RESUMO
AIM: We sought to identify markers of motor and nonmotor function in Parkinson's disease (PD) using advanced neuroimaging techniques in subjects with PD. METHODS: We enrolled 26 nondemented PD subjects and 12 control subjects. All subjects underwent [(18)F]fluorodeoxyglucose positron emission computed tomography (FDG-PET) and magnetic resonance imaging, and a complete neuropsychological battery. RESULTS: FDG-PET of subjects with PD revealed significant metabolic elevations in the bilateral posterior lentiform nucleus, posterior cingulate, and parahippocampus, and metabolic reductions in the bilateral temporoparietal association cortex and occipital lobe versus controls. PD subjects had significant reductions in executive/attention function, memory/verbal learning, and speed of thinking, and significantly increased depression, anxiety and apathy scores compared with controls. Motor dysfunction correlated with increased metabolism in the posterior lentiform nucleus, pons, and cerebellum, and decreased metabolism in the temporoparietal lobe. Cognitive dysfunction correlated with increased posterior cingulate metabolism and decreased temporoparietal lobe metabolism. Depressive symptoms correlated with increased amygdala metabolism; anxiety scores correlated with decreased caudate metabolism, and apathy scores correlated with increased metabolism in the anterior cingulate and orbitofrontal lobe and decreased metabolism in the temporoparietal association cortex. CONCLUSIONS: Our findings showed that motor, cognitive, and emotional dysfunction in PD are associated with distinct patterns of cerebral metabolic changes.
Assuntos
Glicemia/metabolismo , Encéfalo/metabolismo , Doença de Parkinson/metabolismo , Idoso , Biomarcadores/metabolismo , Encéfalo/diagnóstico por imagem , Mapeamento Encefálico/métodos , Estudos de Casos e Controles , Feminino , Fluordesoxiglucose F18 , Humanos , Modelos Logísticos , Imageamento por Ressonância Magnética , Masculino , Testes Neuropsicológicos , Doença de Parkinson/diagnóstico , Doença de Parkinson/psicologia , Tomografia por Emissão de Pósitrons , Curva ROCRESUMO
Epidural motor cortex stimulation has been reported to be effective in treating some movement disorders. Nevertheless, clinical results have been variable and no double-blinded evaluations have been reported. The aim of this study was to investigate efficacy and safety of unilateral subdural motor cortex stimulation in patients with essential tremor and Parkinson's disease. Six patients with essential tremor and five parkinsonian patients were selected. Craniotomy was performed under local anaesthesia with conscious sedation. A four contact electrode (Resume II model 3587, Medtronic, Inc) was positioned on the motor cortex, after identification of the area with direct monopolar cortical stimulation. Soon after surgery, a variety of different settings of stimulation were assessed using standard rating scales to select the optimal stimulation parameters. The effects of chronic stimulation were evaluated in both groups of patients after 3 months (double-blinded fashion) and 1 year (open fashion). In essential tremor, contralateral hand tremor scores significantly improved (P = 0.04) with stimulation during the double-blinded study, whereas in Parkinson's disease, there were no changes in the OFF medication/on stimulation motor scores compared with off stimulation. At 1 year, tremor was improved by stimulation in two out of three patients with essential tremor available at follow-up, whereas no improvement was observed in the five parkinsonian patients. One parkinsonian patient had a cortical venous infarct. Three other patients had self-limiting seizures with aggressive trials of stimulation in the period of dosage selection. These findings suggest that unilateral subdural motor cortex stimulation may be useful for contralateral hand tremor in selected patients with essential tremor but was not effective in improving parkinsonian signs in our series.
Assuntos
Terapia por Estimulação Elétrica/métodos , Tremor Essencial/terapia , Lateralidade Funcional/fisiologia , Córtex Motor/fisiologia , Doença de Parkinson/terapia , Idoso , Biofísica , Método Duplo-Cego , Eletrodos Implantados , Feminino , Seguimentos , Humanos , Imageamento por Ressonância Magnética , Masculino , Testes Neuropsicológicos , Estudos Retrospectivos , Espaço Subdural/fisiologia , Fatores de Tempo , Resultado do TratamentoRESUMO
Spiral analysis is a computerized method of analyzing upper limb motor physiology through the quantification of spiral drawing. The objective of this study was to determine whether spirals drawn by patients with Niemann-Pick disease type C (NPC) could be distinguished from those of controls, and to physiologically characterize movement abnormalities in NPC. Spiral data consisting of position, pressure, and time were collected from 14 NPC patients and 14 age-matched controls, and were analyzed by the Mann-Whitney U test. NPC spirals were characterized by: lower speed (2.67 vs. 9.56 cm/s, P < 0.001) and acceleration (0.10 vs. 2.04 cm/s(2), P < 0.001), higher loop width variability (0.88 vs. 0.28, P < 0.001), tremor (5/10 vs. 0/10 trials in the dominant hand, P < 0.001), and poor overall spiral rating (2.53 vs. 0.70, P < 0.005). NPC spirals also exhibited sustained drawing pressure profiles that were abnormally invariant with time. Other features, such as the tightness of loop widths, were normal. Our findings reveal that differing aspects of tremor, Parkinsonism, ataxia, and dystonia are quantifiable in NPC patients.
Assuntos
Movimento/fisiologia , Doença de Niemann-Pick Tipo C/patologia , Doença de Niemann-Pick Tipo C/fisiopatologia , Análise Numérica Assistida por Computador , Extremidade Superior/fisiopatologia , Adolescente , Adulto , Estudos de Casos e Controles , Eletromiografia/métodos , Feminino , Humanos , Masculino , Estatísticas não Paramétricas , Adulto JovemRESUMO
BACKGROUND: Episodes of subacute worsening of motor function occur commonly in Parkinson disease (PD), but there has been surprisingly little research about the clinical characteristics of these exacerbations in the outpatient setting. METHODS: Retrospective study of an established cohort of 120 outpatients with PD. Primary outcome measures were the frequency, causes, and outcomes of motor exacerbations. Statistical analysis was performed to compare baseline characteristics of subjects with subsequent exacerbations versus without subsequent exacerbations. RESULTS: Over an 18-month period, 43 exacerbations occurred, affecting 30 of 120 subjects (25.0%). Infection was the single most frequent underlying cause, accounting for 11 of 43 (25.6%) exacerbations. Other common etiologies were anxiety (n=8), medication errors (n=6), poor adherence (n=6), medication side effects (n=3), and postoperative decline (n=3). Overall, 35 episodes (81.4%) were attributable to reversible or treatable causes. Most subjects recovered fully, but 10 (33.3%) experienced recurrent episodes, 5 (16.7%) suffered permanent decline, and 1 died. At baseline, subjects with exacerbations had a significantly longer median disease duration (7.8 vs. 5.7 y, P=0.003), lower Mini-Mental State Examination scores (27.0±3.3 vs. 28.6±1.6, P=0.02), higher modified Hoehn and Yahr scores (2.2±0.5 vs. 1.9±0.5, P=0.006), greater dopaminergic medication use (median, 750.0 vs. 395.0 levodopa equivalents; P=0.009), and a greater prevalence of motor complications (55.2% vs. 29.4%, P=0.01) than subjects without exacerbations. CONCLUSIONS: Exacerbations are common in PD, associated with more advanced disease, and usually attributable to treatable secondary causes such as intercurrent infection. Increased recognition of these underlying causes may help to decrease morbidity, reduce health care costs, and optimize quality of care in PD.
Assuntos
Movimento/fisiologia , Doença de Parkinson/complicações , Doença de Parkinson/psicologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Antiparkinsonianos/uso terapêutico , Feminino , Humanos , Levodopa/uso terapêutico , Masculino , Entrevista Psiquiátrica Padronizada , Pessoa de Meia-Idade , Movimento/efeitos dos fármacos , Avaliação de Resultados em Cuidados de Saúde , Pacientes Ambulatoriais , Doença de Parkinson/tratamento farmacológico , Qualidade de Vida , Estudos Retrospectivos , Índice de Gravidade de DoençaRESUMO
BACKGROUND: Patient telephone calls are a major form of unreimbursed healthcare utilization in Parkinson's disease (PD), yet little is known about potential risk factors for frequent calling behavior. METHODS: Prospective cohort study of 175 non-demented outpatients with PD. Our primary outcome measure was the frequency of patient telephone calls over a three-month period relative to baseline demographics, State-Trait Anxiety Index (STAI) and Beck Anxiety Inventory (BAI) scores, Unified Parkinson's Disease Rating Scale (UPDRS) motor scores, and medication use. Based on the median call rate (1 call/3 months), subjects were dichotomized into frequent (≥2 calls) and infrequent (≤1 call) caller groups. RESULTS: A total of 297 calls were received, of which 264 (89%) were from the frequent caller group (n = 63 subjects), and only 33 (11%) were from the infrequent caller group (n = 112 subjects). Compared with calls from infrequent callers, those from frequent callers more commonly related to somatic symptoms of PD (46.8% vs. 19.4%, p = 0.007). In multivariate logistic regression analysis, independent predictors of frequent calling were: anxiety (STAI ≥55; adjusted OR = 2.62, p = 0.02), sleep disorders (adjusted OR = 2.36, p = 0.02), dyskinesias (adjusted OR = 3.07, p = 0.03), and dopamine agonist use (adjusted OR = 2.27, p = 0.03). Baseline demographics, UPDRS motor scores, and levodopa use were similar in both groups. CONCLUSIONS: Frequent patient telephone calls in PD are independently associated with anxiety, sleep disorders, dyskinesias, and dopamine agonist use, with a minority of patients accounting for the majority of calls. Aggressive treatment of these non-motor symptoms and motor complications might potentially reduce the burden of patient telephone calls in PD.
Assuntos
Linhas Diretas/estatística & dados numéricos , Doença de Parkinson/psicologia , Doença de Parkinson/terapia , Idoso , Ansiedade/etiologia , Ansiedade/psicologia , Ansiedade/terapia , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doença de Parkinson/complicações , Valor Preditivo dos Testes , Estudos Prospectivos , Transtornos do Sono-Vigília/etiologia , Transtornos do Sono-Vigília/psicologia , Transtornos do Sono-Vigília/terapia , Fatores de TempoRESUMO
Subthalamic nucleus deep brain stimulation (STN-DBS) is effective in advanced Parkinson's disease (PD), but its effects on the levodopa response are unclear. We studied the levodopa response after long-term STN-DBS, STN-DBS efficacy and predictive value of preoperative levodopa response to long-term DBS benefit in 33 PD patients with bilateral STN-DBS. Patients were assessed using the Unified Parkinson's Disease Rating Scale preoperatively (with and without medications) and postoperatively (without medications or stimulation, with only medications or stimulation, and with both medications and stimulation). Levodopa response significantly decreased postoperatively by 31.1% at 3 years and 32.3% at 5 years, possibly related to the reduction in medication requirement, direct STN stimulation effect or PD progression. STN-DBS alone significantly improved motor scores (37.2% at 3 years and 35.1% at 5 years) and activities of daily living scores (27.1% at 3 years and 19.2% at 5 years). Anti-PD drugs were significantly reduced by 47.9% at 3 years and 39.8% at 5 years. However, the magnitude of the preoperative response to levodopa did not predict DBS benefit at 3 and 5 years.
Assuntos
Antiparkinsonianos/uso terapêutico , Estimulação Encefálica Profunda/métodos , Levodopa/uso terapêutico , Doença de Parkinson , Núcleo Subtalâmico/cirurgia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Doença de Parkinson/tratamento farmacológico , Doença de Parkinson/patologia , Doença de Parkinson/cirurgia , Estudos Retrospectivos , Estatísticas não Paramétricas , Fatores de Tempo , Resultado do TratamentoRESUMO
Orthostatic tremor (OT) is a condition described as high-frequency tremors predominantly in the legs and trunk, which are present not only in the standing position but also during isometric contraction of the limb muscles. This report is one of the largest OT series describing clinical and neurophysiologic findings in 26 subjects with OT. The main findings included 13.0 to 18.6 Hz leg tremors while standing with varied patterns of phase relationships between the antagonists of the ipsilateral leg and between the homologous muscles of the contralateral leg, short latency tremor onset upon standing with abrupt cessation after sitting, coexistence of tremors in the cranial structures and the arms, and sense of unsteadiness without actual falls. Although the oscillator of OT is most likely located in the brainstem, cerebral cortex, basal ganglia, and cerebellum may also be involved in its pathogenesis.
Assuntos
Perna (Membro)/fisiopatologia , Tremor/fisiopatologia , Idoso , Idoso de 80 Anos ou mais , Eletromiografia/métodos , Feminino , Lateralidade Funcional/fisiologia , Humanos , Imageamento por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Análise Espectral , Tremor/tratamento farmacológicoRESUMO
Detecting psychogenic tremors (PsychT) is often challenging. As there are no laboratory investigations or imaging techniques that can confirm the diagnosis, PsychT is identified on a clinical basis. We present a tree-based statistical algorithm derived from quantitative computerized tremor recordings as a novel method to help in the recognition of PsychT. The goal of this study was to show that objective data from computerized tremor recordings, when processed through a tree-based statistical algorithm, can be used to determine whether a patient can be classified as having PsychT.
Assuntos
Algoritmos , Transtornos Psicofisiológicos/diagnóstico , Tremor/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Diagnóstico Diferencial , Eletromiografia/métodos , Feminino , Humanos , Cinética , Masculino , Pessoa de Meia-Idade , Modelos Estatísticos , Exame Neurológico , Valor Preditivo dos Testes , Sensibilidade e Especificidade , Processamento de Sinais Assistido por Computador , Tremor/classificação , Tremor/fisiopatologiaRESUMO
Corticobasal degeneration is one of the neurodegenerative tauopathies, which are defined as a group of heterogeneous dementias and movement disorders that are characterized neuropathologically by prominent intracellular accumulations of abnormal filaments formed by the microtubule-associated protein tau. Although there are no curative treatments, symptomatic and supportive management can be helpful. Many new therapies are still under development. However, more needs to be learned about the pathogenesis and molecular biology of this disease before an effective therapy can be developed.
RESUMO
Voice and head (neck) tremor commonly occur in patients with essential tremor (ET), but involvement of cranial musculature is generally limited to these specific cranial structures, and action tremor of the forehead has not been reported. We describe a patient with ET who had forehead tremor. The tremor seemed to be task-specific, and neurophysiological features suggested that the forehead tremor was dystonic. The presence of forehead tremor in a patient with ET probably indicates an additional pathophysiologic process. The explanation for the specificity of involvement of cranial musculature in ET is not known, but this clinical observation might help guide investigators who are interested in the underlying pathophysiology of this condition.