RESUMEN
INTRODUCTION: Parkinson' disease (PD) is one of the most prevalent neurodegenerative diseases, and more than half of patients with PD experience falls. Research for clinically useful risk factors predicting falls has yielded inconsistent findings so far. Hence the aim of the study is to validate two different posturography techniques and one modified-timed up and go test (TUG) in discriminating fallers and non-fallers among PD patients. METHODS: 32 patients diagnosed with idiopathic PD were assessed with: Dizziness handicap inventory, Activities-specific balance confidence scale, modified-TUG, sensorial organization test (SOT) and limits of stability (LOS) of computer dynamic posturography, results of free-field body sway analysis with Vertiguard device and number of falls. RESULTS: Fallers had longer time to perform modified-TUG and required more steps. On average, fallers performed SOT and LOS significantly worse and Vertiguard device indicated a higher risk of falling. Based on the area under the curve of receiver operating characteristics analyses, the overall accuracy of directional control of LOS and steps in modified-TUG are close to 0.9 (high accuracy). Also assessment with Vertiguard device is more efficient in identifying fallers than the parameters of SOT. DISCUSSION: Our results indicate that LOS, mobile posturography (Vertiguard), vestibular input of SOT and number of steps taken in modified-TUG are very useful to identify fallers in PD patients.
Asunto(s)
Accidentes por Caídas/prevención & control , Técnicas de Diagnóstico Neurológico/instrumentación , Técnicas de Diagnóstico Neurológico/normas , Mareo/fisiopatología , Enfermedad de Parkinson/fisiopatología , Equilibrio Postural , Trastornos de la Sensación/diagnóstico , Trastornos de la Sensación/fisiopatología , Factores de Edad , Anciano , Anciano de 80 o más Años , Diagnóstico por Computador/métodos , Mareo/etiología , Femenino , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Enfermedad de Parkinson/complicaciones , Curva ROC , Factores de Riesgo , Trastornos de la Sensación/etiología , Caracteres SexualesRESUMEN
The aim of this study was to assess effectiveness of balance training with a vibrotactile neurofeedback system in improving overall stability in patients with Parkinson's disease (PD). Ten patients diagnosed with idiopathic PD were included. Individualization of the rehabilitation program started with a body sway analysis of stance and gait tasks (Standard Balance Deficit Test, SBDT) by using the diagnostic tool of the applied device (Vertiguard(®)-RT). Those tasks with the poorest outcome as related to age- and gender-related controls were included in the training program (not more than six tasks). Improvement of postural stability was assessed by performing SBDT, Sensory Organization Test (SOT) of Computerized Dynamic Posturography (CDP), Dizziness Handicap Inventory (DHI), activity-specific balance confidence scale and recording the number of falls over the past three months. Furthermore, scores of SOT and DHI of 10 PD patients previously trained in an earlier study (by using CDP) were compared with results of those in the present study. After neurofeedback training (NFT), there was a statistically significant improvement in body sway (calculated over all training tasks), number of falls, and scores of SOT, DHI and ABC. In comparison with CDP-training, a statistically significant higher increase of SOT score was observed for patients after NFT with the Vertiguard-RT device compared to CDP training. Our results showed that a free-field vibrotactile NFT with Vertiguard(®)-RT device can improve balance in PD patients in everyday life conditions very effectively, which might led in turn to a reduction of falls.
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Accidentes por Caídas/prevención & control , Monitoreo Fisiológico/instrumentación , Neurorretroalimentación/instrumentación , Enfermedad de Parkinson/fisiopatología , Enfermedad de Parkinson/rehabilitación , Equilibrio Postural/fisiología , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Propiocepción/fisiología , Estadísticas no Paramétricas , Tacto , VibraciónRESUMEN
Deep brain stimulation (DBS) is an established surgical therapy for intractable movement disorders, such as Parkinson's disease, essential tremor and dystonia. As the number of treated patients has increased rapidly, new sets of problems about complications of DBS have arisen. Bowstringing is defined as abnormal tethering of leads between the pulse generators and stimulating electrode, associated with pain and contracture of the neck over the extension cable. We report the case of a 56-year-old woman with a history of advanced Parkinson's disease who had been treated by implantation of a bilateral, subthalamic nucleus, deep brain stimulator. A car accident caused the rupture of the right electrode, which was replaced. Six months after the replacement the patient presented disabling pain and tension in the neck where deep brain extension cables were located. A cervical incision was performed to excise scar tissue. Bowstringing is a rare complication of DBS and although patients sometimes report discomfort and tension in the cervical region, surgical procedures are not normally required.
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Estimulación Encefálica Profunda/efectos adversos , Electrodos Implantados/efectos adversos , Migración de Cuerpo Extraño/etiología , Dolor de Cuello/etiología , Accidentes de Tránsito , Cicatriz/etiología , Remoción de Dispositivos , Falla de Equipo , Femenino , Migración de Cuerpo Extraño/diagnóstico por imagen , Migración de Cuerpo Extraño/cirugía , Movimientos de la Cabeza , Humanos , Imagen por Resonancia Magnética , Persona de Mediana Edad , Imagen Multimodal , Dolor de Cuello/diagnóstico por imagen , Dolor de Cuello/cirugía , Enfermedad de Parkinson/complicaciones , Enfermedad de Parkinson/terapia , Estrés Mecánico , Tomografía Computarizada por Rayos XRESUMEN
Continuous apomorphine infusion has been an established treatment for advanced Parkinson's disease for over two decades. This article reviews the different methods for starting treatment and propose a consensus methodology for it, as well as for the modification of prior treatment, in order to standardize and reduce the variability of clinical practice.
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Antiparkinsonianos/uso terapéutico , Apomorfina/uso terapéutico , Agonistas de Dopamina/uso terapéutico , Enfermedad de Parkinson/tratamiento farmacológico , Cuidados Posteriores , Atención Ambulatoria , Antiparkinsonianos/administración & dosificación , Apomorfina/administración & dosificación , Apomorfina/efectos adversos , Benserazida/uso terapéutico , Carbidopa/uso terapéutico , Cuidadores , Agonistas de Dopamina/administración & dosificación , Relación Dosis-Respuesta a Droga , Quimioterapia Combinada , Humanos , Infusiones Subcutáneas/normas , Levodopa/uso terapéutico , Educación del Paciente como Asunto , Selección de Paciente , Estudios RetrospectivosRESUMEN
PURPOSE: In patients with Parkinson's disease (PD), balance impairment involves considerable morbi-mortality from the numerous falls that may result. In an earlier postural study, we detected that a deteriorated processing of vestibular input is implicated. The aim of the present study is to assess the effectiveness of vestibular rehabilitation in improving overall stability in patients with PD. METHOD: Out of an initial group of 45 patients with PD, we chose those presenting a high risk of falls, based on their score on the timed up and go test (TUG). Rehabilitation was performed on 10 patients using computerised dynamic posturography (CDP). Improvement was assessed using the dizziness handicap inventory (DHI), the TUG and the CDP. RESULTS: We found statistically significant improvement in the sensorial organisation test (SOT) and the limits of stability and rhythmic weight shift tests measured by the CDP, the DHI and the TUG. These improvements continue to be statistically significant 1 year post-treatment. CONCLUSION: Vestibular rehabilitation in PD has shown to be effective in improving the activities of daily life, gait velocity and balance, as well as in reducing the risk of falls. Moreover, these benefits persist over time.
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Accidentes por Caídas/prevención & control , Biorretroalimentación Psicológica/instrumentación , Trastornos Neurológicos de la Marcha/fisiopatología , Trastornos Neurológicos de la Marcha/rehabilitación , Enfermedad de Parkinson/fisiopatología , Enfermedad de Parkinson/rehabilitación , Equilibrio Postural/fisiología , Enfermedades Vestibulares/fisiopatología , Enfermedades Vestibulares/rehabilitación , Actividades Cotidianas , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Desempeño Psicomotor , Estadísticas no ParamétricasRESUMEN
Continuous subcutaneous apomorphine infusion (CSAI) is, at present, an alternative option for advanced Parkinson's disease (PD) with motor fluctuations. We studied the evolution of patients with PD and severe motor fluctuations long-term treated with CSAI. We reviewed data from 82 patients with PD (mean age, 67 +/- 11.07; disease duration, 14.39 +/- 5.7 years) and severe motor fluctuations referred to 35 tertiary hospitals in Spain. These patients were long-term treated (for at least 3 months) with CSAI and tolerated the procedure without serious side effects. We compared the baseline data of these 82 patients (before CSAI) with those obtained from the last follow-up visit of each patient. The mean follow-up of CSAI was 19.93 +/- 16.3 months. Mean daily dose of CSAI was 72.00 +/- 21.38 mg run over 14.05 +/- 1.81 hours. We found a statistically significant reduction in off-hours, according to self-scoring diaries (6.64 +/- 3.09 vs. 1.36 +/- 1.42 hours/day, P < 0.0001), total and motor UPDRS scores (P < 0.0001), dyskinesia severity (P < 0.0006), and equivalent dose of antiparkinsonian therapy (1,405 +/- 536.7 vs. 800.1 +/- 472.9 mg of levodopa equivalent units P < 0.0001). CSAI is an effective option for patients with PD and severe fluctuations, poorly controlled by conventional oral drug treatment.