Effects of transcranial pulsed electromagnetic field stimulation on quality of life in Parkinson's disease.

BACKGROUND AND PURPOSE: Pulsed electromagnetic fields induce a protective and anti-inflammatory effect in the nervous system primarily due to growth factor upregulation that possibly abates neurodegeneration in Parkinson's disease (PD). This study investigated treatment effects of transcranial pulsed electromagnetic fields (T-PEMFs) on quality of life in PD and the feasibility and safety of this treatment. METHODS: In this double-blinded clinical study, 97 participants with idiopathic PD (Hoehn & Yahr stage I-IV), on optimal medical anti-parkinsonian treatment, were block randomized (3:3) to either active (n = 49) or placebo treatment (n = 48). Treatment with T-PEMFs entailed one daily 30-min home treatment for eight consecutive weeks. The 39-item Parkinson's Disease Questionnaire (PDQ-39) was assessed at baseline and endpoint. A special questionnaire was used to profile adverse events by interviewing the participants over the full treatment period. Treatment compliance was accounted for by daily treatment registration. RESULTS: The active group improved with respect to clinical effect size for the two dimensions, i.e. mobility and activities of daily living, compared with the placebo group. No between-group differences were found for the remaining PDQ-39 dimensions. There were no between-group difference in adverse events. Treatment compliance was 97.9%. CONCLUSION: Treatment with T-PEMFs improved mobility and activities of daily living scores for clinical effect size only in the active group, indicating a positive treatment response for motor symptoms. No difference was found between the two groups for the remaining PDQ-39 dimensions. The treatment had no or only mild adverse events and was performed with high compliance.

Treatment for Helicobacter pylori infection and risk of Parkinson's disease in Denmark.

BACKGROUND AND PURPOSE: It has been speculated that gastrointestinal infection with Helicobacter pylori (HP) contributes to the development of Parkinson's disease (PD). We used nationwide Danish registers to investigate this hypothesis. METHODS: We identified 4484 patients with a first time PD diagnosis between 2001 and 2008 from the Danish National Patient Register (DNPR) and 22, 416 population controls from the Danish Civil Registration System (CRS). Information on drug use was obtained from the National Prescription Registry (NPR). We used logistic regression to compute odds ratios (OR) for the association between treatment for HP and risk of PD. RESULTS: Prescriptions for HP-eradication drugs and proton pump inhibitors (PPI) 5 or more years prior to the diagnosis of PD were associated with a 45% and 23% increase in PD risk, respectively. Hospitalizations and outpatient visits for gastritis and peptic/duodenal ulcers, however, were not associated with PD. CONCLUSIONS: Our population-based study suggests that chronic HP infections and/or gastritis contribute to PD or that these are PD-related pathologies that precede motor symptoms.

Prevalence and incidence of Parkinson's disease in The Faroe Islands.

OBJECTIVE: A study in The Faroe Islands in 1995 suggested a high prevalence of idiopathic Parkinson's disease (IPD) and total parkinsonism of 187.6 and 233.4 per 100,000 inhabitants respectively. METHODS: Detailed case-finding methods 10 years later were used and a neurologist has verified the diagnosis. RESULTS: The crude prevalence of IPD and total parkinsonism was 206.7 per 100,000 and 227.4 per 100,000 respectively. The age-adjusted prevalence is twice as high as data from Norway and Denmark. Age at initiation of treatment and the fatality rate did not explain the increased prevalence. During 1995-2005, the average annual incidence was 21.1 per 100,000 persons for Parkinson's disease, and 22.9 per 100,000 persons, if including atypical parkinsonism. CONCLUSION: The high prevalence was verified and linked to a high incidence. The cause of the high prevalence is unknown, but neurotoxic contaminants in traditional food may play a role in the pathogenesis in this population, perhaps jointly with genetic predisposition.

Validation of the PHEEM instrument in a Danish hospital setting.

The Postgraduate Hospital Educational Environment Measure (PHEEM) has been translated into Danish and then validated with good internal consistency by 342 Danish junior and senior hospital doctors. Four of the 40 items are culturally dependent in the Danish hospital setting. Factor analysis demonstrated that seven items are interconnected. This information can be used to shorten the instrument by perhaps another three items.

High prevalence of Parkinson's disease in the Faroe Islands.

We used several case-findings methods and strict criteria for case ascertainment to diagnose parkinsonism and idiopathic Parkinson's disease (PD) in the Faroe Islands. In the last few years before the prevalence date of July 1, 1995, we searched various registries from pharmacies, hospitals, and general practices, and found 195 patients with suspected parkinsonism out of 43,709 inhabitants. After excluding those who died before the prevalence date or were treated with levodopa (LD) for other diseases, a total of 124 patients remained for study, of whom 122 participated. We found 102 patients with parkinsonism and 82 with PD versus the expected 53 (p < 0.001, age-specific prevalences in the county of Rogaland, Norway). The overall prevalence of PD was estimated to be 187.6 and the age-adjusted prevalence to be 183.3 versus 110.9 per 100,000 inhabitants in the county of Rogaland. Compared to the study from Rogaland, the mean age at onset of PD symptoms, the mean age at the prevalence date, and the duration of PD indicated that the higher prevalence was not due to either an early onset nor to a longer duration of PD. A lower proportion of definite PD, a lower mean score on the Hoehn-Yahr scale, and a lower average dose of LD suggest that the high prevalence may be due to early diagnosis and a higher ascertainment of cases with mild disease. However, a high incidence cannot be excluded.

A double-blind, placebo-controlled, randomized, multi-center study of pramipexole in advanced Parkinson's disease.

Pramipexole (SND 919), a potent non-ergot dopamine agonist, or placebo, was administered to 69 patients with advanced Parkinson's disease (33 received placebo, 36 received pramipexole) in a double-blind, randomized, multi-center study in which individually optimized doses of L-dopa plus a dopa decarboxylase inhibitor were associated with dyskinesia, "on-off" fluctuation, dystonia, akinesia, or end-of-dose deterioration. Study medication was titrated over 7 weeks to the maximal tolerated dose or to the maximal dose allowed by the study (5 mg/day in four divided doses). Dosing was maintained for 4 weeks and then tapered during the final week. Total score on the Unified Parkinson's Disease Rating Scale (UPDRS) for the intent-to-treat population was significantly improved in the pramipexole-treated group compared with the placebo-treated group (16.9 +/- 14.9 vs 9.0 +/- 16.1; p = 0.0184). By the end of maintenance, the mean reduction in L-dopa requirement was -150.7 mg for pramipexole-treated patients compared to -10.6 for placebo-treated patients. The most common adverse events (< 10%) were dizziness, insomnia, nausea, and postural hypotension. Aggravated parkinsonism occurred only after withdrawal of the study medication. Treatment with pramipexole in doses up to 5 mg/day was safe and well tolerated by patients with advanced Parkinson's disease.Copyright Lippincott-Raven Publishers

Tremor frequency patterns in mercury vapor exposure, compared with early Parkinson's disease and essential tremor.

A new portable tremometer allows determination of tremor intensities at different tremor frequencies. Based on past studies, two tremor frequency windows of similar size were chosen at 3.0-6.5 Hz and 6.6-10.0 Hz to reflect major tremor intensities in Parkinson's disease and mercury vapor poisoning, respectively. In 81 healthy controls, total tremor intensity was higher for the preferred hand and depended on age. Ten patients treated for Parkinson's disease showed substantially increased tremor intensity, especially within the low-frequency window. This pattern was also apparent in 14 patients with de novo Parkinson's disease whose overall tremor intensity was only mildly elevated. In contrast, ten patients with essential tremor had peak frequencies in both windows, and some patients had increased tremor on one side only. Sixty-three Brazilian gold traders exposed to mercury vapor showed increased tremor predominantly in the high-frequency window. Three of the gold traders had a narrower tremor peak at frequencies of 7-8 Hz. While the urine-mercury concentration was significantly associated with the current number of burning sessions per week, it did not correlate with tremor intensities. However, eight traders had a urinary mercury excretion level above 50 microg and at the same time a greatly increased average tremor intensity within the high-frequency window. These patterns were statistically significant for relative tremor intensities, but were less clear when total intensities were used. These observations suggest that the relative distribution of tremor intensities in specific frequency bands may be a valuable supplement to current diagnostic methods for subjects with mercury vapor exposure.

Bridges and barriers to recovery: clinical observations from an opiate recovery project.

Clinical issues are described in opiate addicts attempting to taper off methadone maintenance, and techniques are suggested to help this patient population. The observations were generated in an experimental "Tapering Network" project, in which opiate addicts on methadone maintenance had the opportunity to receive individual and group counseling, relapse prevention training, self-help groups, and other services. Vignettes illustrate clinical problems with intimacy and social isolation, identity as a former addict, and a "post methadone syndrome" characterized by vulnerability, dramatic swings in mood, and disordered thinking for a period of up to six months after detoxification. To counteract these barriers to recovery, a program model is suggested that uses curricula available in the emerging literature on treatment of substance abuse. These techniques can provide bridges to recovery.

Family functioning as a predictor of progress in substance abuse treatment.

This study tested the hypothesis that the level of family functioning is related to changes in the patient's progress while in treatment. We studied the relation of family functioning, as measured by the Family Adaptability and Cohesion Scales' (FACES II) dimensions of cohesion and adaptability, to 7 dimensions of the severity of patient drug use, as measured by the Addiction Severity index (ASI). The results indicated that family functioning, the cohesion dimension in particular, predicts severity of patient's dysfunction resulting from drug use and family and psychological problems. In particular, 28% of the variability in the ASI Drug Problems, 52% of the variability in the ASI Family Problems, and 29% of the variability in the ASI Psychological Problems were accounted for by the FACES II cohesion score. Although the study has several limitations, it supports the relevance of family factors in the treatment of drug-addicted patients.

Parkinson's disease among Inuit in Greenland: organochlorines as risk factors.

OBJECTIVES: In the present study we investigate organochlorines as possible risk factors for Parkinson's disease (PD) in an arctic population. This has never been done before. STUDY DESIGN: Case-control study of Inuit in Greenland. MATERIALS AND METHODS: Plasma from 31 PD (20 males and 11 females) (mean age 69 yr) and 122 controls (57 males and 65 females) (mean age 61 yr) was analysed for 31 PCBs and pesticides by dual-column GC-ECD and GC-NCI/MS. RESULTS: Plasma concentrations of PCBs and pesticides were markedly increased in both PD and controls. The concentrations did not differ between the PD cases and controls. However, the mean DDE concentration was higher in PD than in controls (42.1 and 15.0 microg/l, respectively, and with a wide range among the PD cases). The difference was significant for log transformed DDE values after control for age and sex (p=0.005). CONCLUSION: A few epidemiological studies indicate a possible connection between exposure to pesticides and PD. The idea that exposure to organochlorines may be an important risk factor for PD among the Inuit in Greenland requires more investigations.

[Cerebral infarction in systemic lupus erythematosus]. / Cerebrale infarkter ved systemisk lupus erythematosus.

The case-history of a man aged 31 years with systemic lupus erythematosus and cerebral infarction is presented. Although patients with active disease are young, cerebral infarcts are strikingly frequent among them.

[Sex education for teenage girls seeking abortion]. / Seksualoplysning blandt abortsøgende teenagere.

PIP: Of 216 women under age 21 who were admitted for termination of pregnancy in the hospitals in Funen, 159 completed a questionnaire about their sexual experience and contraceptive habits (reply %=75.3%). The answers concerning sexual information were compared with the replies given in an interview investigation of a representative section of 16-20 year old women in which 281 (reply %=75.3%) answered the same question via the omnibus investigation from the Institute of Social Research. The 208 (74.0%) of these individuals who had had coitus constituted the reference group. Although the 2 groups were chosen and questioned in different ways, great agreement in replies was found. Patients seeking termination of pregnancy were thus not more dissatisfied with the sex education which they had received in school. No radical differences were found in the sources of information nor in how frequently the young people had talked to their parents about coitus. Nevertheless, the patients seeking pregnancy terminations considered their knowledge about contraception to be poorer than that of the reference group. Advice appears to be necessary in connection with pregnancy termination. In conclusion, it must be emphasized that no marked differences were found in the sex education which these young women received. Other factors must be investigated in order to explain the unwanted pregnancies. (author's modified)^ieng

[Brachial irradiation plexopathy]. / Brakial strålepleksopati.

Irradiation neuropathy is a term for the damage to peripheral nerve tissue due to irradiation. Brachial irradiation plexopathy is irradiation neuropathy affecting the brachial plexus. This is most frequently a complication of irradiation therapy for cancer of the breast. The incidence varies considerably and is lowest with low total doses of irradiation and limited fractions. The latent period varies from months to several years. The neurological manifestations are paraesthesiae in the fingers, pain, hypaesthesia, hypalgesia, disaesthesia, paresis, hyporeflexia, muscular atrophy and possibly vegetative disturbances. Horner's syndrome may occur. Lymphoedema is observed in approximately on third of the patients. The course of brachial irradiation plexopathy is progressive. No specific treatment is available. The diagnosis is based on the case history, clinical picture, electrodiagnosis and CT of the brachial plexus region. The most important differential diagnosis is metastatic infiltration in the brachial plexus. These two conditions are differentiated best by means of CT guided surgical exploration and histological examination of the tissue. The irreversible nature of brachial irradiation plexopathy and its marked resistance to treatment are such that the optimal irradiation hygienic rules must be observed.

[Hemorrhage in cerebral cavernous hemangioma as a cause of hemiballismus]. / Blødning i cerebralt kavernøst haemangiom som årsag til hemiballisme.

A 19 year old righthanded woman, without previous neurological symptoms, was examined in April 1993, because of involuntary movements affecting especially the right hand, but also her right leg and the right side of her face. Magnetic Resonance Imagning (MRI), showed a process located in the area of the left subthalamic nucleus, which was recognized as a cavernous haemangioma. A left carotic arteriography in August was normal. The patient had a complete regression of her symptoms, wherefore there was no indication for neurosurgical intervention. The patient is still being followed without treatment.