Facial tremors in patients with and without parkinsonism.

Facial (lip and jaw) tremors can be an early sign of Parkinson's disease (PD), essential tremor and other parkinsonisms. Its response to acute dopaminergic therapy and further predictive clinical diagnosis has not been previously addressed. The aim of this study was to evaluate facial tremors response to acute dopaminergic therapy and further predictive value for clinical diagnosis. A retrospective review of medical records from patients with recent onset of facial tremor, with or without parkinsonism, submitted to acute levodopa challenge for clinical prediction of sustained long-term dopaminergic response was conducted. Twenty-eight out of 559 patients (5 %) had facial tremors, which responded to levodopa in 46 % of patients. Facial tremors response to acute levodopa challenge showed 92 % sensitivity and 93 % specificity to predict a final PD diagnosis. In PD patients, facial tremor magnitude of response to levodopa was not different from that of hand rest tremor (p = 0.8). Facial tremors, although infrequent, can be an early sign of PD. Positive response to acute levodopa challenge predicts long-term PD diagnosis.

Management of constipation in Parkinson's disease.

INTRODUCTION: Constipation is a frequent non-motor feature of Parkinson's disease (PD). It is the most common gastrointestinal symptom of the disease and it can precede motor symptoms by as much as 20 years. Constipation can produce discomfort and affect activities of daily living, productivity and quality of life, thus warranting early diagnosis and treatment. AREAS COVERED: In this review, the safety and efficacy of traditional and novel strategies for constipation management will be discussed. A treatment algorithm for constipation in PD will be presented. EXPERT OPINION: Polyethylene glycol and lubiprostone are first-line compounds recommended by evidence-based medicine guidelines for the treatment of constipation due to slow colonic transit in PD. Management of constipation secondary to defecatory dysfunction due to pelvic floor dyssynergia can be done by levodopa or apomorphine injections, botulinum toxin type A injection into the puborectalis muscle, and nonpharmacological interventions, like biofeedback therapy or functional magnetic stimulation, which showed some benefit in PD patients with constipation, but in general more extensive studies are warranted.

Validation of a new scale for the evaluation of sialorrhea in patients with Parkinson's disease.

Sialorrhea is common in Parkinson disease (PD), affecting approximately 70% to 75% of patients. Several tools for measuring saliva volume or production exist, but none are designed specifically for assessing sialorrhea-related discomfort. The objective of this study was to develop and validate a clinical scale for subjective evaluation of sialorrhea in PD. In Phase I, internal consistency of the Sialorrhea Clinical Scale for PD (SCS-PD) was established in 39 PD patients. In Phase II, scale validity was proven through saliva volume measurements obtained in 49 PD patients and 27 healthy volunteers. Internal consistency estimated using Cronbach's alpha was 0.78, indicating none of the original seven items tested needed to be removed. Twenty-one patients complaining of sialorrhea (63%) studied during Phase II, showed higher SCS-PD scores but no differences in saliva volume. SCS-PD scores showed significant correlation with saliva volume (r = 0.41; P = 0.004) and with total Unified Parkinson's Disease Rating Scale Part III (UPDRS III) scores (r = 0.70). Furthermore, saliva volume showed inverse relation to age in PD patients as well as in controls (r = -0.3 and r = -0.4; P < 0.05), but SCS-PD scores did not. The SCS-PD scale showed good internal consistency and validity, providing support for its use in routine clinical sialorrhea-related discomfort evaluation.