RESUMEN
Introduction: Differential diagnoses between essential tremor and Parkinson's disease is challenging in some individuals, with both disorders sharing similarities. Considering these links, we hypothesized that both conditions have a similar profile for some antioxidant molecules, including 25-hydroxyvitamin D and bilirubin. Methods: We performed a cross-sectional study comparing serum levels of 25-hydroxyvitamin D and bilirubin in 31 ET patients, 38 PD, and 65 controls matched for age. We used the Fahn-Tolosa-Marin scale for the severity of tremors in the ET group. We used Hohen-Yahr and MDS-UPDRS part III scales in the PD group. In addition, we evaluated sociodemographic characteristics, including age, sex, ethnicity, years of study, duration of disease, and use of primidone. Results: We found no differences in serum levels for 25-hydroxyvitamin D or bilirubin subtype levels between the ET and PD groups. We found low levels of indirect bilirubin in the PD group compared to the controls. We did not find differences between ET and controls in all biomarkers of the study. Conclusion: ET and PD patients have similar profiles for 25-hydroxyvitamin D and bilirubin serum levels. The discovery of differences in oxidative stress biomarkers in both conditions, mainly low-cost substances available clinically, can assist in the differential diagnosis and, in the future, prognostication and better therapy management (AU).
Introdução: O diagnóstico diferencial entre tremor essencial (TE) e a doença de Parkinson (DP) é desafiador em alguns indivíduos com ambas as afecções apresentando algumas similaridades. Assim sendo, hipotetizamos que ambas têm perfil similar de algumas moléculas antioxidantes, incluindo 25-hidroxivitamina D e bilirrubina. Méto-dos: Realizamos um estudo transversal comparando os níveis séricos de 25-hidroxivitamina D e bilirrubinas em 31 indivíduos com TE, 38 com DP e 65 controles pareados por idade. A escala de Fahn-Tolosa-Marin foi usada para avaliação da gravidade do tremor no grupo com TE e Hohen-Yahr e UPDRS parte III na avaliação do grupo com DP. Também foram avaliadas as características sociodemográficas. Resultados: Não encontramos diferenças nos níveis séricos de 25-hidroxivitamina D ou bilirrubina entre os grupos TE e DP. Encontramos baixos níveis de bilirrubina indireta no grupo DP comparado aos controles. Não encontramos diferenças entre os grupos com TE e controles em nenhum dos biomarcadores do estudo. Conclusão: Pacientes com TE e DP apresentam níveis séricos semelhantes de 25-Hidroxivitamina D e bilirrubinas. Diferenças nos biomarcadores de estresse oxidativo em ambas as condi-ções, principalmente substâncias de baixo custo disponíveis na clínica, pode auxiliar no diagnóstico diferencial e, futuramente, no prognóstico e otimização terapêutica (AU).
Asunto(s)
Humanos , Masculino , Femenino , Anciano , Anciano de 80 o más Años , Enfermedad de Parkinson/terapia , Bilirrubina , Calcifediol , Temblor Esencial/terapiaRESUMEN
Abstract Background Music-based interventions are promising for cognitive rehabilitation in Parkinson's disease; however, systematic reviews covering the topic are scarce. Objective To analyze the effectiveness of music-based interventions for cognitive rehabilitation in PD. Method Systematic review study based on PRISMA criteria. The descriptors Parkinson's disease, Parkinson's disease, idiopathic Parkinson's disease, music-based interventions, music therapy, music training, auditory stimulation, music, rhythm, rhythmic, cognition, and cognitive were used. Five databases were searched PubMed/MEDLINE, PsycInfo, Scopus, Web of Science, and Cochrane in May 2022. Only randomized controlled trials with no limit on publication date or language were included. Risk of bias was assessed following Cochrane Collaboration criteria for development of systematic intervention reviews. Results Nine hundred nineteen articles were found by the descriptors; 266 were excluded for being repeated; 650 for not meeting the inclusion criteria. The remaining three articles were included and analyzed. The interventions consisted of practices with emphasis on rhythm and were conducted in groups. Risks of important biases were observed, such as lack of blinding in the allocation of participants and in the assessment of outcomes, as well as incomplete data for some outcomes. Conclusion Overall, the results showed no evidence of efficacy of music-based interventions for cognitive outcomes in PD.
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Enfermedad de Parkinson/terapia , Entrenamiento Cognitivo/métodos , Musicoterapia/métodosRESUMEN
OBJECTIVE@#To observe the effects of acupuncture on swallowing function and quality of life for patients with dysphagia in Parkinson's disease (PD).@*METHODS@#A total of 60 patients of PD with dysphagia were randomly divided into an observation group (30 cases, 2 cases dropped off) and a control group (30 cases, 3 cases dropped off). The control group was given conventional medication therapy and rehabilitation training. On the basis of the treatment as the control group, the observation group was given acupuncture at Fengfu (GV 16), Baihui (GV 20), Shenting (GV 24), Yintang (GV 24+), Yansanzhen and bilateral Fengchi (GB 20), 30 min each time, once a day, 6 times a week for 4 weeks. Before and after treatment, the Kubota water swallowing test, standardized swallowing assessment (SSA) and swallowing quality of life (SWAL-QOL) were used to evaluate the swallowing function and quality of life of the two groups.@*RESULTS@#After treatment, the Kubota water swallowing test grade, SSA scores in the two groups were decreased compared with those before treatment (P<0.05, P<0.001),the SWAL-QOL scores were increased compared with those before treatment (P<0.001); in the observation group,the Kubota water swallowing test grade and SSA score were lower than those in the control group (P<0.05),the SWAL-QOL score was higher than that in the control group (P<0.001).@*CONCLUSION@#On the basis of conventional medication therapy and rehabilitation training,acupuncture could improve the swallowing function and quality of life for patients of PD with dysphagia.
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Humanos , Trastornos de Deglución/terapia , Deglución , Calidad de Vida , Enfermedad de Parkinson/terapia , Terapia por Acupuntura , AguaRESUMEN
Magnetic resonance-guided focused ultrasound (MRgFUS) is a novel and minimally invasive technology. Since the US Food and Drug Administration approved unilateral ventral intermediate nucleus-MRgFUS for medication-refractory essential tremor in 2016, studies on new indications, such as Parkinson's disease (PD), psychiatric diseases, and brain tumors, have been on the rise, and MRgFUS has become a promising method to treat such neurological diseases. Currently, as the second most common degenerative disease, PD is a research hotspot in the field of MRgFUS. The actions of MRgFUS on the brain range from thermoablation, blood-brain barrier (BBB) opening, to neuromodulation. Intensity is a key determinant of ultrasound actions. Generally, high intensity can be used to precisely thermoablate brain targets, whereas low intensity can be used as molecular therapies to modulate neuronal activity and open the BBB in conjunction with injected microbubbles. Here, we aimed to summarize advances in the application of MRgFUS for the treatment of PD, with a focus on thermal ablation, BBB opening, and neuromodulation, in the hope of informing clinicians of current applications.
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Humanos , Enfermedad de Parkinson/terapia , Encéfalo , Barrera Hematoencefálica , Temblor Esencial/cirugía , Neoplasias Encefálicas , Imagen por Resonancia Magnética/métodos , Espectroscopía de Resonancia MagnéticaRESUMEN
The paper introduces professor ZHUANG Li-xing's clinical experience in treatment of dyskinesia of Parkinson's disease with acupuncture at triple-acupoint prescription. In pathogenesis, dyskinesia of Parkinson's disease refers to yang deficiency and disturbing wind. In treatment, acupuncture focuses on warming yang, promoting the circulation of the governor vessel, regulating the spirit and stopping trembling; and Baihui (GV 20), Suliao (GV 25) and Dingchanxue (Extra) are selected to be "trembling relief needling". In combination with Jin's three needling, named "three-trembling needling" "three-governor-vessel needling" and "three-spasm needling", the triple-acupoint prescription is composed. To ensure the favorable therapeutic effect, this prescription is modified according to the symptoms and the specific techniques of acupuncture are combined such as conducting qi, harmonizing yin and yang, and manipulating gently for reinforcing and reducing.
Asunto(s)
Humanos , Puntos de Acupuntura , Enfermedad de Parkinson/terapia , Terapia por Acupuntura/métodos , Acupuntura , DiscinesiasRESUMEN
Parkinson's disease (PD) is a common neurodegenerative disease characterized by motor symptoms, including bradykinesia, resting tremor, and progressive rigidity. More recently, non-motor symptoms of PD, such as pain, depression and anxiety, and autonomic dysfunction, have attracted increasing attention from scientists and clinicians. As one of non-motor symptoms, pain has high prevalence and early onset feature. Because the mechanism of PD-related pathological pain is unclear, the clinical therapy for treating PD-related pathological pain is very limited, with a focus on relieving the symptoms. This paper reviewed the clinical features, pathogenesis, and therapeutic strategies of PD-related pathological pain and discussed the mechanism of the chronicity of PD-related pathological pain, hoping to provide useful data for the study of drugs and clinical intervention for PD-related pathological pain.
Asunto(s)
Humanos , Enfermedad de Parkinson/terapia , Enfermedades Neurodegenerativas , Enfermedades del Sistema Nervioso Autónomo/complicaciones , Ansiedad , Dolor/etiologíaRESUMEN
RESUMO Este estudo descreve os resultados de duas intervenções diferentes para a disartria na doença de Parkinson (DP). Trata-se de dois pacientes do sexo masculino com DP e disartria hipocinética que foram submetidos à avaliação fonoaudiológica. O primeiro (S1) recebeu dez sessões de 20 minutos de estimulação transcraniana por corrente contínua (ETCC), enquanto o segundo (S2) recebeu dez sessões de 20 minutos de ETCC e terapia fonoaudiológica. Os pacientes foram reavaliados imediatamente após a intervenção e novamente após 30 dias. A melhora no tempo de fonação, movimento velar e outras medidas de disartria foram mais significativas no S1. De acordo com os parâmetros da análise acústica de fonte glótica, a melhora nas medidas de frequência e Jitter, Shimmer e ruído foi maior no S2 tanto na avaliação pós-intervenção imediata quanto na avaliação 30 dias pós-intervenção, seguida por S1 na avaliação pós-intervenção imediata. S1 apresentou melhores resultados na avaliação perceptivo-auditiva de fala e voz, enquanto S2 obteve melhores escores na análise acústica. Esses achados sugerem que a terapia fonoaudiológica convencional associada à ETCC tem um impacto mais significativo na fala e voz do que a ETCC isolada, demonstrando o potencial da ETCC como tratamento complementar para pacientes com DP.
ABSTRACT This study describes the results of two different interventions for dysarthria in Parkinson's disease (PD). It concerns two male patients with PD and hypokinetic dysarthria who underwent speech and voice assessment. The first (S1) received ten 20-minute sessions of transcranial direct current stimulation (tDCS), while the second (S2) received ten 20-minute sessions of tDCS as well as speech therapy. The patients were re-evaluated immediately after the intervention and again after 30 days. Improvements in phonation time, velar movement, and other measures of dysarthria were more significant in S1. According to the acoustic analysis source parameters, improvements in the frequency measurements and Jitter, Shimmer, and noise measurements were greater in S2 in both the immediate post-intervention and 30-day postintervention assessments, followed by S1 in the immediate post-intervention assessment. S1 showed better results in the auditory-perceptual evaluation of speech and voice, whereas S2 obtained better scores in acoustic analysis. These findings suggest that conventional speech therapy combined with tDCS has a more significant impact on speech and voice than tDCS alone, demonstrating the potential of tDCS as an adjuvant treatment for patients with PD.
Asunto(s)
Humanos , Masculino , Anciano , Enfermedad de Parkinson/terapia , Logopedia , Disartria/terapia , Estimulación Transcraneal de Corriente Directa/métodosRESUMEN
La neuromodulación es una práctica médica implementada desde hace más de cuatro décadas. En lo que respecta a la Neurocirugía, cumple un papel en el tratamiento de diversas patologías (Parkinson, distonías, epilepsia, etc.) y con un gran potencial para aplicarlas en otras (trastorno obsesivo compulsivo [TOC], dolor pélvico). Es por ello que, en los últimos años, se cuadruplicaron las inversiones de empresas biotecnológicas en este campo por la demanda y aplicación de la terapia. La neuromodulación abarca también otras especialidades, como por ejemplo Otorrinolaringología (ORL) en implantes cocleares, Cardiología con diversos modelos de marcapasos cardíacos, Endocrinología con bombas de infusión de medicamentos, Uroginecología en incontinencia, etcétera. Nuestra institución aplica en su práctica clínica todas estas técnicas, y cumple una función jerárquica como centro de referencia en educación y políticas sanitarias. Por estos aspectos, sumados a su infraestructura, personal profesional y enfoque sanitario, puede ser considerada como un Centro de Neuromodulación referente en la región. (AU)
Neuromodulation is a medical practice established for more than forty years. In the neurosurgical field it plays a role in the treatment of different diseases (Parkinson, Dystonia, Epilepsy, etc) and has a great potential to apply in other pathologies (Obsessive Compulsive Disorder, Pelvic pain). In the last years the biotechnological industry has quadrupled the investment in this field because of the demand and therapy application. Neuromodulation encompasses other specialities, for example otorhinolaryngology in cochlear implants, in cardiology with different models of pacemakers, endocrinology with implanted infusion pumps, urological gynecology in incontinence treatments, etc. Our institution applies all these techniques in its clinical practice, having a hierarchical role as a reference center in education and health policies. Due to these aspects, added to its infrastructure, professional staff and health approach, it can be considered as a reference Neuromodulation Center in the region. (AU)
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Humanos , Enfermedad de Parkinson/terapia , Neurotransmisores/uso terapéutico , Estimulación Encefálica Profunda , Dolor Crónico/terapia , Epilepsia Refractaria/terapia , Manejo del Dolor/métodos , Estado FuncionalRESUMEN
Objetivo: apresentar o estado da arte das publicações expressas na literatura cientifica mundial sobre a temática, bem como identificar os benefícios terapêuticos da Cannabis medicinal no tratamento dos sintomas das doenças neurodegenerativas especificamente doenças de Parkinson, esclerose múltipla e Alzheimer. Método: trata-se de uma revisão integrativa da literatura, cuja busca de dados foi realizada nas bibliotecas virtuais. Web of Science, Scopus, Medline, Lilacs, Cochrane Library e Scielo no período de agosto a outubro de 2021. Resultados: foram encontrados 158 artigos. Vinte e tres artigos foram selecionados para serem lidos na íntegra e 8 atenderam aos critérios desta revisão. Conclusão: as evidências mostram que embora cada vez mais prescritos ou autorizados, a cannabis medicinal ou os Canabinóides para a doenças neurodegenerativas continuam a ser controversos para muitos médicos.
Objective: to present the state of the art of publications expressed in the world Scientific literature on the subject, as well as to identify the therapeutic benefits of medicinal cannabis in the treatment of neurodegenerative diseases, specifically, Parkinson's diseases, multiple sclerosis and Alzheimer's. Method: this is an integrative literature review, whose data search was performed in virtual librares. Web of Science, Scopus, Medline, Lilacs, Cochrane Library and Scielo from August to October 2021. Results:158 articles were found. Twenty-three articles were selected to be read in full and 8 met the criteria of this review. Conclusion: evidence shows that although increasingly prescribed or authorized, medical cannabis or Cannabinoids for chronic pain remain controversial for many physicians.
Objetivo: presentar el estado del arte de las publicaciones expresadas en la literatura científica mundial sobre el tema, así como identificar los beneficios terapéuticos del cannabis medicinal en el tratamiento de enfermedades neurodegenerativas, en concreto, las enfermedades de Parkinson, la esclerosis múltiple y el Alzheimer. Método: se trata de una revisión integradora de la literatura, cuya búsqueda de datos se realizó en bibliotecas virtuales. Web of Science, Scopus, Medline, Lilacs, Cochrane Library y Scielo de agosto a octubre de 2021. Resultados: se encontraron 158 artículos. Se seleccionaron veintitrés artículos para ser leídos en su totalidad y ocho cumplieron los criterios de esta revisión. Conclusión: la evidencia muestra que, aunque cada vez más se prescribe o autoriza, el cannabis medicinal o los cannabinoides para el dolor crónico siguen siendo controvertidos para muchos médicos.
Asunto(s)
Humanos , Masculino , Femenino , Cannabinoides/uso terapéutico , Cannabis/efectos de los fármacos , Enfermedades Neurodegenerativas/tratamiento farmacológico , Marihuana Medicinal , Enfermedad de Parkinson/terapia , Dolor Crónico/terapia , Esclerosis Múltiple/terapiaRESUMEN
ABSTRACT: Parkinson's disease can harm the functional capacity of a person, which may lead to a worse motor coordination and balance, increasing the risk of falls, and consequently to morbidities or even death. So, complimentary therapies to the drug therapy as exercise programs the aim to increase coordination and balance may avoid the possible falls that may occur and to increase the life quality for people with this illness. Thus, the present study is aimed to verify the efficiency of a four-week exercise program formed by balance and motor coordination on people living with Parkinson using Berg scale to evaluate it. Twelve individuals (64.18 ± 9.54 years; 73.83 ± 14.97 kg; 168.25 ± 8.24 cm) were submitted to two sessions each week consisted of exercises divided in three series of 90 seconds, in a total of eight sessions. The Berg scores increase significatively (p = 0.033) from 43.58 ± 6.53 to 46 ± 5.22. Since scores less than 45 mean a high probability of falls, it is possible to say that the applied program was effective in increase the balance for these individuals, consequently, leading to a better functional capacity and a possible better life quality.
RESUMEN: La enfermedad de Parkinson deteriora la capacidad funcional del paciente al afectar su coordinación motora y el equilibrio, lo que puede provocar caídas y, en consecuencia, morbilidades asociadas o incluso la muerte. De esta manera, las terapias auxiliares de la terapia farmacológica, como los programas de ejercicio físico que buscan mejorar la coordinación y el equilibrio, pueden ayudar a evitar el riesgo de caídas y, por lo tanto, mejorar la calidad de vida de las personas afectadas por esta enfermedad. Por tanto, el presente estudio tiene como objetivo verificar la efectividad de un programa de ejercicios de cuatro semanas que incluye ejercicios de equilibrio y coordinación motora para mejorar el equilibrio de las personas con Parkinson, utilizando la escala de Berg. Doce personas (64,18 ± 9,54 años; 73,83 ± 14,97 kg; 168,25 ± 8,24 cm) se sometieron a dos sesiones semanales de ejercicios divididos en tres series de 90 segundos para cada ejercicio, para un total de ocho sesiones. La puntuación de los individuos en la escala de Berg aumentó significativamente (p = 0,033) de 43,58 ± 6,53 a 46 ± 5,22. Sabiendo que los puntajes inferiores a 45 significan una probabilidad considerable de caídas, es posible afirmar que el programa de ejercicio aplicado fue efectivo para mejorar el equilibrio de los individuos y, en consecuencia, puede conducir a una mejora en la capacidad funcional del individuo y una posible mejora en la calidad de vida.
Asunto(s)
Humanos , Masculino , Femenino , Persona de Mediana Edad , Anciano , Enfermedad de Parkinson/terapia , Ejercicio Físico , Equilibrio Postural , Calidad de Vida , Accidentes por Caídas , Accidentes por Caídas/prevención & controlRESUMEN
Abstract Aim: This study aims to compare a functional training protocol and Mat Pilates for individuals with Parkinson's disease and to evaluate the effects on motor symptoms, as well as non-motor symptoms using a randomized controlled trial. Methods: Protocol for a randomized clinical trial in which 45 individuals with Parkinson's disease will be recruited and randomly allocated to one of three groups: (1) functional training; (2) Mat Pilates; (3) control group. Both intervention groups will have 60 min classes twice a week for 12 weeks. The primary outcome will be analyzed through motor symptoms, including balance, mobility, muscle strength, handgrip strength, flexibility, range of motion, and cardiorespiratory fitness. Secondary outcomes will include non-motor symptoms such as cognition, aging perspective, mood, anxiety, and depression. Conclusion: This will be the first randomized trial to compare the effects of functional training and Mat Pilates in a population with Parkinson's disease. It is hypothesized that improvements in motor and non-motor symptoms will be greater and more lasting after functional training and Mat Pilates interventions than those that maintain their routine activities, given the benefits of exercise and the unprecedented protocols in this disease.
Asunto(s)
Humanos , Enfermedad de Parkinson/terapia , Ejercicio Físico , Técnicas de Ejercicio con Movimientos/instrumentación , Actividad Motora , Ensayos Clínicos Controlados Aleatorios como AsuntoRESUMEN
OBJECTIVE@#To compare the clinical efficacy between Jiao's scalp acupuncture combined with virtual reality (VR) rehabilitation training and VR rehabilitation training alone for motor dysfunction in patients with Parkinson's disease (PD).@*METHODS@#A total of 52 patients with PD were randomly divided into an observation group and a control group, 26 cases in each group. The patients in both groups were treated with routine basic treatment, and the patients in the control group were treated with VR rehabilitation training. The patients in the observation group were treated with Jiao's scalp acupuncture on the basis of the control group. The scalp points included the movement area, balance area and dance tremor control area. Both groups were treated once a day, 5 times a week for a total of 8 weeks. Before treatment and 4 and 8 weeks into treatment, the gait parameters (step distance, step width, step speed and step frequency), timed "up and go" test (TUGT) time and unified Parkinson's disease rating scale part Ⅲ (UPDRS-Ⅲ) score were compared between the two groups, and the clinical efficacy was evaluated.@*RESULTS@#Four weeks into treatment, except for the step width in the control group, the gait parameters of the two groups were improved, the TUGT time was shortened, and the UPDRS-Ⅲ scores were reduced (P<0.01, P<0.05); the step distance in the observation group was better than that in the control group, and the UPDRS-Ⅲ score in the observation group was lower than that in the control group (P<0.05). Eight weeks into treatment, the gait parameters of the two groups were improved, the TUGT time was shortened, and the UPDRS-Ⅲ scores were reduced (P<0.01); the step distance and step speed in the observation group were better than those in the control group, the TUGT time in the observation group was shorter than that in the control group, and the UPDRS-Ⅲ score in the observation group was lower than that in the control group (P<0.05, P<0.01). The total effective rate was 92.3% (24/26) in the observation group, which was higher than 69.2% (18/26) in the control group (P<0.05).@*CONCLUSION@#Jiao's scalp acupuncture combined with VR rehabilitation training could improve the gait parameters, walking ability and motor function in patients with PD. The clinical effect is better than VR rehabilitation training alone.
Asunto(s)
Humanos , Terapia por Acupuntura/efectos adversos , Marcha , Enfermedad de Parkinson/terapia , Cuero Cabelludo , Realidad VirtualRESUMEN
OBJECTIVE@#To compare the curative effect of panlong needling at Jiaji (EX-B 2) combined with western medication and western medication alone on motor dysfunction in patients with Parkinson's disease (PD) of liver and kidney deficiency.@*METHODS@#A total of 98 patients with PD were randomly divided into an acupuncture and medication group (49 cases, 1 case dropped off) and a western medication group (49 cases,1 case was removed). The patients in the western medication group were given oral of levodopa and benserazide hydrochloride tablets, 125 mg each time, three times a day in the 1st week, and the dose was increased according to the needs of the patients' condition from the 2nd week until 250 mg each time, three times a day, for 16 consecutive weeks. On the basis of the same western medication treatment as the western medication group, panlong needling was applied at Jiaji (EX-B 2) from C2 to L5 in the acupuncture and medication group, once a day, 20 times as a course of treatment, for 4 consecutive courses. The scores of unified Parkinson's disease rating scale (UPDRS-Ⅲ, UPDRS-Ⅳ), TCM symptoms score, and 39-item Parkinson's disease questionnaire (PDQ-39) score were evaluated before treatment, after treatment and during follow-up of 1 month after treatment, respectively. The safety of the two groups was compared.@*RESULTS@#After treatment and during follow-up, except the PDQ-39 score of the western medication group, the scores of UPDRS-Ⅲ, UPDRS-Ⅳ, TCM syndrome and PDQ-39 were lower than those before treatment in the two groups (P<0.05), and the scores of above indexes in the acupuncture and medication group were lower than those of the western medication group (P<0.05). The total incidence of adverse reactions in the acupuncture and medication group was 10.4% (5/48), which was lower than 29.2% (14/48) in the western medication group (P<0.05).@*CONCLUSION@#Panlong needling at Jiaji (EX-B 2) combined with western medication could significantly improve the motor dysfunction and clinical symptoms, improve the quality of life and has high safety, and the efficacy is superior to western medication alone.
Asunto(s)
Humanos , Puntos de Acupuntura , Terapia por Acupuntura , Clorofenoles , Riñón , Hígado , Enfermedad de Parkinson/terapia , Calidad de Vida , Resultado del TratamientoRESUMEN
BACKGROUND: The progression of Parkinson's disease is associated with complications, most of them preventable. AIM: To analyze hospitalizations with a diagnosis of Parkinson's disease in Chile, comparing the different health subsystems. MATERIAL AND METHODS: Analysis of hospital discharge database available at the website of the Chilean Ministry of Health. Discharges that incorporated the diagnosis of Parkinson's disease (ICD 10 code G20), between the years 2001 and 2018 were analyzed. RESULTS: The rate of discharges with the diagnosis of Parkinson's disease was 34.5 per 100,000 hospitalizations. The figures were 55.2 and 29.8 discharges per 100,000 in 2001 and 2018, respectively. Sixty seven percent of hospital admissions for Parkinson's occurred in the public sector and corresponded to beneficiaries of the public health insurance system (FONASA). Beneficiaries of private insurance systems accounted for 12% of hospital admissions. The mean hospital stay was 13.4 days. CONCLUSIONS: There is a decrease over time in the rate of hospitalizations with Parkinson's disease. This trend may be related with the incorporation of this disease in a special governmental program that guarantees a timely access to diagnosis and treatment.
Asunto(s)
Humanos , Enfermedad de Parkinson/diagnóstico , Enfermedad de Parkinson/terapia , Enfermedad de Parkinson/epidemiología , Chile/epidemiología , Hospitalización , Hospitales , Tiempo de InternaciónRESUMEN
OBJECTIVE@#To observe the effect of acupuncture on swallowing function and nutritional status of patients with Parkinson's disease (PD) dysphagia.@*METHODS@#A total of 56 patients with PD dysphagia were randomly divided into an observation group and a control group, 28 cases in each one. Both groups were given conventional treatment and swallowing function rehabilitation training.On the basis, the observation group was treated with acupuncture (filiform needling and tongue picking acupuncture). The acupoints of filiform needling were Lianquan (CV 23), Shanglianquan (Extra), Yifeng (TE 17), etc.; and the tongue picking acupuncture was applied at Jinjin (EX-HN 12), Yuye (EX-HN 13) and posterior pharyngeal wall. Rehabilitation training and acupuncture were performed once a day for 5 consecutive days a week, 2 weeks as a course of treatment, 3 courses in total. The swallowing function [oral transit time (OTT), swallowing response time (SRT), pharyngeal transit time (PTT), laryngeal closure duration (LCD)] and nutritional indexes [body mass index (BMI), serum albumin (ALB), serum prealbumin (PA), hemoglobin (Hb)] in the two groups were evaluated before and after treatment, and the clinical effects were compared.@*RESULTS@#After treatment, the paste and liquid OTT, SRT, PTT, LCD in the two groups were shorter than those before treatment (@*CONCLUSION@#Acupuncture-assisted rehabilitation training can improve the swallowing function and nutritional status in patients with Parkinson's disease swallowing disorders.
Asunto(s)
Humanos , Puntos de Acupuntura , Terapia por Acupuntura , Trastornos de Deglución/terapia , Enfermedad de Parkinson/terapia , Accidente Cerebrovascular , Resultado del TratamientoRESUMEN
RESUMO A doença de Parkinson (DP) é uma doença neurodegenerativa, caracterizada por disfunções motoras e não motoras. Pacientes com DP também podem apresentar problemas de linguagem, incluindo deficit em tarefas de nomeação. Dificuldade em tarefas de nomeação é uma característica importante da afasia de Broca, transtorno de linguagem associado a lesões pós-acidente vascular cerebral (AVC) no córtex pré-frontal inferior esquerdo (área de Broca). Aqui, apresenta-se o caso de um paciente de 79 anos diagnosticado com DP (estágio 4 na escala de Hoehn e Yahr) e afasia crônica não fluente pós-AVC, com deficit de nomeação severos. O paciente foi tratado com uma nova combinação de terapia audiovisual de produção e estimulação transcraniana por corrente contínua (ETCC), técnica neuromodulatória não invasiva, que tem sido cada vez mais adotada para potencializar terapias fonoaudiológicas. ETCC anodal (2 mA) foi aplicada sobre o córtex pré-frontal inferior esquerdo (F7 no sistema 10/20), durante nove sessões de 20 minutos, ao longo de duas semanas, enquanto o paciente tentava nomear imagens de objetos comuns com o auxílio de vídeos curtos mostrando uma boca articulando os sons do nome do objeto (pista audiovisual). Observou-se aumento significativo nos escores de nomeação entre o pré e o pós-tratamento, tanto para imagens treinadas, quanto para não treinadas, mas fonemicamente similares (generalização). Os resultados apresentaram indícios iniciais de que terapia audiovisual de produção associada à ETCC anodal sobre a área de Broca pode representar uma alternativa viável para pacientes com deficits de nomeação severos.
ABSTRACT Parkinson's disease (PD) is a neurodegenerative disorder characterized by motor and nonmotor symptoms. PD patients may present language problems, including deficits in confrontation naming. Naming deficits are also an important feature of Broca's aphasia, a condition associated with post-stroke damage to the left inferior prefrontal cortex (Broca's area). We present the case of a 79-year old, male patient diagnosed with both PD (stage 4 in Hoehn and Yahr's scale) and chronic post-stroke, non-fluent aphasia. The patient, with particularly severe naming deficits, was treated with a novel combination of audiovisual production therapy and transcranial direct current stimulation (tDCS), a noninvasive neuromodulatory technique that has been increasingly used to potentiate speech therapy. Anodal tDCS (2 mA) was applied to the left inferior prefrontal cortex (F7 in the 10/20 system) in nine 20-min sessions over two weeks while the patient tried to name pictures of common objects aided by short videos of an articulating mouth (audiovisual cue). We found significant pre- to post-training naming improvement for treated items and for untreated, phonemically similar items (generalization). The results provide initial indication that audiovisual production therapy combined with anodal tDCS over Broca's area may represent a viable treatment alternative for patients with severe naming deficits.
Asunto(s)
Humanos , Masculino , Anciano , Afasia de Broca/terapia , Enfermedad de Parkinson/terapia , Estimulación Transcraneal de Corriente Directa/métodos , Pruebas del LenguajeRESUMEN
ABSTRACT: Objective: To evaluate the effects of resistance training on metabolic and cardiovascular responses during maximal cardiopulmonary exercise testing in patients with Parkinson's disease. Methods: Twenty-four patients with Parkinson's disease (modified Hoehn and Yahr stages 2 to 3) were randomly assigned to one of two groups: Control or Resistance Training. Patients in the Resistance Training Group completed an exercise program consisting of five resistance exercises (two to four sets of six to 12 repetitions maximum per set) twice a week. Patients in the Control Group maintained their usual lifestyle. Oxygen uptake, systolic blood pressure and heart rate were assessed at rest and during cycle ergometer-based maximal cardiopulmonary exercise testing at baseline and at 12 weeks. Assessments during exercise were conducted at absolute submaximal intensity (slope of the linear regression line between physiological variables and absolute workloads), at relative submaximal intensity (anaerobic threshold and respiratory compensation point) and at maximal intensity (maximal exercise). Muscle strength was also evaluated. Results: Both groups had similar increase in peak oxygen uptake after 12 weeks of training. Heart rate and systolic blood pressure measured at absolute and relative submaximal intensities and at maximal exercise intensity did not change in any of the groups. Muscle strength increased in the Resistance Training but not in the Control Group after 12 weeks. Conclusion: Resistance training increases muscle strength but does not change metabolic and cardiovascular responses during maximal cardiopulmonary exercise testing in patients with Parkinson's disease without cardiovascular comorbidities.
RESUMO Objetivo: Avaliar os efeitos do treinamento resistido nas respostas metabólicas e cardiovasculares ao teste de esforço cardiopulmonar máximo em pacientes com doença de Parkinson. Métodos: Vinte e quarto pacientes com doença de Parkinson (estágios 2 a 3 de Hoehn e Yahr modificado) foram aleatoriamente randomizados em dois grupos: Controle e Treinamento Resistido. O Grupo Treinamento Resistido realizou, duas vezes por semana, cinco exercícios resistidos, duas a quatro séries, seis a 12 repetições máximas por série. O Grupo Controle manteve seu estilo de vida. No início e após 12 semanas, consumo de oxigênio, pressão arterial sistólica e frequência cardíaca foram avaliados em repouso e durante um teste de esforço cardiopulmonar máximo realizado em um cicloergômetro. As avaliações durante o exercício foram realizadas nas intensidades submáximas (a inclinação da regressão linear entre as variáveis fisiológicas e as cargas absolutas), nas intensidades submáximas relativas (limiar anaeróbico e ponto de compensação respiratória) e na intensidade máxima (pico do exercício). Adicionalmente, foi avaliada a força muscular. Resultados: Comparado com o início, o consumo de oxigênio pico aumentou, de forma semelhante, em ambos os grupos após 12 semanas. A frequência cardíaca e a pressão arterial sistólica avaliadas nas intensidades submáximas absolutas e relativas, assim como no pico do exercício, não se modificaram em nenhum dos grupos. Finalmente, diferente do Grupo Controle, a força muscular aumentou no Grupo Treinamento Resistido após 12 semanas. Conclusão: Em pacientes com doença de Parkinson sem comorbidades cardiovasculares, o treinamento resistido aumenta a força muscular, mas não modifica as respostas metabólicas e cardiovasculares ao teste de esforço cardiopulmonar máximo.
Asunto(s)
Humanos , Enfermedad de Parkinson/terapia , Entrenamiento de Fuerza , Umbral Anaerobio , Prueba de Esfuerzo , Frecuencia CardíacaRESUMEN
Many recent studies have shown that the gut microbiome plays important roles in human physiology and pathology. Also, microbiome-based therapies have been used to improve health status and treat diseases. In addition, aging and neurodegenerative diseases, including Alzheimer's disease and Parkinson's disease, have become topics of intense interest in biomedical research. Several researchers have explored the links between these topics to study the potential pathogenic or therapeutic effects of intestinal microbiota in disease. But the exact relationship between neurodegenerative diseases and gut microbiota remains unclear. As technology advances, new techniques for studying the microbiome will be developed and refined, and the relationship between diseases and gut microbiota will be revealed. This article summarizes the known interactions between the gut microbiome and neurodegenerative diseases, highlighting assay techniques for the gut microbiome, and we also discuss the potential therapeutic role of microbiome-based therapies in diseases.