCLUSION Bilateral stimulation of the mid-lower PPN (more caudal than previous reports) without costimulation of other brain targets may be beneficial for the subgroup of patients with Parkinson disease who experience severe gait freezing and postural instability with frequent falls, which persist even while on medication. Choosing appropriate outcome measures and accounting for the possibility of prolonged stimulation washout effects appear to be important for detecting the clinical benefits.

scholarly journals Progression of Self-Perceived Speech and Swallowing Impairment in Early Stage Parkinson's Disease: Longitudinal Analysis of the Unified Parkinson's Disease Rating Scale

2021 ◽  
pp. 1-13
Author(s):  
Christopher R. Watts ◽  
Yan Zhang
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Rating Scale ◽  
Age At Diagnosis ◽  
Newly Diagnosed ◽  
Speech Impairment ◽  
Self Perceptions ◽  
Disease Rating ◽  
Motor Phenotype ◽  
Over Time

Purpose: The purpose of this study was to investigate the presence and progression of self-perceived speech and swallowing impairments in newly diagnosed people with Parkinson's disease (PD) longitudinally across 6 years. Method: Longitudinal data from the Parkinson's Progression Markers Initiative were analyzed across six consecutive years in a cohort of 269 newly diagnosed people with PD, and a subset of those ( n = 211) who were assessed at every time point across the 6 years. Dependent variables included self-perceived ratings of speech and swallowing impairment severity from the Unified Parkinson's Disease Rating Scale. Patient-centered factors of age at diagnosis and motor phenotype were also assessed to determine if they were related to the change in self-perceived speech and swallowing impairments. Results: Overall, self-perceived speech and swallowing impairments were present in newly diagnosed people with PD, although over time, the degree of severity for both remained in the mild range. However, the rate of change over time was significant for perceived speech impairment, F (5.5, 1158.8) = 21.1, p < .001), and perceived swallowing impairment, F (5.2, 1082.6) = 8.6, p < .001. Changes for speech and swallowing impairment were both in the direction of progressive severity. There were no effects of age at diagnosis or motor phenotype on the degree of change for either speech or swallowing. Conclusions: Self-perceptions of speech and swallowing impairment changed significantly over time in newly diagnosed people with PD (PWPD). Consistent with existing literature, self-perceptions of speech impairment were rated as more severe than those of swallowing impairment. These findings reveal that even in the early years postdiagnoses, PWPD are experiencing changes to speech and swallowing function, albeit within the mildly severe range. The presence of self-perceived mild speech and swallowing impairments in the initial years postdiagnosis may support the need for intervention to improve and or sustain function over time.

Subthalamic deep brain stimulation after anesthetic inhalation in Parkinson disease: a preliminary study

2008 ◽  
Vol 109 (2) ◽  
pp. 238-244 ◽  
Author(s):  
Sheng-Huang Lin ◽  
Tsung-Ying Chen ◽  
Shinn-Zong Lin ◽  
Ming-Hwang Shyr ◽  
Yu-Cheng Chou ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Parkinson Disease ◽  
Brain Stimulation ◽  
Rating Scale ◽  
Neuronal Firing ◽  
Electrode Implantation ◽  
Disease Rating ◽  
The Mean ◽  
Preliminary Study ◽  
Deep Brain

Object The authors of this preliminary study investigated the outcome and feasibility of intraoperative microelectrode recording (MER) in patients with Parkinson disease (PD) undergoing deep brain stimulation of the subthalamic nucleus (STN) after anesthetic inhalation. Methods The authors conducted a retrospective analysis of 10 patients with PD who received a desflurane anesthetic during bilateral STN electrode implantation. The MERs were obtained as an intraoperative guide for final electrode implantation and the data were analyzed offline. The functional target coordinates of the electrodes were compared preoperatively with estimated target coordinates. Results Outcomes were evaluated using the Unified Parkinson's Disease Rating Scale 6 months after surgery. The mean improvement in total and motor Unified Parkinson's Disease Rating Scale scores was 54.27 ± 17.96% and 48.85 ± 16.97%, respectively. The mean STN neuronal firing rate was 29.7 ± 14.6 Hz. Typical neuronal firing patterns of the STN and substantia pars nigra reticulata were observed in each patient during surgery. Comparing the functional target coordinates, the z axis coordinates were noted to be significantly different between the pre- and postoperative coordinates. Conclusions The authors found that MER can be adequately performed while the patient receives a desflurane anesthetic, and the results can serve as a guide for STN electrode implantation. This may be a good alternative surgical method in patients with PD who are unable to tolerate deep brain stimulation surgery with local anesthesia.

Measuring Agency Change Across the Domain of Hypnosis

2019 ◽  
Author(s):  
Vince Polito ◽  
Amanda Barnier ◽  
Erik Woody
Keyword(s):  
Rating Scale ◽  
Sense Of Agency ◽  
Pass Rates ◽  
Current Experiment ◽  
Multidimensional Construct ◽  
Time Points ◽  
Hypnotic Induction ◽  
Different Types ◽  
Over Time ◽  
Postexperimental Inquiry

Building on Hilgard’s (1965) classic work, the domain of hypnosis has been conceptualised by Barnier, Dienes, and Mitchell (2008) as comprising three levels: (1) classic hypnotic items, (2) responding between and within items, and (3) state and trait. The current experiment investigates sense of agency across each of these three levels. Forty-six high hypnotisable participants completed an ideomotor (arm levitation), a challenge (arm rigidity) and a cognitive (anosmia) item either following a hypnotic induction (hypnosis condition) or without a hypnotic induction (wake condition). In a postexperimental inquiry, participants rated their feelings of control at three time points for each item: during the suggestion, test and cancellation phases. They also completed the Sense of Agency Rating Scale (Polito, Barnier, &amp; Woody, 2013) for each item. Pass rates, control ratings, and agency scores fluctuated across the different types of items and for the three phases of each item; also, control ratings and agency scores often differed across participants who passed versus failed each item. Interestingly, whereas a hypnotic induction influenced the likelihood of passing items, it had no direct effect on agentive experiences. These results suggest that altered sense of agency is not a unidimensional or static quality “switched on” by hypnotic induction, but a dynamic multidimensional construct that varies across items, over time and according to whether individuals pass or fail suggestions.

scholarly journals Salivary caffeine in Parkinson’s disease

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Giorgio Leodori ◽  
Maria Ilenia De Bartolo ◽  
Daniele Belvisi ◽  
Alessia Ciogli ◽  
Andrea Fabbrini ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Rating Scale ◽  
De Novo ◽  
Oral Intake ◽  
Caffeine Intake ◽  
Motor Complications ◽  
Disease Rating ◽  
Caffeine Metabolism ◽  
Movement Disorder Society

AbstractWe aimed to investigate salivary caffeine content, caffeine absorption and metabolism in Parkinson’s disease (PD) and verify whether salivary caffeine can be used as a biomarker of PD. We enrolled 98 PD patients and 92 healthy subjects. Caffeine and its major metabolite, paraxanthine, were measured in saliva samples collected before and 4 h after the oral intake of caffeine (100 mg). We measured caffeine absorption as the normalized increase in caffeine levels, and caffeine metabolism as the paraxanthine/caffeine ratio. The Movement Disorder Society Unified Parkinson's Disease Rating Scale part III, the Hoehn & Yahr, the presence of motor complications, and levodopa equivalent dose (LED) were assessed and correlated with caffeine levels, absorption, and metabolism. The effects of demographic and environmental features possibly influencing caffeine levels were also investigated. Caffeine levels were decreased in patients with moderate/advanced PD, while caffeine levels were normal in patients with early and de-novo PD, unrelated to caffeine intake. Caffeine absorption and metabolism were normal in PD. Decreased salivary caffeine levels in PD were associated with higher disease severity, longer duration, and the presence of motor complications, no significant association was found with LED. Salivary caffeine decrease correlates with PD progression.

scholarly journals A Comparison of Pain between Parkinson’s Disease and Multiple System Atrophy: A Clinical Cross-Sectional Survey

2019 ◽  
Vol 2019 ◽  
pp. 1-6
Author(s):  
He-Yang You ◽  
Lei Wu ◽  
Hai-Ting Yang ◽  
Chen Yang ◽  
Xiao-Ling Ding
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Multiple System Atrophy ◽  
Rating Scale ◽  
Depression Scale ◽  
Healthy Controls ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Disease Rating ◽  
Vas Scores

Background. Pain is frequent in Parkinson’s disease (PD) and Parkinson-plus syndrome. This study aimed to assess the prevalence, characteristics, therapy (especially the effect of dopaminergic therapy), and associated symptoms of pain in Parkinson's disease and multiple system atrophy (MSA) patients. Methods. Seventy-one PD patients, sixty-five MSA patients, and forty age-matched healthy controls were enrolled and evaluated by using the German pain questionnaire and visual analogue scale (VAS). In addition, the influence of pain in PD patients on anxiety, depression, and the quality of life was assessed with the Hospital Anxiety and Depression Scale (HADS) and Parkinson’s Disease Questionnaire (PDQ-39). Results. Compared to that of the healthy controls, the PD and MSA patients had a significantly higher presence of pain (P<0.01, P<0.01). PD patients had a higher presence of pain than MSA patients (P=0.007). No difference in VAS scores was observed between the PD and MSA patients (P=0.148). A total of 21 PD patients (42.85%) with pain and 13 MSA patients (43.33%) with pain received treatment. A total of 13 PD patients with pain and 6 MSA patients with pain had an improved pain intensity after using dopaminergic medication. The differences in the disease duration, Hoehn and Yahr stages, and scores on the Unified Parkinson’s Disease Rating Scale motor score, HAD-D, HAD-A, and PDQ-39 were significant between the PD patients with and without pain. Conclusion. PD and MSA patients are prone to pain with insufficient treatment. Pain interventions should be provided as soon as possible to improve the patient’s life.

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