The effect of levodopa-carbidopa intestinal gel infusion long-term therapy on motor complications in advanced Parkinson's disease: a multicenter Romanian experience.

Chronic treatment with oral levodopa is associated with an increased frequency of motor complications in the late stages of Parkinson's disease (PD). Continuous administration of levodopa-carbidopa intestinal gel (LCIG-Duodopa(®), Abbott Laboratories), which has been available in Romania since 2009, represents an option for treating patients with advanced PD. Our primary objective was to report changes in motor complications after initiation of LCIG therapy. The secondary objectives were as follows: to determine the impact of LCIG therapy on the daily levodopa dose variation before/and after LCIG, to collect patient self-assessments of quality of life (QoL), and to study the overall tolerability and safety of LCIG administration. A retrospective analysis (2009-2013) of LCIG therapy and the experience in nine neurology centers in Romania was performed. The impact of LCIG therapy was evaluated by analyzing changes in motor fluctuations, dyskinesia and the patients' QoL after initiating therapy. The safety of LCIG therapy was estimated by noting agent-related adverse events (AEs) and medical device-related AEs. In the 113 patients included, we observed a significant improvement in PD symptoms after initiation of LCIG therapy. The "on" period increased, with a mean value of 6.14 h, and the dyskinesia period was reduced, with a mean value of 29.4 %. The quantified non-motor symptoms subsided. The patients exhibited significant improvements in QoL scores. There were few AEs and few cases of LCIG therapy discontinuation. LCIG is an important and available therapeutic option for managing patients with advanced PD.

Autonomic impairment in patients with migraine.

OBJECTIVE: Heart rate variability analysis of electrocardiogram is becoming an increasingly common method to non-invasively evaluate autonomic nervous function. The aim of the study was to investigate cardiac autonomic function in subjects with and without migraine by using 24-hour ambulatory electrocardiographic recordings. PATIENTS AND METHODS: We investigated 27 subjects with migraine (10 with migraine with aura and 17 without aura) during headache free periods and 10 age-matched healthy control subjects. The migraine was diagnosed using the International Classification of Headache Disorders 2nd Edition criteria. Beck Depression and Beck Anxiety Inventory forms were completed by all subjects. Time and frequency-domain of HRV was analyzed for two periods: diurnal and nocturnal. RESULTS: We found an increased frequency of anxiety and depressive symptoms in migraine patients, especially in migraine with aura group. The heart rate variability parameters SDNN, RMSSD, high frequency were decreased and low frequency was increased in migraine patients during night period compared with normal subjects, most affected were migraine with aura patients. During day period we found modification for SDNN, RMSSD and high frequency parameters only in migraine with aura group. CONCLUSIONS: Reduced parasympathetic activity with sympathetic predominance was found in migraine patients during the night period, most affected being migraine with aura patients.

Multiple sclerosis and pregnancy.

Multiple sclerosis is one of the main reasons for invalidation of young adults of both sexes. The disease is more common in women than in men. The illness begins most frequently in patients between the ages of 20 and 40 years, which is also the most fertile period for women. MS is an immune-mediated disease with chronic evolution marked by exacerbations and remissions that amplify the degree of disability. The most common clinical picture is the one with relapse and remission whose evolution is greatly improved after immunomodulatory treatment. We have revised the literature together with the data from the national multiple sclerosis society and the cases that are in the National Programme of Multiple Sclerosis, mainly the ones that are assigned to the regional center of Iasi, at the Neurology Clinic inside the Clinical Rehabilitation Hospital Iasi. Pregnancy is quite frequent in female patients with MS. Certain risks are present during pregnancy, birth and breastfeeding and certain protocols must be applied, such as interrupting the immunomodulatory treatment before the conception. Child delivery must be closely monitored and it must take into consideration the dysfunction that the patient has and be adapted to the existing deficits. There are some methods that may be used during delivery for female patients with multiple sclerosis in order to make this process smooth and reduce the risk of postpartum complications. Multiple sclerosis is an invalidating disease, with a high prevalence in women. Pregnancy in patients with MS is not such a natural phenomenon as in a healthy female and it requires a multidisciplinary team in order to ensure the safety of both the mother and the newborn.

Parkinson's disease and carotid intima-media thickness.

UNLABELLED: Reports about the impact of cerebrovascular disease (CVD) on clinical status in Parkinson's disease (PD) are rather controversial. There have been a few studies and inconsistent results regarding the coincidence of Parkinson's disease (PD) and atherosclerotic diseases, such as cerebrovascular disease. Carotid intima-media thickness (IMT) is a known marker for subclinical atherosclerosis. AIM: This study was done to investigate the carotid IMT between PD patients and controls. MATERIAL AND METHODS: A total of 54 PD patients and 50 controls were examined. The duration of Parkinson's disease, the severity of Parkinson's disease (the Hoehn-Yahr stage) and carotid IMT were examined. RESULTS: The mean Hoehn and Yahr stage was 2.78 (range 2-4). Duration of disease had a mean of 7.59 +/- 0.85 years. The left CCA mean IMT was 0.900 +/- 0.147 in Parkinson group and 0.828 +/- 0.118 in control group (p = 0.007). The right CCA mean IMT was 0.891 +/- 0.176 mm in the Parkinson group and 0.860 +/- 0.164 in control group (p = 0.360). No relationship between the Hoehn and Yahr stages or the duration of PD with the IMT were found by the Pearson's correlation test. CONCLUSIONS: The carotid IMT was higher in PD patients than in controls.

Autonomic dysfunction in type 2 diabetes mellitus with and without vascular dementia.

INTRODUCTION: Autonomic dysfunction has been implicated in sudden cardiac death and cognitive impairment in diabetes. OBJECTIVES: Objectives of the study were to examine the associations between vascular, metabolic risk factors, autonomic and cognitive function in patients with diabetes mellitus. METHOD: We investigate autonomic function in 45 participants with type 2 diabetes and in 23 age related normal subjects, using Ewing's tests and power spectral analysis of heart rate variability. Mini Mental State Examination and Hachinski's ischemic scale were used to identify vascular dementia. Only 11 patients were diagnosed with vascular dementia. RESULTS: The glycosylated haemoglobin, triglycerides, and systolic blood pressure had much larger values in vascular dementia patients compared to the controls. The averages of results obtained in heart rate deep-breathing, Valsalva ratio and lying-to-standing tests for vascular dementia patients are statistically lower than the averages for controls. Vascular dementia patients had a greater fall in blood pressure on standing (p<0.001) and reduced blood pressure responses to isometric exercise (p<0.001) in comparison with controls. Also they had an increase in the mean heart rate at rest (p<0.05), a decrease in time domain parameters of heart rate variability (p<0.001), and an increase in the low/high frequency component ratio (p<0.001) indicating a vagal-sympathetic dysfunction. CONCLUSIONS: Using standard cardiovascular reflex tests and analysis of heart rate variability we demonstrated an impairment of the autonomic nervous system in vascular dementia patients with marked parasympathetic dysfunction and sympathetic predominance.

Clinical improvement and cortical adaptations after functional electrical stimulation in Parkinson's disease patients.

Parkinson's disease (PD) is a neurodegenerative disease of the central nervous system. Although PD is commonly characterized by well-known clinical manifestations, it also involves imbalances in the cortico-subcortical excitation and inhibition processes. Functional electrical stimulation can improve the motor condition of PD patients as a supplement to levodopa therapy. In this study, clinical (using specific tests) and paraclinical (using single-pulse transcranial magnetic stimulation) examinations revealed an improvement in the motor symptoms and the bilateral activation of the primary motor areas of the upper limbs after unilateral functional electrical stimulation in PD patients.

[Functional electrical stimulation effect on the motor performances in Parkinsonian patients]. / Efectul stimularii electrice functionale asupra performantelor motorii la pacientii Parkinsonieni.

UNLABELLED: Parkinson's disease (PD) is a neurodegenerative disease involving dopaminergic, cholinergic, glutaminergic, serotoninergic and noradrenergic neurons, having as clinical manifestations both motor and non-motor symptoms. Functional electrical stimulation (FES) is a complementary therapy that can improve the motor disabilities (i.e. bradykinesia, hypokynesia and the motor block/"freezing"). THE AIM of this study is to assess, by clinical scales and tests, the influence of FES on motor symptoms in Parkinsonian patients and to establish the differences in motor learning with healthy subjects. MATERIAL AND METHODS: 26 PD patients and 15 healthy volunteers were included in the study. The two groups of subjects were clinically assessed at two different points in time: before and after ten consecutive days of FES exercise for 30 min/day on the most affected/less skilful upper and lower limb. RESULTS: All of the clinical tests revealed bilaterally improvements in both groups, mainly in PD patients group, even if the FES application was unilaterally. CONCLUSIONS: Unilateral peripheral electrostimulation improves bilaterally motor performances due to an interhemispheric transfer called "cross education". This phenomenon seems to be more pronounced in Parkinsonian patients because of the alteration of cortical inhibition.

[Cutaneous thermographic changes in diabetic polyneuropathy]. / Modificari termografice în polineuropatia diabetica.

AIM: to demonstrate the effectiveness of the thermography method in assessing and diagnosing peripheral polyneuropathy and risk of developing ulcerative lesions in diabetic patients planting. MATERIAL AND METHODS: Study was prospective and included 90 patients of both sexes, aged between 18 and 70 years in the Neurology Clinic of the Rehabilitation Hospital Iasi from January 2010-January 2011. The study group consists of 60 patients diagnosed with type 2 diabetes complicated with sensory- motor polyneuropathy. Control group consisted of 30 patients, selected from apparently healthy general population to assess the normal thermographic profile. To register thermic values it was used a thermal infrared camera FLIR A320 type of setting individual emission on the skin areas examined with automatic temperature correction reflected the distance or relative humidity. RESULTS: Gender distribution of patients in the study group was predominantly male (63%), the ratio M/F = 1.7/1. Motor conduction velocity in the study group was significantly reduced both the SPE (41 +/- 2.8 m/s) and SPI (40.5 +/- 3.1 m/s). Skin temperature was significantly higher in the control group compared with controls, both legs and the plantar surface (33.70 +/- 0.80; 28 +/- 0.50 t degrees C). CONCLUSIONS: Thermographic changes in patients with sensory-motor neuropathy is an early sign in the detection and prevention of risk of injury planting.Thermography can be a useful method for diagnosis and dynamic evaluation of patients with peripheral sensory-motor polyneuropathy.

[Research on correlations between intima media thickness and arterial diameter in patients with stroke]. / Cercetari privind corelatiile între indicele intima-medie si diametrul arterial la pacientii cu accident vascular cerebral.

UNLABELLED: Stroke has become in the last years the first cause of mortality and major invalidity throughout the world. Intima media thickness is a very good marker for subclinical atherosclerosis and also for predicting future cardio and cerebrovascular events. The aim of this study is to try to find some correlations between the value of the intima media thickness and of arterial diameter in patients with stroke. MATERIAL AND METHODS: We evaluated 40 patients, selected by well defined criteria. The intima media thickness (IMT) and arterial diameter were measured with a standard method, by cervical ultrasound mode B, at the common carotid artery. Other parameters considered were age and sex. RESULTS: Gender distribution of subjects in the study group was predominantly male (57,5%), with age between 26 to 78 years old, with a median age of 53,45 +/- 14,40 years old. Statistically, the study group was omogenous regarding age and sex. The IMT value in the study group has varied between 0,5 mm and 1,5 mm on the left side and between 0,5 mm and 1,4 mm on the right side. The value of the arterial diameter has varied between 5,60 mm and 11,90 mm on the left side and between 5,60 mm and 11,20 mm on the right side. Applying the t-Student test we could see no statistical significance (p>0,05). Correlating these values to sex and age we could see a direct correlation between the parameters measured, especially on the right side. CONCLUSIONS: In this study the values of IMT and arterial diameter had no statistical significant value on their own, but were strongly correlated with sex and age in patients with stroke.

[The clinical, imaging and electrophysiological correlations in Paget's disease]. / Corelatii clinice, imagistice si electrofiziologice în boala Paget.

The work presents two cases of Paget disease with a complex neurological description. The first case, a woman of 59 years, presents a spastic paraparesis with multiple syndrome of cranial nerves. The second case, a woman of 60 years, presents a spastic tetraparesis with myoclonus. The cranial radiography stood out to both patients the thickness of the bones of the skull in the context of the existence of some grown titres of the alkaline phosphate. The examination CT to the second patient indicates an important cerebral atrophy. Auditory evoked potentials (AEPs) show to the first patient the increasing in time of the latency of the first wave and to the second patient the inequality of latency from the right to left a wave I and the growing latency of the interval I-III to the left. Visual evoked potentials (VEPs) to the second patient indicate the delay of all the component parts. If the radiological examination asserts the diagnosis, the electrophysiological probings diagnose the complications and the evolution of the disease.