ABSTRACT
BACKGROUND: Therapeutic education programs are effective in several chronic conditions. However, evidence is lacking in multiple system atrophy (MSA). We aimed to assess efficacy and safety of a comprehensive therapeutic education program in people with MSA (PwMSA) and their caregivers. METHODS: In this prospective longitudinal study we included 16 PwMSA and their main caregivers in 4 groups of 4 dyads each. The program consisted of eight 60-min interdisciplinary sessions: introduction, orthostatic hypotension, speech therapy, gait and respiratory physiotherapy, psychological support, urinary dysfunction, occupational therapy/social work. UMSARS, NMSS, PDQ39, EQ5 and Zarit scales were administered at baseline and 6 months later. After each session participants filled-out a modified EduPark satisfaction questionnaire and a Likert scale. Educational material was generated for each session after suggestions by participants. RESULTS: At baseline PwMSA and caregivers were comparable in age and sex, with significant correlation between UMSARS-IV (disability) and PDQ39 (quality of life). Adherence to sessions was of 94,92 %. Total modified EduPark scores and Likert scales did not differ in PwMSA vs. caregivers, mild-moderate vs. severe-advanced cases or between genders. The significant difference in satisfaction across sessions (p = 0.03) was driven by higher scores in speech, respiratory and occupational therapy sessions. Longitudinally there was no significant worsening in any scale, nor a significant increase post-vs. pre-program in the number of consultations. CONCLUSIONS: The healthcare education program in MSA was feasible, satisfactory, and safe for patients and caregivers. The educational material of the program is being forwarded to incident MSA cases attending our clinic.
Subject(s)
Caregivers , Multiple System Atrophy , Quality of Life , Registries , Humans , Male , Female , Multiple System Atrophy/therapy , Multiple System Atrophy/rehabilitation , Middle Aged , Longitudinal Studies , Aged , Caregivers/psychology , Caregivers/education , Pilot Projects , Patient Education as Topic , Patient Satisfaction , Prospective StudiesABSTRACT
INTRODUCTION: In a degenerative disorder such as Parkinson's disease (PD), it is important to establish clinical stages that allow to know the course of the disease. Our aim was to analyze whether a scale combining Hoehn and Yahr's motor stage (H&Y) and the nonmotor symptoms burden (NMSB) (assessed by the nonmotor symptoms scale (NMSS)) provides information about the disability and the patient's quality of life (QoL) with regard to a defined clinical stage. MATERIALS AND METHODS: Cross-sectional study in which 603 PD patients from the COPPADIS cohort were classified according to H&Y (1, stage I; 2, stage II; 3, stage III; 4, stage IV/V) and NMSB (A: NMSS = 0-20; B: NMSS = 21-40; C: NMSS = 41-70; D: NMSS ≥ 71) in 16 stages (HY.NMSB, from 1A to 4D). QoL was assessed with the PDQ-39SI, PQ-10, and EUROHIS-QOL8 and disability with the Schwab&England ADL (Activities of Daily Living) scale. RESULTS: A worse QoL and greater disability were observed at a higher stage of H&Y and NMSB (p < 0.0001). Combining both (HY.NMSB), patients in stages 1C and 1D and 2C and 2D had significantly worse QoL and/or less autonomy for ADL than those in stages 2A and 2B and 3A and 3B, respectively (p < 0.005; e.g., PDQ-39SI in 1D [n = 15] vs 2A [n = 101]: 28.6 ± 17.1 vs 7.9 ± 5.8; p < 0.0001). CONCLUSION: The HY.NMSB scale is simple and reflects the degree of patient involvement more accurately than the H&Y. Patients with a lower H&Y stage may be more affected if they have a greater NMS burden.
ABSTRACT
OBJECTIVES: To compare the characteristics of patients undergoing treatment with continuous intestinal infusion of levodopa-carbidopa (CIILC) for advanced Parkinson's disease and the data on the effectiveness and safety of CIILC in the different autonomous communities (AC) of Spain. METHODS: A retrospective, longitudinal, observational study was carried out into 177 patients from 11 CAs who underwent CIILC between January 2006 and December 2011. We analysed data on patients' clinical and demographic characteristics, variables related to effectiveness (changes in off time/on time with or without disabling dyskinesia; changes in Hoehn and Yahr scale and Unified Parkinson's Disease Rating Scale scores; non-motor symptoms; and Clinical Global Impression scale scores) and safety (adverse events), and the rate of CIILC discontinuation. RESULTS: Significant differences were observed between CAs for several baseline variables: duration of disease progression prior to CIILC onset, off time (34.9-59.7%) and on time (2.6-48.0%; with or without disabling dyskinesia), Hoehn and Yahr score during on time, Unified Parkinson's Disease Rating Scale-III score during both on and off time, presence of≥ 4 motor symptoms, and CIILC dose. Significant differences were observed during follow-up (> 24 months in 9 of the 11 CAs studied) for the percentage of off time and on time without disabling dyskinesia, adverse events frequency, and Clinical Global Impression scores. The rate of CIILC discontinuation was between 20-40% in 9 CAs (78 and 80% in remaining 2 CAs). CONCLUSIONS: This study reveals a marked variability between CAs in terms of patient selection and CIILC safety and effectiveness. These results may have been influenced by patients' baseline characteristics, the availability of multidisciplinary teams, and clinical experience.
Subject(s)
Antiparkinson Agents , Parkinson Disease , Antiparkinson Agents/administration & dosage , Antiparkinson Agents/therapeutic use , Carbidopa/administration & dosage , Carbidopa/therapeutic use , Gels , Humans , Levodopa/administration & dosage , Levodopa/therapeutic use , Parkinson Disease/drug therapy , Retrospective Studies , SpainABSTRACT
C-reactive protein (CRP) is a biomarker of systemic inflammation that has been linked to accelerated decline in walking speed in older adults. The aim of the present study was to compare the CRP levels of PD patients with vs patients without freezing of gait (FOG). Patients and controls participating in the COPPADIS-2015 study that performed blood extraction for determining molecular serum biomarkers were included. Patients with FOG were identified as those with a score of 1 or greater on item-3 of the Freezing of Gait Questionnaire (FOG-Q). Immunoassay was used for determining ultrasensitive CRP (US-CRP) level (mg/dL). In the PD group (n = 225; 61.8 ± 9.5 years old, 61.8% males), 32% of the patients presented FOG but none in the control group (n = 65; 60.3 ± 6.1 years old, 56.9% males) (p < 0.0001). Differences in US-CRP level were significant in patients with FOG vs patients without FOG and vs controls (0.31 ± 0.52 vs 0.16 ± 0.21 vs 0.21 ± 0.22; p = 0.04). Significant differences were also observed between patients with vs without FOG (p = 0.001) but not between patients and controls (p = 0.163). US-CRP level was related to FOG (OR = 4.369; 95% CI 1.105-17.275; p = 0.036) along with H&Y (OR = 2.974; 95% CI 1.113-7.943; p = 0.030) and non-motor symptoms burden (NMSS total score; OR = 1.017; 95% CI 1.005-1.029; p = 0.006) after adjusting for age, gender, disease duration, equivalent daily levodopa dose, number of non-antiparkinsonian drugs per day, motor fluctuations, cognition, motor phenotype, and chronic use of anti-inflammatory drugs. The present study suggests that serum US-CRP level is related to FOG in PD patients. Inflammation could be linked to FOG development.
Subject(s)
Biomarkers/blood , C-Reactive Protein/analysis , Gait Disorders, Neurologic/blood , Parkinson Disease/blood , Aged , Female , Gait Disorders, Neurologic/etiology , Humans , Male , Middle Aged , Parkinson Disease/complicationsABSTRACT
BACKGROUND AND PURPOSE: In Parkinson's disease (PD), the course of the disorder is highly variable between patients. Well-designed, prospective studies for identifying PD progression biomarkers are necessary. Our aim was to show the results of baseline evaluations of an ongoing global PD project, COPPADIS-2015 (Cohort of Patients with PArkinson's DIsease in Spain, 2015). METHODS: This was an observational, descriptive, nationwide study (Spain). The recruitment period ended in October 2017. Baseline evaluation included more than 15 validated scales and complementary studies in a subgroup of participants. RESULTS: In total, 1174 subjects from 35 centres were considered valid for baseline analysis: 694 patients (62.6 ± 8.9 years old, 60.3% males), 273 caregivers (58.5 ± 11.9 years old, 31.8% males) and 207 controls (61 ± 8.3 years old, 49.5% males). The mean disease duration was 5.5 ± 4.4 years. Hoehn and Yahr stage was 1 or 2 in 90.7% of the patients whilst 33.9% and 18.1% of them presented motor fluctuations and dyskinesias, respectively. The mean Non-Motor Symptoms Scale total score was 45.4 ± 38.1, and 30.4% of the patients presented cognitive impairment, 16.1% major depression, 12.7% impulse control disorder, 7.2% compulsive behaviour, 57.2% pain and 13.2% falls. Compared to the control group, PD patients presented a significantly higher burden of non-motor symptoms and a worse quality of life. More than 300 subjects conducted complementary studies (serum biomarkers, genetic and neuroimaging). CONCLUSIONS: Parkinson's disease is a complex disorder and different non-motor symptoms are frequently present and are more prevalent than in controls. In real clinical practice it is important to ask for them.
Subject(s)
Parkinson Disease/pathology , Aged , Aged, 80 and over , Caregivers/statistics & numerical data , Cognition Disorders/epidemiology , Cognition Disorders/etiology , Cohort Studies , Comorbidity , Disease Progression , Disruptive, Impulse Control, and Conduct Disorders , Female , Humans , Longitudinal Studies , Male , Mental Disorders/epidemiology , Mental Disorders/etiology , Middle Aged , Movement Disorders/epidemiology , Movement Disorders/etiology , Parkinson Disease/epidemiology , Parkinson Disease/psychology , Prospective Studies , Quality of Life , Socioeconomic Factors , Spain/epidemiologyABSTRACT
INTRODUCTION: A large percentage of patients with Parkinson's disease (PD) develop motor fluctuations, dyskinesias, and severe non-motor symptoms within 3 to 5 years of starting dopaminergic therapy, and these motor complications are refractory to treatment. Several authors refer to this stage of the disease as advanced Parkinson's disease. OBJECTIVE: To define the clinical manifestations of advanced PD and the risk factors for reaching this stage of the disease. DEVELOPMENT: This consensus document has been prepared by using an exhaustive literature search and by discussion of the contents by an expert group on movement disorders of the Sociedad Española de Neurología (Spanish Neurology Society), coordinated by two of the authors (JK and MRL). CONCLUSIONS: Severe motor fluctuations and dyskinesias, axial motor symptoms resistant to levodopa, and cognitive decline are the main signs in the clinical phenotype of advanced PD.
Subject(s)
Parkinson Disease/physiopathology , Parkinson Disease/therapy , Adult , Age Factors , Aged , Antiparkinson Agents/adverse effects , Antiparkinson Agents/therapeutic use , Biomarkers , Cognition Disorders/diagnosis , Cognition Disorders/etiology , Cognition Disorders/psychology , Consensus , Dementia/etiology , Disease Progression , Dyskinesias/etiology , Female , Gait Disorders, Neurologic/etiology , Gait Disorders, Neurologic/physiopathology , Humans , Male , Middle Aged , Parkinson Disease/complications , Parkinson Disease/psychology , Phenotype , Quality of Life , Risk Factors , Sex CharacteristicsABSTRACT
INTRODUCTION: Many patients who have had Parkinson's disease (PD) for several years will present severe motor fluctuations and dyskinesias which require more aggressive therapies. The different approaches which are now available include deep brain stimulation of the subthalamic nucleus or medial globus pallidus, subcutaneous infusion of apomorphine, and intestinal infusion of levodopa-carbidopa. OBJECTIVE: To define the indications and results for the 3 available therapies for advanced PD. DEVELOPMENT: Exhaustive review of the literature concerning the indications and results of deep brain stimulation, subcutaneous apomorphine infusion and duodenal infusion of levodopa/carbidopa gel to treat patients with advanced Parkinson disease. CONCLUSIONS: Although numerous studies have confirmed the efficacy of the 3 different therapies in advanced PD, there are no comparative studies that would allow us to define the best candidate for each technique.
Subject(s)
Parkinson Disease/physiopathology , Parkinson Disease/therapy , Antiparkinson Agents/administration & dosage , Antiparkinson Agents/adverse effects , Antiparkinson Agents/therapeutic use , Apomorphine/administration & dosage , Apomorphine/adverse effects , Apomorphine/therapeutic use , Cognition Disorders/etiology , Cognition Disorders/therapy , Deep Brain Stimulation , Disease Progression , Humans , Infusions, Intravenous , Parkinson Disease/drug therapy , Parkinson Disease/psychology , Psychotic Disorders/etiology , Psychotic Disorders/therapyABSTRACT
Koro and Cotard syndromes are uncommon conditions described in a variety of psychiatric and medical disorders. The authors report the third case of a simultaneous presentation of both syndromes, in a 62-year-old inpatient Spanish male with major depressive disorder with psychotic features, parkinsonism and cognitive impairment. A discussion of the literature and the possible relationship between both syndromes and other neuropsychiatric disorders are presented.
Subject(s)
Affective Disorders, Psychotic/complications , Cerebrovascular Disorders/complications , Cognitive Dysfunction/complications , Delusions/complications , Depressive Disorder, Major/complications , Koro/complications , Parkinson Disease, Secondary/complications , Schizophrenia, Paranoid/complications , Humans , Male , Middle Aged , Spain , SyndromeABSTRACT
Symptom control, daily "on" time, and quality of life (QoL) of nine patients with Advanced Parkinson's Disease was assessed following 18-months treatment with Continuous Intraduodenal Levodopa Infusion (CIDLI). Patients had severe motor fluctuations and dyskinesias and had previously received treatment with oral levodopa and dopamine agonists. There were significant improvements in patients' symptoms on the Unified Parkinson's Disease Rating Scale, and QoL (Parkinson's Disease QoL Questionnaire; Schwab & England Capacity for Daily Living Scale; p < 0.05). Mean (+/-SD) daily "on" time increased from 6.1 +/- 1.9 to 12.0 +/- 3.4 h (p < 0.05). Improved QoL in APD was associated with CIDLI-related improvements in symptom control and increase in daily "on" time.
Subject(s)
Antiparkinson Agents/administration & dosage , Duodenum/physiology , Levodopa/administration & dosage , Parkinson Disease/drug therapy , Parkinson Disease/psychology , Quality of Life , Activities of Daily Living , Aged , Disability Evaluation , Duodenum/drug effects , Female , Follow-Up Studies , Humans , Male , Middle Aged , Severity of Illness IndexABSTRACT
Valproate-induced hyperammonemic encephalopathy (VHE) is an unusual complication characterized by a decreasing level of consciousness, focal neurological deficits, cognitive slowing, vomiting, drowsiness, and lethargy. We have thoroughly reviewed the predisposing factors and their screening, the biochemical and physiopathological mechanisms involved, the different treatments described, and those that are being investigated. Etiopathogenesis is not completely understood, although hyperammonemia has been postulated as the main cause of the clinical syndrome. The increase in serum ammonium level is due to several mechanisms, the most important one appearing to be the inhibition of carbamoylphosphate synthetase-I, the enzyme that begins the urea cycle. Polytherapy with several drugs, such as phenobarbital and topiramate, seems to contribute to hyperammonemia. Hyperammonemia leads to an increase in the glutamine level in the brain, which produces astrocyte swelling and cerebral edema. There are several studies that suggest that treatment with supplements of carnitine can lead to an early favorable clinical response due to the probable carnitine deficiency induced by a valproate (VPA) treatment. Development of the progressive confusional syndrome, associated with an increase in seizure frequency after VPA treatment onset, obliges us to rule out VHE by screening for blood ammonium levels and the existence of urea cycle enzyme deficiency, such as ornithine carbamoyltransferase deficiency. Electroencephalography (EEG) is characterized by signs of severe encephalopathy with continuous generalized slowing, a predominance of theta and delta activity, occasional bursts of frontal intermittent rhythmic delta activity, and triphasic waves. These EEG findings, as well as clinical manifestations and hyperammonemia, tend to normalize after VPA withdrawal.
Subject(s)
Anticonvulsants/adverse effects , Glutamic Acid/metabolism , Hepatic Encephalopathy/chemically induced , Hyperammonemia/chemically induced , Valproic Acid/adverse effects , Brain/metabolism , Brain/physiopathology , Brain Edema/chemically induced , Brain Edema/metabolism , Brain Edema/physiopathology , Carbamoyl-Phosphate Synthase (Glutamine-Hydrolyzing)/antagonists & inhibitors , Carbamoyl-Phosphate Synthase (Glutamine-Hydrolyzing)/metabolism , Carnitine/therapeutic use , Diagnosis, Differential , Glutamine/metabolism , Hepatic Encephalopathy/diagnosis , Hepatic Encephalopathy/physiopathology , Humans , Hyperammonemia/metabolism , Hyperammonemia/physiopathologySubject(s)
Disease Outbreaks/veterinary , Francisella tularensis/classification , Tularemia/veterinary , Animals , Arvicolinae , Francisella tularensis/isolation & purification , Francisella tularensis/pathogenicity , Humans , Rabbits , Spain/epidemiology , Ticks , Tularemia/epidemiology , Tularemia/etiology , VirulenceABSTRACT
We evaluated three molecular methods for identification of Francisella strains: pulsed-field gel electrophoresis (PFGE), amplified fragment length polymorphism (AFLP) analysis, and 16S rRNA gene sequencing. The analysis was performed with 54 Francisella tularensis subsp. holarctica, 5 F. tularensis subsp. tularensis, 2 F. tularensis subsp. novicida, and 1 F. philomiragia strains. On the basis of the combination of results obtained by PFGE with the restriction enzymes XhoI and BamHI, PFGE revealed seven pulsotypes, which allowed us to discriminate the strains to the subspecies level and which even allowed us to discriminate among some isolates of F. tularensis subsp. holarctica. The AFLP analysis technique produced some degree of discrimination among F. tularensis subsp. holarctica strains (one primary cluster with three major subclusters and minor variations within subclusters) when EcoRI-C and MseI-A, EcoRI-T and MseI-T, EcoRI-A and MseI-C, and EcoRI-0 and MseI-CA were used as primers. The degree of similarity among the strains was about 94%. The percent similarities of the AFLP profiles of this subspecies compared to those of F. tularensis subsp. tularensis, F. tularensis subsp. novicida, and F. philomiragia were less than 90%, about 72%, and less than 24%, respectively, thus permitting easy differentiation of this subspecies. 16S rRNA gene sequencing revealed 100% similarity for all F. tularensis subsp. holarctica isolates compared in this study. These results suggest that although limited genetic heterogeneity among F. tularensis subsp. holarctica isolates was observed, PFGE and AFLP analysis appear to be promising tools for the diagnosis of infections caused by different subspecies of F. tularensis and suitable techniques for the differentiation of individual strains.
Subject(s)
Bacterial Typing Techniques , Francisella tularensis/classification , Polymorphism, Restriction Fragment Length , Tularemia/diagnosis , Animals , DNA, Ribosomal/analysis , Electrophoresis, Gel, Pulsed-Field , Francisella tularensis/genetics , Genes, rRNA , Genotype , Humans , Molecular Sequence Data , RNA, Ribosomal, 16S/genetics , Sequence Analysis, DNA , Spain/epidemiology , Tularemia/microbiologyABSTRACT
OBJECTIVE: To study the efficacy of N-duopropenide against various gram-positive and gram-negative organisms. SAMPLE POPULATION: One field strain each of Pasteurella multocida subsp multocida, Staphylococcus aureus, Listeria monocytogenes, and L ivanovii, and 2 field strains of Escherichia coli. PROCEDURE: Strains were tested with and without serum as organic matter, using quantitative suspension and carrier tests. Six concentrations of active ingredient (0.005, 0.01, 0.05, 0.11, 0.27, and 0.55%) and 6 contact times (15 and 30 seconds and 1, 3, 5, and 10 minutes) were studied for each. RESULTS: Globally, N-duopropenide was more effective in suspension tests than in carrier tests, and when organisms were suspended in saline solution rather than serum. Under the most disadvantageous conditions (carrier test with serum), a concentration of 0.55% N-duopropenide acting for only 15 seconds was effective in inactivating P multocida subsp multocida and was even more effective against the 2 Listeria species tested. For E coli strains, the same concentration also was effective, but after 10 minutes of contact. On the other hand, N-duopropenide was unable to inactivate the S aureus strain in the carrier test with serum, a concentration of 0.55% for 10 minutes was necessary to inactivate it without organic matter; however, N-duopropenide was highly effective against this organism in the suspension test, even with serum. CONCLUSION: N-duopropenide was highly effective in vitro against 5 of the most commonly encountered organisms in clinical veterinary medicine and, consequently, might be a good choice in control measures against common pathogenic organisms in modern production systems.
Subject(s)
Aldehydes/pharmacology , Disinfectants/pharmacology , Gram-Negative Bacteria/drug effects , Gram-Positive Bacteria/drug effects , Quaternary Ammonium Compounds/pharmacology , Animals , Cattle , Escherichia coli/drug effects , Feces/microbiology , Female , Listeria/drug effects , Listeria monocytogenes/drug effects , Mastitis/microbiology , Mastitis/veterinary , Microbial Sensitivity Tests , Pasteurella multocida/drug effects , Pneumonia/microbiology , Pneumonia/veterinary , Sheep , Sheep Diseases/microbiology , Staphylococcus aureus/drug effects , Swine , Swine Diseases/microbiologyABSTRACT
A fluoroacetate-resistant mutant of Escherichia coli K-12 (MM-294) accumulated less acetate in the medium during growth to high cell density in fermentor cultures and was shown to be defective in its phosphotransacetylase activity. The mutant had an improved ability to continue growing during induction of interleukin-2 (IL-2) synthesis, and in fermentor cultures it gave a higher level of specific IL-2 accumulation than its parent during expression under control of the temperature-sensitive pL promoter. In flask cultures at lower cell density, the mutant again produced less acetate than the parent, although both showed a much lower level of acetate accumulation than that seen in fermentors at high cell density. Both showed a higher specific expression level of IL-2 in flask cultures, and there was a greater difference between the mutant and its parent in the final extent of specific IL-2 accumulation in fermentor cultures compared with flask cultures. Thus, the concentration of acetate in the medium, which was much higher in fermentor cultures (greater than or equal to 300 mM after 5 h of induction) than in flask cultures (less than or equal to mM) of the parent organism, was a significant factor in limiting expression of the heterologous protein product, IL-2. The acetate kinase-phosphotransacetylase pathway was therefore a major source of acetate formation in these cultures. Blocking this pathway improved accumulation of IL-2 and did not slow growth.