ABSTRACT
BACKGROUND: STAT-ON™ is an objective tool that registers ON-OFF fluctuations making possible to know the state of the patient at every moment of the day in normal life. Our aim was to analyze the opinion of different Parkinson's disease experts about the STAT-ON™ tool after using the device in a real clinical practice setting (RCPS). METHODS: STAT-ON™ was provided by the Company Sense4Care to Spanish neurologists for using it in a RCPS. Each neurologist had the device for at least three months and could use it in PD patients at his/her own discretion. In February 2020, a survey with 30 questions was sent to all participants. RESULTS: Two thirds of neurologists (53.8% females; mean age 44.9±9 years old) worked in a Movement Disorders Unit, the average experience in PD was 16±6.9 years, and 40.7% of them had previously used other devices. A total of 119 evaluations were performed in 114 patients (range 2-9 by neurologist; mean 4.5±2.3). STAT-ON™ was considered "quite" to "very useful" by 74% of the neurologists with an overall opinion of 6.9±1.7 (0, worst; 10, best). STAT-ON™ was considered better than diaries by 70.3% of neurologists and a useful tool for the identification of patients with advanced PD by 81.5%. Proper identification of freezing of gait episodes and falls were frequent limitations reported. CONCLUSION: STAT-ON™ could be a useful device for using in PD patients in clinical practice.
Subject(s)
Gait Disorders, Neurologic , Parkinson Disease , Humans , Male , Female , Adult , Middle Aged , Expert Testimony , Surveys and Questionnaires , NeurologistsABSTRACT
INTRODUCTION: In a degenerative disorder such as Parkinson's disease (PD), it is important to establish clinical stages that allow to know the course of the disease. Our aim was to analyze whether a scale combining Hoehn and Yahr's motor stage (H&Y) and the nonmotor symptoms burden (NMSB) (assessed by the nonmotor symptoms scale (NMSS)) provides information about the disability and the patient's quality of life (QoL) with regard to a defined clinical stage. MATERIALS AND METHODS: Cross-sectional study in which 603 PD patients from the COPPADIS cohort were classified according to H&Y (1, stage I; 2, stage II; 3, stage III; 4, stage IV/V) and NMSB (A: NMSS = 0-20; B: NMSS = 21-40; C: NMSS = 41-70; D: NMSS ≥ 71) in 16 stages (HY.NMSB, from 1A to 4D). QoL was assessed with the PDQ-39SI, PQ-10, and EUROHIS-QOL8 and disability with the Schwab&England ADL (Activities of Daily Living) scale. RESULTS: A worse QoL and greater disability were observed at a higher stage of H&Y and NMSB (p < 0.0001). Combining both (HY.NMSB), patients in stages 1C and 1D and 2C and 2D had significantly worse QoL and/or less autonomy for ADL than those in stages 2A and 2B and 3A and 3B, respectively (p < 0.005; e.g., PDQ-39SI in 1D [n = 15] vs 2A [n = 101]: 28.6 ± 17.1 vs 7.9 ± 5.8; p < 0.0001). CONCLUSION: The HY.NMSB scale is simple and reflects the degree of patient involvement more accurately than the H&Y. Patients with a lower H&Y stage may be more affected if they have a greater NMS burden.
ABSTRACT
INTRODUCCIÓN: El manejo de la enfermedad de Parkinson en la mujer en edad fértil nos plantea como principal reto el manejo de la enfermedad y los fármacos durante el embarazo y lactancia. El aumento de la edad gestacional de la mujer hace más probable que la incidencia de embarazos pueda incrementarse. OBJETIVO: Definir las características clínicas y los factores que condicionan la vida de la mujer en edad fértil con enfermedad de Parkinson y definir una guía de actuación y manejo del embarazo en estas pacientes. RESULTADOS: Este documento de consenso se ha realizado mediante una búsqueda bibliográfica exhaustiva y discusión de los contenidos realizados por un grupo de expertos en trastornos del movimiento de la Sociedad Española de Neurología. CONCLUSIONES: La enfermedad de Parkinson afecta a todos los aspectos relacionados con la salud sexual y reproductiva de la mujer en edad fértil. Se debe planificar el embarazo en las mujeres con enfermedad de Parkinson para minimizar los riesgos teratogénicos sobre el feto. Se recomienda un abordaje multidisciplinar de estas pacientes para tener en cuenta todos los aspectos implicados
INTRODUCTION: The main challenge of Parkinson's disease in women of childbearing age is managing symptoms and drugs during pregnancy and breastfeeding. The increase in the age at which women are having children makes it likely that these pregnancies will become more common in future. OBJECTIVES: This study aims to define the clinical characteristics of women of childbearing age with Parkinson's disease and the factors affecting their lives, and to establish a series of guidelines for managing pregnancy in these patients. RESULTS: This consensus document was developed through an exhaustive literature search and a discussion of the available evidence by a group of movement disorder experts from the Spanish Society of Neurology. CONCLUSIONS: Parkinson's disease affects all aspects of sexual and reproductive health in women of childbearing age. Pregnancy should be well planned to minimise teratogenic risk. A multidisciplinary approach should be adopted in the management of these patients in order to take all relevant considerations into account
Subject(s)
Humans , Female , Pregnancy , Consensus , Practice Guidelines as Topic , Parkinson Disease/therapy , Movement Disorders/therapy , Pregnancy Complications/therapy , Parkinson Disease/physiopathology , Movement Disorders/physiopathology , Pregnancy Complications/physiopathology , Risk Factors , Antiparkinson Agents/therapeutic use , Breast Feeding , SpainABSTRACT
INTRODUCCIÓN: Muchas enfermedades que cursan con trastornos del movimiento hipercinético comienzan o afectan a mujeres en edad fértil. Es importante conocer los riesgos que tienen las mujeres con estas enfermedades durante el embarazo, así como los posibles efectos de los tratamientos sobre el feto. OBJETIVOS: Definir las características clínicas y los factores que condicionan la vida de la mujer en edad fértil con distonía, corea, síndrome de Tourette, temblor y síndrome de piernas inquietas. Definir una guía de actuación y manejo del embarazo y lactancia en las pacientes con esta enfermedad. 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 (SEN). CONCLUSIONES: En todas las mujeres que padecen o comienzan con trastornos del movimiento hipercinéticos se debe valorar el riesgo-beneficio de los tratamientos, reducir al máximo la dosis eficaz o administrarlo de forma puntual en los casos en que sea posible. En aquellas enfermedades de causa hereditaria es importante un consejo genético para las familias. Es importante reconocer los trastornos del movimiento desencadenados durante el embarazo como determinadas coreas y síndrome de piernas inquietas
INTRODUCTION: Many diseases associated with hyperkinetic movement disorders manifest in women of childbearing age. It is important to understand the risks of these diseases during pregnancy, and the potential risks of treatment for the fetus. OBJECTIVES: This study aims to define the clinical characteristics and the factors affecting the lives of women of childbearing age with dystonia, chorea, Tourette syndrome, tremor, and restless legs syndrome, and to establish guidelines for management of pregnancy and breastfeeding in these patients. RESULTS: This consensus document was developed through an exhaustive literature search and a discussion of the content by a group of movement disorder experts from the Spanish Society of Neurology. CONCLUSIONS: We must evaluate the risks and benefits of treatment in all women with hyperkinetic movement disorders, whether pre-existing or with onset during pregnancy, and aim to reduce effective doses as much as possible or to administer drugs only when necessary. In hereditary diseases, families should be offered genetic counselling. It is important to recognise movement disorders triggered during pregnancy, such as certain types of chorea and restless legs syndrome
Subject(s)
Humans , Female , Pregnancy , Consensus , Practice Guidelines as Topic , Parkinson Disease/therapy , Movement Disorders/therapy , Pregnancy Complications/therapy , Parkinson Disease/physiopathology , Movement Disorders/physiopathology , Pregnancy Complications/physiopathology , Risk Factors , Antiparkinson Agents/therapeutic use , Breast Feeding , Genetic Counseling , Deep Brain Stimulation/methods , SpainABSTRACT
INTRODUCTION: The aim of the present study was to examine the frequency of self-reported sleep problems and their associated factors in a large cohort of PD patients. METHODS: PD patients and controls, recruited from 35 centers of Spain from the COPPADIS cohort were included in this cross-sectional study. Sleep problems were assessed by the Spanish version of the Parkinson's disease Sleep Scale version 1 (PDSS-1). An overall score below 82 or a score below 5 on at least 1 item was defined as sleep problems. RESULTS: The frequency of sleep problems was nearly double in PD patients compared to controls: 65.8% (448/681) vs 33.5% (65/206) (p < 0.0001). Mean total PDSS score was lower in PD patients than controls: 114.9 ± 28.8 vs 132.8 ± 16.3 (p < 0.0001). Quality of life (QoL) was worse in PD patients with sleep problems compared to those without: PDQ-39SI, 19.3 ± 14 vs 13 ± 11.6 (p < 0.0001); EUROHIS-QoL8, 3.7 ± 0.5 vs 3.9 ± 0.5 (p < 0.0001). Non-motor symptoms burden (NMSS; OR = 1.029; 95%CI 1.015-1.043; p < 0.0001) and impulse control behaviors (QUIP-RS; OR = 1.054; 95%CI 1.009-1.101; p = 0.018) were associated with sleep problems after adjustment for age, gender, disease duration, daily equivalent levodopa dose, H&Y, UPDRS-III, UPDRS-IV, PD-CRS, BDI-II, NPI, VAS-Pain, VAFS, FOGQ, and total number of non-antiparkinsonian treatments. CONCLUSION: Sleep problems were frequent in PD patients and were related to both a worse QoL and a greater non-motor symptoms burden in PD. These findings call for increased awareness of sleep problems in PD patients.
Subject(s)
Parkinson Disease , Sleep Wake Disorders , Cross-Sectional Studies , Humans , Parkinson Disease/complications , Parkinson Disease/epidemiology , Quality of Life , Sleep Wake Disorders/epidemiology , Surveys and QuestionnairesABSTRACT
INTRODUCTION: Many diseases associated with hyperkinetic movement disorders manifest in women of childbearing age. It is important to understand the risks of these diseases during pregnancy, and the potential risks of treatment for the fetus. OBJECTIVES: This study aims to define the clinical characteristics and the factors affecting the lives of women of childbearing age with dystonia, chorea, Tourette syndrome, tremor, and restless legs syndrome, and to establish guidelines for management of pregnancy and breastfeeding in these patients. RESULTS: This consensus document was developed through an exhaustive literature search and a discussion of the content by a group of movement disorder experts from the Spanish Society of Neurology. CONCLUSIONS: We must evaluate the risks and benefits of treatment in all women with hyperkinetic movement disorders, whether pre-existing or with onset during pregnancy, and aim to reduce effective doses as much as possible or to administer drugs only when necessary. In hereditary diseases, families should be offered genetic counselling. It is important to recognise movement disorders triggered during pregnancy, such as certain types of chorea and restless legs syndrome.
Subject(s)
Movement Disorders , Parkinson Disease , Adolescent , Adult , Chorea , Dystonia , Female , Humans , Movement Disorders/drug therapy , Parkinson Disease/drug therapy , Restless Legs Syndrome/drug therapy , Tourette Syndrome , Young AdultABSTRACT
INTRODUCTION: The main challenge of Parkinson's disease in women of childbearing age is managing symptoms and drugs during pregnancy and breastfeeding. The increase in the age at which women are having children makes it likely that these pregnancies will become more common in future. OBJECTIVES: This study aims to define the clinical characteristics of women of childbearing age with Parkinson's disease and the factors affecting their lives, and to establish a series of guidelines for managing pregnancy in these patients. RESULTS: This consensus document was developed through an exhaustive literature search and a discussion of the available evidence by a group of movement disorder experts from the Spanish Society of Neurology. CONCLUSIONS: Parkinson's disease affects all aspects of sexual and reproductive health in women of childbearing age. Pregnancy should be well planned to minimise teratogenic risk. A multidisciplinary approach should be adopted in the management of these patients in order to take all relevant considerations into account.
Subject(s)
Parkinson Disease , Adolescent , Adult , Consensus , Female , Humans , Neurology , Parkinson Disease/drug therapy , Young AdultABSTRACT
BACKGROUND: Depression and impulse control disorders (ICDs) are both common in Parkinson's disease (PD) patients and their coexistence is frequent. Our aim was to determine the relationship between depression and impulsive-compulsive behaviors (ICBs) in a large cohort of PD patients. METHODS: PD patients recruited from 35 centers of Spain from the COPPADIS cohort from January 2016 to November 2017 were included in the study. The QUIP-RS (Questionnaire for Impulsive-Compulsive Disorders in Parkinson's Disease-Rating Scale) was used for screening ICDs (cutoff points: gambling ≥6, buying ≥8, sex≥8, eating≥7) and compulsive behaviors (CBs) (cutoff points: hobbyism-punding ≥7). Mood was assessed with the BDI-II (Beck Depression Inventory - II) and major, minor, and subthreshold depression were defined. RESULTS: Depression was more frequent in PD patients with ICBs than in those without: 66.3% (69/104) vs 47.5% (242/509); p<0.0001. Major depression was more frequent in this group as well: 22.1% [23/104] vs 14.5% [74/509]; p=0.041. Considering types of ICBs individually, depression was more frequent in patients with pathological gambling (88.9% [8/9] vs 50.2% [303/603]; p=0.021), compulsive eating behavior (65.9% [27/41] vs 49.7% [284/572]; p=0.032), and hobbyism-punding (69% [29/42] vs 49.4% [282/571]; p=0.010) than in those without, respectively. The presence of ICBs was also associated with depression (OR=1.831; 95%CI 1.048-3.201; p=0.034) after adjusting for age, sex, civil status, disease duration, equivalent daily levodopa dose, antidepressant treatment, Hoehn&Yahr stage, non-motor symptoms burden, autonomy for activities of daily living, and global perception of QoL. LIMITATIONS: Cross-sectional design. CONCLUSIONS: Depression is associated with ICBs in PD. Specifically, with pathological gambling, compulsive eating behavior, and hobbyism-punding.
Subject(s)
Disruptive, Impulse Control, and Conduct Disorders , Parkinson Disease , Activities of Daily Living , Compulsive Behavior/epidemiology , Cross-Sectional Studies , Depression/epidemiology , Disruptive, Impulse Control, and Conduct Disorders/epidemiology , Humans , Parkinson Disease/complications , Parkinson Disease/epidemiology , Quality of Life , SpainABSTRACT
BACKGROUND: STAT-ON™ is an objective tool that registers ON-OFF fluctuations making possible to know the state of the patient at every moment of the day in normal life. Our aim was to analyze the opinion of different Parkinson's disease experts about the STAT-ON™ tool after using the device in a real clinical practice setting (RCPS). METHODS: STAT-ON™ was provided by the Company Sense4Care to Spanish neurologists for using it in a RCPS. Each neurologist had the device for at least three months and could use it in PD patients at his/her own discretion. In February 2020, a survey with 30 questions was sent to all participants. RESULTS: Two thirds of neurologists (53.8% females; mean age 44.9±9 years old) worked in a Movement Disorders Unit, the average experience in PD was 16±6.9 years, and 40.7% of them had previously used other devices. A total of 119 evaluations were performed in 114 patients (range 2-9 by neurologist; mean 4.5±2.3). STAT-ON™ was considered "quite" to "very useful" by 74% of the neurologists with an overall opinion of 6.9±1.7 (0, worst; 10, best). STAT-ON™ was considered better than diaries by 70.3% of neurologists and a useful tool for the identification of patients with advanced PD by 81.5%. Proper identification of freezing of gait episodes and falls were frequent limitations reported. CONCLUSION: STAT-ON™ could be a useful device for using in PD patients in clinical practice.
ABSTRACT
BACKGROUND: The role of subthreshold depression (subD) in Parkinson's Disease (PD) is not clear. The present study aimed to compare the quality of life (QoL) in PD patients with subD vs patients with no depressive disorder (nonD). Factors related to subD were identified. MATERIAL AND METHODS: PD patients and controls recruited from the COPPADIS cohort were included. SubD was defined as Judd criteria. The 39-item Parkinson's disease Questionnaire (PDQ-39) and the EUROHIS-QOL 8-item index (EUROHIS-QOL8) were used to assess QoL. RESULTS: The frequency of depressive symptoms was higher in PD patients (nâ¯=â¯694) than in controls (nâ¯=â¯207) (pâ¯<â¯0.0001): major depression, 16.1% vs 7.8%; minor depression, 16.7% vs 7.3%; subD, 17.4% vs 5.8%. Both health-related QoL (PDQ-39; 18.1⯱â¯12.8 vs 11.6⯱â¯10; pâ¯<â¯0.0001) and global QoL (EUROHIS-QOL8; 3.7⯱â¯0.5 vs 4⯱â¯0.5; pâ¯<â¯0.0001) were significantly worse in subD (nâ¯=â¯120) than nonD (nâ¯=â¯348) PD patients. Non-motor Symptoms Scale (NMSS) total score was higher in subD patients (45.9⯱â¯32 vs 29.1⯱â¯25.8;pâ¯<â¯0.0001). Non-motor symptoms burden (NMSS;ORâ¯=â¯1.019;95%CI 1.011-1.028; pâ¯<â¯0.0001), neuropsychiatric symptoms (NPI; ORâ¯=â¯1.091; 95%CI 1.045-1.139; pâ¯<â¯0.0001), impulse control behaviors (QUIP-RS; ORâ¯=â¯1.035; 95%CI 1.007-1063; pâ¯=â¯0.013), quality of sleep (PDSS; ORâ¯=â¯0.991; 95%CI 0.983-0.999; pâ¯=â¯0.042), and fatigue (VAFS-physical; ORâ¯=â¯1.185; 95%CI 1.086-1.293; pâ¯<â¯0.0001; VAFS-mental; ORâ¯=â¯1.164; 95%CI 1.058-1.280; pâ¯=â¯0.0001) were related to subD after adjustment to age, disease duration, daily equivalent levodopa dose, motor status (UPDRS-III), and living alone. CONCLUSIONS: SubD is a frequent problem in patients with PD and is more prevalent in these patients than in controls. QoL is worse and non-motor symptoms burden is greater in subD PD patients.
Subject(s)
Parkinson Disease , Quality of Life , Depression/epidemiology , Depression/etiology , Fatigue/epidemiology , Fatigue/etiology , Humans , Parkinson Disease/complications , Parkinson Disease/epidemiology , Surveys and QuestionnairesABSTRACT
BACKGROUND AND PURPOSE: In Parkinson's disease (PD), the course of the disorder is highly variable between patients. Well-designed, prospective studies for identifying PD progression biomarkers are necessary. Our aim was to show the results of baseline evaluations of an ongoing global PD project, COPPADIS-2015 (Cohort of Patients with PArkinson's DIsease in Spain, 2015). METHODS: This was an observational, descriptive, nationwide study (Spain). The recruitment period ended in October 2017. Baseline evaluation included more than 15 validated scales and complementary studies in a subgroup of participants. RESULTS: In total, 1174 subjects from 35 centres were considered valid for baseline analysis: 694 patients (62.6 ± 8.9 years old, 60.3% males), 273 caregivers (58.5 ± 11.9 years old, 31.8% males) and 207 controls (61 ± 8.3 years old, 49.5% males). The mean disease duration was 5.5 ± 4.4 years. Hoehn and Yahr stage was 1 or 2 in 90.7% of the patients whilst 33.9% and 18.1% of them presented motor fluctuations and dyskinesias, respectively. The mean Non-Motor Symptoms Scale total score was 45.4 ± 38.1, and 30.4% of the patients presented cognitive impairment, 16.1% major depression, 12.7% impulse control disorder, 7.2% compulsive behaviour, 57.2% pain and 13.2% falls. Compared to the control group, PD patients presented a significantly higher burden of non-motor symptoms and a worse quality of life. More than 300 subjects conducted complementary studies (serum biomarkers, genetic and neuroimaging). CONCLUSIONS: Parkinson's disease is a complex disorder and different non-motor symptoms are frequently present and are more prevalent than in controls. In real clinical practice it is important to ask for them.
Subject(s)
Parkinson Disease/pathology , Aged , Aged, 80 and over , Caregivers/statistics & numerical data , Cognition Disorders/epidemiology , Cognition Disorders/etiology , Cohort Studies , Comorbidity , Disease Progression , Disruptive, Impulse Control, and Conduct Disorders , Female , Humans , Longitudinal Studies , Male , Mental Disorders/epidemiology , Mental Disorders/etiology , Middle Aged , Movement Disorders/epidemiology , Movement Disorders/etiology , Parkinson Disease/epidemiology , Parkinson Disease/psychology , Prospective Studies , Quality of Life , Socioeconomic Factors , Spain/epidemiologyABSTRACT
No disponible
Subject(s)
Humans , Male , Adult , Chorea/complications , Chorea , Positron-Emission Tomography/instrumentation , Positron-Emission Tomography/methods , Positron-Emission Tomography , Skull/pathology , Skull , Neuroacanthocytosis/complications , Neuroacanthocytosis , Cognitive Dysfunction/complications , Blotting, Western/methods , Blotting, Western , Magnetic Resonance Imaging/methodsABSTRACT
Introducción. Hay pruebas científicas inequívocas del beneficio clínico de las unidades de ictus y de la trombólisis en el ictus isquémico. Sin embargo, aún existen desigualdades en la cobertura y el tipo de tratamiento que reciben estos pacientes en función de su lugar de residencia y de la dotación tecnológica y organización de los hospitales de un determinado sistema de salud. La telemedicina aplicada al ictus se plantea como herramienta efectiva para reducir esta desigualdad en el acceso y en los resultados de la atención médica. Desarrollo. En este trabajo se revisan los requerimientos asociados con la implantación de un sistema de teleictus, su desarrollo en el Servei de Salut de les Illes Balears y las principales experiencias publicadas hasta la fecha. Además, se avanza parte de la información obtenida en una evaluación formal a punto de finalizar de su efectividad y seguridad respecto a las de la trombólisis convencional en las Illes Balears. Conclusiones. La implantación de un sistema de telemedicina aplicado al ictus es factible y permite ampliar la cobertura del tratamiento especializado. En el Servei de Salut de les Illes Balears se ha logrado mejorar notablemente el acceso a la trombólisis del ictus mediante el proyecto Teleictus balear. Su efectividad y seguridad parecen ser muy similares a las del tratamiento convencional (AU)
Introduction. Currently, clinical benefits of stroke units and thrombolysis in ischaemic stroke are evidence-based. However, inequities in coverage and in treatment provided to these patients still persist due to geographical differences in residence, technological capacity and organization among health care systems. Telestroke is considered to be an effective tool for reducing inequities in coverage and health outcomes of stroke patients. Development. This paper reviews the requirements of implementation of telestroke units, their deployment in the Health Service of the Balearic Islands, and the main experiences reported so far. Further, preliminary results of an ongoing formal assessment of effectiveness and safety of telestroke relative to conventional stroke treatment are advanced. Conclusions. Implementation of a telestroke system is feasible and allows increasing specialized treatment coverage. The Health Service of the Balearic Islands is fulfilling its goal of improving thrombolysis coverage by means of telestroke. Its effectiveness and safety appear to be similar to those of conventional treatment (AU)
Subject(s)
Humans , Telemedicine , Stroke/therapy , Thrombolytic Therapy/methods , Remote Consultation , VideoconferencingSubject(s)
Behavior, Animal/drug effects , Dopamine Agents/toxicity , Dopamine Agonists/pharmacology , MPTP Poisoning , Receptors, Dopamine D1/agonists , Receptors, Dopamine D2/agonists , Animals , Antiparkinson Agents/pharmacology , Drug Tolerance , Female , Indoles/pharmacology , Macaca fascicularis , Male , Movement/drug effects , Oxazines/pharmacology , Phenanthridines/pharmacologyABSTRACT
We studied a ten-year old girl with livedo reticularis and multiple central nervous system ischemic attacks beginning when she was five. Blood tests were positive for cryoglobulins and antiphospholipid antibodies; superior limb angiography showed occlusion and irregularities of the vessel walls and temporal artery biopsy revealed concentric thickening of the vessel wall due to fibrotic subendothelial proliferation. Sneddon's syndrome was diagnosed. Onset of this syndrome during early childhood has not been previously reported.
Subject(s)
Antibodies, Antiphospholipid/blood , Cerebrovascular Disorders/complications , Skin Diseases, Vascular/complications , Adrenal Cortex Hormones/therapeutic use , Cerebrovascular Disorders/diagnosis , Cerebrovascular Disorders/physiopathology , Child, Preschool , Corpus Striatum/physiopathology , Female , Fibroblasts/ultrastructure , Humans , Magnetic Resonance Imaging , Skin Diseases, Vascular/diagnosis , Skin Diseases, Vascular/drug therapyABSTRACT
Although substantial therapeutic advances have been developed during the last decade, L-dopa remains as the most successful treatment for Parkinson's disease. However, about 80% of the patients show motor and psychiatric complications after several years of levodopa treatment. Thus, new therapeutic approaches have been undertaken during the last decade in order obtain a better control of the motor symptoms. Adrenal medullar grafts into caudate nucleus and/or putamen have been widely studied as a new therapeutic strategy. They have been undertaken in more than 300 parkinsonian patients and the general finding is that adrenal medullar grafts induce a significant improvement of motor symptoms which remain 1 year after the surgery. The mechanisms by which they can elicit a motor improvement are not well understood since chromaffin cells do not survive in the host brain after transplantation as demonstrated by PET scan studies. The present work summarizes the results found by different authors as well as the mechanisms involved in the motor improvement observed in these patients.
