[Promoting responsible self-medication in the context of Parkinson's disease: Development of a practical guide for drug-drug interactions and assessment by patients and community pharmacy professionals]. / Sensibilisation à l'automédication responsable au cours de la maladie de Parkinson : réalisation de fiche sur les interactions médicamenteuses et évaluation par les patients et les professionnels de l'officine.

CONTEXT: Parkinson disease is a neurodegenerative disorder characterized by motor and non-motor symptoms. Symptomatic treatment is based on dopaminergic medications. In case of self-medication practices, there may be drug-drug interactions between over-the-counter medication and dopaminergic medications. Thus, the aim of our work was to develop a practical guide summarizing drug-drug interactions and assess it by patients and community pharmacy professionals. METHODS: We performed a systematic analysis of drug-drug interactions between OTC medications available in France and antiparkinsonians (ATC Class N04) using Theriaque® and Drugs® databases, and summarized the results in a practical guide. We assessed patients' satisfaction by a questionnaire administered to hospitalized patients in a French expert center for Parkinson's disease. We estimated the impact of the guide on community pharmacy professionals through a survey online, by satisfaction, knowledge acquisition and estimated awareness in professional context. RESULTS: We identified 16 OTC medication, related to seven symptoms, interacting with antiparkinsonians. We obtained 67 responses from patients, expressing high satisfaction. We obtained 101 responses from professionals, reporting high satisfaction, knowledge acquisition and increased awareness in professional context. CONCLUSION: Our results highlight the relevance of the guide and suggest that we may increase its dissemination to patients and community pharmacies.

[Precoce survey: a new self-assessment patient card for early detection and management of Parkinson disease fluctuations]. / Etude Précoce: évaluation d'un autoquestionnaire de dépistage et prise en charge précoces des fluctuations dans la maladie de Parkinson.

It has been known for more than 30 years that the efficiency of the dopaminergic treatments can wear off. Currently, motor fluctuations and especially non-motor fluctuations (dysautonomic, cognitive/psychiatric or sensory/pain) remain often underdiagnosed in the first years of treatment. The patient self-questionnaire used in this study has been developed and validated in the United States. Its French version has been tested in daily practice in a study with 938 Parkinson's patients followed-up by movement disorders specialists. Use of this self-assessment patient card has resulted in the detection of fluctuations in 49% of patients, considered nonfluctuating by neurologists after a clinical assessment. The impact of these fluctuations unknown at first is significant, since these motor and/or non motor symptoms are considered troublesome or perturbing for daily life activities by 70% of fluctuating patients. The investigators have recognized the usefulness of this self-assessment in order to detect fluctuations in 81% of fluctuating patients, which lead them to modify the treatment in 76% of them.

Assessment of cortico-spinal tract impairment in multiple system atrophy using transcranial magnetic stimulation.

OBJECTIVE: Among Parkinsonian syndromes, pyramidal signs suggesting cortico-spinal impairment are a hallmark of multiple system atrophy (MSA). Although it is crucial to diagnose correctly this disease to choose the appropriate treatment, the available diagnostic criteria lack sensitivity. Cortical excitability patterns assessed by transcranial magnetic stimulation (TMS) do not differentiate Parkinsonian disorders. TMS using triple stimulation technique (TST) accurately detects cortico-spinal impairment. We hypothesized that this technique could detect such impairment in MSA patients. METHODS: The TST was applied along with single and paired-pulse TMS to 31 patients fulfilling the diagnostic criteria for MSA-P (n=10), MSA-C (n=4), progressive supranuclear palsy (PSP; n=6) and Idiopathic Parkinson's disease (IPD; n=11) and 11 control subjects. RESULTS: Single and paired-pulse TMS patterns did not differ between any patient group. The TST pattern was abnormal in five MSA-P, one MSA-C and one PSP patients but not in IPD patients or controls. The mean TST ratio for MSA-P (86.6%) was significantly different from IPD (99.1%; p<0.05) whereas ratios for MSA-C (92.1%) and PSP (93.3%) were not different from IPD or controls (99.5%). CONCLUSIONS: These results suggest that TST is effective to assess cortico-spinal impairment in MSA. SIGNIFICANCE: TST might be useful for the diagnosis of atypical Parkinsonism.

Quantitative voice analysis in the assessment of bulbar involvement in amyotrophic lateral sclerosis.

Bulbar and pseudobulbar symptoms are diagnostic criteria of amyotrophic lateral sclerosis (ALS). One of the earliest symptoms of bulbar involvement is voice deterioration. Until now voice assessment in ALS patients has been done mainly by perceptual analysis. The objective parameters, including acoustic measures, one aerodynamic measure and the maximal phonation time, have been measured only in a few small series of patients. The first purpose of this prospective study was to determine which vocal parameters discriminate ALS patients with bulbar involvement from control patients. The second was to identify sensitive parameters for early detection of voice deterioration due to bulbar involvement in pre-symptomatic ALS patients. The voices of 63 female ALS patients, including 40 with bulbar symptoms (sALS patients) and 23 without bulbar symptoms (aALS patients), were studied using an objective voice analysis system that allows simultaneous analysis of acoustic and aerodynamic parameters. Measurements were compared with those obtained in 40 normal female subjects (control patients). Five of eight acoustic parameters were significantly different among the three groups: jitter, coefficient of variation for frequency, shimmer, number of harmonics, and maximum phonatory frequency range. Three aerodynamic parameters, phonatory airflow, cycle-to-cycle variation for phonatory airflow, and coefficient of variation for phonatory airflow were significantly different between sALS patients and control patients. No aerodynamic parameter allowed discrimination between aALS patients and control patients. This study shows that acoustic parameters are more sensitive than aerodynamic parameters for early detection of bulbar involvement. Nevertheless, the measurements used can predict bulbar involvement in 73% of those in the sALS group, but only in 52% of those in the aALS group.