ABSTRACT
Introducción. Muchos de los pacientes con enfermedad de Parkinson (EP) presentan al cabo de varios años fluctuaciones y discinesias graves que requieren de terapias algo más agresivas como la estimulación cerebral profunda del núcleo subtalámico o globo pálido medial, la infusión continua de apomorfina y la infusión intestinal continua de levodopa-carbidopa. Objetivo: Establecer las indicaciones y resultados de las 3 técnicas disponibles en la actualidad para el tratamiento de la EP avanzada. Desarrollo: Revisión exhaustiva de los datos publicados en la literatura sobre las indicaciones y resultados de la estimulación cerebral profunda del núcleo subtalámico, infusión subcutánea de apomorfina e infusión intestinal continua de levodopa-carbidopa en pacientes con EP avanzada. Conclusiones: Aunque existen numerosos estudios que han descrito la eficacia de cada una de estas 3 técnicas, faltan estudios comparativos que permitan definir el candidato ideal para cada una de las técnicas (AU)
Introduction: Many patients who have had Parkinson's disease (PD) for several years will present severe motor fluctuations and dyskinesias which require more aggressive therapies. The different approaches which are now available include deep brain stimulation of the subthalamic nucleus or medial globus allidus, subcutaneous infusion of apomorphine, and intestinal infusion of levodopa-carbidopa. Objective: To define the indications and results for the 3 available therapies for advanced PD. Development: Exhaustive review of the literature concerning the indications and results of deep brain stimulation, subcutaneous apomorphine infusion and duodenal infusion of levodopa/carbidopa gel to treat patients with advanced Parkinson disease. Conclusions: Although numerous studies have confirmed the efficacy of the 3 different therapies in advanced PD, there are no comparative studies that would allow us to define the best candidate for each technique (AU)
Subject(s)
Humans , Parkinson Disease/therapy , Apomorphine/administration & dosage , Deep Brain Stimulation , Levodopa/administration & dosage , Subthalamic Nucleus/physiopathologyABSTRACT
Introducción: Un porcentaje importante de pacientes con enfermedad de Parkinson (EP) desarrollan complicaciones motoras en forma de fluctuaciones motoras, discinesias y síntomas no motores al cabo de 3-5 años del inicio del tratamiento que resultan de difícil control terapéutico. Esta fase de la enfermedad ha sido definida por algunos autores como fase avanzada de la EP. Objetivo: Definir las características clínicas y los factores de riesgo que condicionan que una EP evolucione a un estadio avanzado. Desarrollo: Este documento de consenso se ha realizado mediante una búsqueda bibliográfica exhaustiva y discusión de los contenidos llevadas a cabo por un grupo de expertos en trastornos del movimiento de la Sociedad Española de Neurología coordinados por dos de los autores (JK y MRL). Conclusiones: La presencia de fluctuaciones motoras y discinesias graves, síntomas motores axiales resistentes a la levodopa y síntomas no motores, como los trastornos cognitivos, representan las principales manifestaciones fenotípicas de una EP Avanzada (AU)
Introduction: A large percentage of patients with Parkinsons disease (PD) develop motor fluctuations, dyskinesias, and severe non-motor symptoms within 3 to 5 years of starting dopaminergic therapy, and these motor complications are refractory to treatment. Several authors refer to this stage of the disease as advanced Parkinsons disease. Objective: To define the clinical manifestations of advanced PD and the risk factors for reaching this stage of the disease. Development: This consensus document has been prepared by using an exhaustive literature search and by discussion of the contents by an expert group on movement disorders of the Sociedad Española de Neurología (Spanish Neurology Society), coordinated by two of the authors (JK and MRL). Conclusions: Severe motor fluctuations and dyskinesias, axial motor symptoms resistant to levodopa, and cognitive decline are the main signs in the clinical phenotype of advanced PD (AU)
Subject(s)
Humans , Parkinson Disease/epidemiology , Motor Skills Disorders/epidemiology , Risk Factors , Phenotype , Quality of Life , Neuropsychological TestsABSTRACT
INTRODUCTION: Many patients who have had Parkinson's disease (PD) for several years will present severe motor fluctuations and dyskinesias which require more aggressive therapies. The different approaches which are now available include deep brain stimulation of the subthalamic nucleus or medial globus pallidus, subcutaneous infusion of apomorphine, and intestinal infusion of levodopa-carbidopa. OBJECTIVE: To define the indications and results for the 3 available therapies for advanced PD. DEVELOPMENT: Exhaustive review of the literature concerning the indications and results of deep brain stimulation, subcutaneous apomorphine infusion and duodenal infusion of levodopa/carbidopa gel to treat patients with advanced Parkinson disease. CONCLUSIONS: Although numerous studies have confirmed the efficacy of the 3 different therapies in advanced PD, there are no comparative studies that would allow us to define the best candidate for each technique.
Subject(s)
Parkinson Disease/physiopathology , Parkinson Disease/therapy , Antiparkinson Agents/administration & dosage , Antiparkinson Agents/adverse effects , Antiparkinson Agents/therapeutic use , Apomorphine/administration & dosage , Apomorphine/adverse effects , Apomorphine/therapeutic use , Cognition Disorders/etiology , Cognition Disorders/therapy , Deep Brain Stimulation , Disease Progression , Humans , Infusions, Intravenous , Parkinson Disease/drug therapy , Parkinson Disease/psychology , Psychotic Disorders/etiology , Psychotic Disorders/therapyABSTRACT
INTRODUCTION: A large percentage of patients with Parkinson's disease (PD) develop motor fluctuations, dyskinesias, and severe non-motor symptoms within 3 to 5 years of starting dopaminergic therapy, and these motor complications are refractory to treatment. Several authors refer to this stage of the disease as advanced Parkinson's disease. OBJECTIVE: To define the clinical manifestations of advanced PD and the risk factors for reaching this stage of the disease. DEVELOPMENT: This consensus document has been prepared by using an exhaustive literature search and by discussion of the contents by an expert group on movement disorders of the Sociedad Española de Neurología (Spanish Neurology Society), coordinated by two of the authors (JK and MRL). CONCLUSIONS: Severe motor fluctuations and dyskinesias, axial motor symptoms resistant to levodopa, and cognitive decline are the main signs in the clinical phenotype of advanced PD.
Subject(s)
Parkinson Disease/physiopathology , Parkinson Disease/therapy , Adult , Age Factors , Aged , Antiparkinson Agents/adverse effects , Antiparkinson Agents/therapeutic use , Biomarkers , Cognition Disorders/diagnosis , Cognition Disorders/etiology , Cognition Disorders/psychology , Consensus , Dementia/etiology , Disease Progression , Dyskinesias/etiology , Female , Gait Disorders, Neurologic/etiology , Gait Disorders, Neurologic/physiopathology , Humans , Male , Middle Aged , Parkinson Disease/complications , Parkinson Disease/psychology , Phenotype , Quality of Life , Risk Factors , Sex CharacteristicsABSTRACT
Electrodiagnostic examination is used relatively little for the assessment of central nervous system disorders. Nevertheless, it should provide useful information for the neurologists in their clinical evaluation of the patient. It could partly contribute to the correct diagnosis of the illness, its differential diagnosis with respect to diseases with smilar clinical presentation and, most of it all, to the identification of the pathophysiological abnormalities possibly responsible for the symptoms and signs characterizing the disease. Electrodiagnostic examination in Neurology enables us to design specific and customized methods for functional examination of mechanisms and circuits of the central nervous system, destined to enhance our understanding of pathophysiological mechanisms. This objective will be more readily accomplished from a common base of understanding and support between clinicians and electrodiagnostic specialists in which scientific curiosity and technical skills can complement each other effectively. In this article, we review some of the most relevant neurophysiological findings in patients with parkinsonian syndrome, with special focus on those that may contribute to the differential diagnosis between parkinsonisms.