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1.
Nihon Yakurigaku Zasshi ; 156(2): 76-80, 2021.
Artigo em Japonês | MEDLINE | ID: mdl-33642534

RESUMO

Parkinson's disease (PD) is a progressive neurodegenerative disease with motor symptoms, such as tremor, akinesia/bradykinesia, rigidity and postural instability due to a loss of nigrostriatal dopaminergic neurons; PD patients also exhibit non-motor symptoms, such as hyposmia, orthostatic hypotension and constipation, which precede motor symptoms. Pathologically, Lewy bodies and neurites, which contains α-synuclein, are observed in the central and peripheral nervous system. To date, it is hypothesized that PD pathology appears first in the olfactory bulb and the enteric nervous system, and propagates progressively through the substantia nigra to finally reach the cerebral cortex. Major medications at present are nosotropic treatments to improve motor dysfunction in PD. Therefore, development of disease-modifying drug is required to slow or prevent PD progression. Astrocytes are known to play an important role in the maintenance of the neuronal environment and exert neuroprotective effects by production of antioxidants and neurotrophic factors and clearing toxic molecules. In the previous study, we demonstrated that astrocytes produced antioxidative molecules metallothionein (MT)-1/2 in response to oxidative stress and protected dopaminergic neurons against oxidative stress. MTs are cysteine-rich proteins possessing antioxidative properties. MTs bind to metals such as zinc (Zn) and copper (Cu) and function in metal homeostasis and detoxification; MTs regulate Zn-mediated transcriptional activation of various genes. Recently, it is reported that MTs prevent Cu-induced aggregation of α-synuclein. In this article, we review a new therapeutic strategy of neuroprotection in PD by targeting MTs in astrocytes.


Assuntos
Doenças Neurodegenerativas , Doença de Parkinson , Astrócitos , Proteínas de Transporte , Humanos , Doença de Parkinson/tratamento farmacológico , alfa-Sinucleína
2.
Artigo em Russo | MEDLINE | ID: mdl-33580755

RESUMO

The paper summarizes the literature and author's data on the development of early (preclinical) diagnosis of Parkinson's disease (PD). Implementation of this diagnosis will promote the use of preventive therapy and change investments in diagnosis and treatment of patients. The paper declares that at present the only approach to early diagnosis of PD is positron-emission tomography of the nigrostriatal dopaminergic system, but it cannot be used for preventive examination due to its high cost. The authors consider that a less specific, but more promising approach to the development of early diagnosis of PD is the search for markers in body fluids, mainly in the blood, in patients at the prodromal stage of PD. Indeed, a number of markers as changes in the level of metabolites of monoamines, sphingolipids, urates, and indicators of oxidative stress were found in patients selected for the risk group of the prodromal stage of PD, according to characteristic premotor symptoms. In addition, it is assumed that the search for blood markers at an earlier - pre-prodromal stage is possible only in animal models of PD at the early preclinical stage. This approach can also be used to verify blood markers identified in patients at the clinical stage of PD. It is also evident that the complex socio-economic factors influencing the incidence of PD is different in developed versus developing countries. The societal and medical costs of Parkinson's are huge and efforts to improve early preclinical diagnosis of PD will lead to considerable economical and societal benefits. For instance this will allow efficient selection of patients for preclinical diagnostic tests. To assess the effectiveness of this strategy considering the uncertainty of socio-economic issues, a modification of the «cost-utility¼ analysis is proposed. For the first time, a Markov model of PD including preclinical diagnostic tests and possible neuroprotective therapy was developed and studied. Analytical outcomes of this process suggest that the idea of developing a new multimodal strategy is promising from a socio-economic point of view.


Assuntos
Doença de Parkinson , Animais , Biomarcadores , Diagnóstico Precoce , Humanos , Doença de Parkinson/diagnóstico , Tomografia por Emissão de Pósitrons , Sintomas Prodrômicos
3.
Artigo em Russo | MEDLINE | ID: mdl-33580759

RESUMO

OBJECTIVE: To evaluate an influence of 8-week course of winter nordic walking as the multitask on the spatial-temporal characteristics of walking and motor disturbances in patients with Parkinson's disease (PD). MATERIAL AND METHODS: Eleven patients (3 men and 8 women, mean age 66.82±3.97 years) with Hoehn and Yahr stage 1 to 2 PD were included in the study. Preliminary medical examination, including the anthropometric profile with the calculation of the body mass index (BMI), the grip strength on the right and left sides, spirometry, functional tests with the physical load (orthostatic test with the determination of systolic and diastolic blood pressure (SBP and DPB) and type of reaction (normal, hypertonic, hypotonic), the 6 Minute Walk Test, timed Up and Go test), was performed to evaluate the physical state. The evaluation of motor function was performed using the unified Parkinson's disease rating scale of the Movement Disorder Society (MDS UPDRS), part III. A 8-week course of nordic walking training was carried out at the certified track on the stadium localized outside of the city, in the wood and parks area in the winter. RESULTS: Compared to the first training, gait velocity increased at the 3rd session, the step length at the 6th. The improvement of the spatial-temporal characteristics of walking was accompanied by the improvement of the motor function as measured by MDS UPDRS, part III. CONCLUSION: Winter nordic walking as multitask is the effective measure of exercise treatment in patients with PD, because it improves the spatial-temporal characteristics of walking and the motor function.


Assuntos
Doença de Parkinson , Caminhada , Idoso , Terapia por Exercício , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Equilíbrio Postural , Estudos de Tempo e Movimento
4.
Adv Mind Body Med ; 35(2): 4-13, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33620331

RESUMO

Aim: The purpose of this article is to enhance our understanding of prayer healing by studying a case which was described as a 'remarkable healing' by a medical assessment team at the Amsterdam University Medical Centre (UMC) in the Netherlands. Method: This retrospective, case-based study of prayer healing investigated numerous reported healings using both medical files and patient narratives. A medical assessment team evaluated the associated medical files, as well as any experiential data. The instances of healing could be classified as 'remarkable' or 'unexplained.' Experiential data were obtained by qualitative, in-depth interviews. The study was transdisciplinary in nature, involving medical, psychological, theological, and philosophical perspectives. The object was to understand such healings within the broader framework of the science-religion debate. Results: We present the case of a female patient, born in 1959, with Parkinson disease who experienced instantaneous, nearly complete healing in 2012 after intercessory prayer. At that point the disease was at an advanced stage, rapidly progressive, with major debilitating symptoms. High doses of oral medication were required. Following this healing there was no recurrence of her former symptoms, while the remaining symptoms continued to improve. She regained all of her capacities at work, as well as in daily life. The medical assessment team described her recovery as 'remarkable.' The patient reported that she had always 'lived with God,' and that at a point when she had given up hope, 'life was given back to her.' This recovery did not make her immune to other illnesses and suffering, but it did strengthen her belief that God cares about human beings. Conclusion: This remarkable healing and its context astonished the patient, her family, and her doctors. The clinical course was extraordinary, contradicting data from imaging studies, as well as the common understanding of this disease. This case also raised questions about medical assumptions. Any attempt to investigate such healings requires the involvement of other disciplines. A transdisciplinary approach that includes experiential knowledge would be helpful. Against the background of the science-religion debate, we feel that the most helpful approach would be one of complementarity and dialogue, rather than stoking controversy.


Assuntos
Cura pela Fé , Doença de Parkinson/terapia , Espiritualidade , Feminino , Humanos , Pessoa de Meia-Idade , Doença de Parkinson/psicologia , Religião e Medicina
5.
Medicine (Baltimore) ; 100(7): e24837, 2021 Feb 19.
Artigo em Inglês | MEDLINE | ID: mdl-33607852

RESUMO

ABSTRACT: Dysautonomia is common in patients with Parkinson disease (PD) since disease early phase. Scales for Outcomes in Parkinson's disease - Autonomic (SCOPA-AUT) is a well-designed scale assessing the autonomic dysfunctions of PD patients. Our objectives were to examine the autonomic dysfunction in PD and scan without evidence of dopaminergic deficit (SWEDD) patients and to assess the correlation of autonomic dysfunctions with cerebrospinal fluid (CSF) biomarkers.An analysis of the Parkinson's Progression Markers Initiative (PPMI) data including 414 PD patients, 60 SWEDD patients, and 170 healthy controls (HCs) with baseline CSF biomarker measurements and SCOPA-AUT assessments was presented. Autonomic symptoms including gastrointestinal, urinary, cardiovascular, pupillomotor, thermoregulatory and sexual dysfunctions were assessed by SCOPA-AUT scales. Spearman correlation test was used to examine the correlations between CSF measurements and each section of SCOPA-AUT scales in HCs and subjects with PD or SWEDD.More severe autonomic dysfunctions were observed in patients with SWEDD than those with PD (P < .001). Specifically, patients with PD have lower scores on the urinary scale [4 (0-17) vs 5 (1-18)], pupillomotor scale [0 (0-3) vs 0 (0-3)], thermoregulatory scale [0 (0-4) vs 1.5 (0-10)] and sexual scale [1 (0-6) vs 2 (0-6)] compared with SWEDD patients. Thermoregulatory dysfunction scores were found correlated with CSF α-syn levels in SWEDD group, and gastrointestinal dysfunction scores were correlated with CSF Abeta1-42 in PD group. Additionally, urinary dysfunction scores were correlated with CSF total tau and tau phosphorylated at threonine 181(p-tau181) levels in both HCs and PD patients.


Assuntos
Biomarcadores/líquido cefalorraquidiano , Dopamina/deficiência , Doença de Parkinson/diagnóstico por imagem , Doença de Parkinson/metabolismo , Idoso , Peptídeos beta-Amiloides/líquido cefalorraquidiano , Sistema Nervoso Autônomo/fisiopatologia , Doenças do Sistema Nervoso Autônomo/líquido cefalorraquidiano , Doenças do Sistema Nervoso Autônomo/diagnóstico , Doenças do Sistema Nervoso Autônomo/fisiopatologia , Regulação da Temperatura Corporal/fisiologia , Estudos de Casos e Controles , Feminino , Gastroenteropatias/metabolismo , Humanos , Masculino , Pessoa de Meia-Idade , Doença de Parkinson/líquido cefalorraquidiano , Doença de Parkinson/fisiopatologia , Disautonomias Primárias/etiologia , Índice de Gravidade de Doença , Inquéritos e Questionários , Doenças Urológicas/metabolismo
6.
Zhonghua Yi Xue Za Zhi ; 101(7): 498-503, 2021 Feb 23.
Artigo em Chinês | MEDLINE | ID: mdl-33631895

RESUMO

Objective: To analyze the characteristic changes of corneal nerve fibers in patients with Parkinson's disease (PD) by corneal confocal microscopy (CCM) and investigate the association of corneal nerve fiber parameters with disease severity and motor symptoms. Methods: Forty-two patients with PD were recruited from the Department of Neurology, Henan University People's Hospital from June 2018 to October 2019. Meanwhile, 40 healthy controls who visited the hospital for physical examination at the same period were enrolled. Corneal nerve fibers in both eyes of all participants were detected by using CCM. The differences of corneal nerve fibers were comparatively analyzed between PD group and healthy controls. Associations of corneal nerve parameters with clinical characteristics such as course of disease, Hoehn and Yahr stage (H-Y stage), unified Parkinson disease rating scale (UPDRS), levodopa equivalent daily dosage (LEDD) were analyzed by using partial correlations. The receiver operating characteristic (ROC) curve was used to analyze the capability of corneal nerve fibers for distinguishing patients with PD from healthy controls. Results: Corneal nerve fiber density (CNFD) in PD group ((19±3)/mm2) was significantly decreased compared with healthy controls ((28±4)/mm2) (t=10.798, P<0.001). However, corneal nerve branch density (CNBD) was significantly increased in PD group ((25±11)/mm2) compared with healthy controls ((18±6)/mm2) (t=-3.427, P=0.001). Meanwhile, corneal nerve fiber length (CNFL) was decreased in PD group ((11.0±2.5) mm/mm2) in comparison with healthy controls ((12.5±1.6) mm/mm2) (t=3.139, P=0.002). ROC curve analysis revealed that CNFD could discriminate PD patients from healthy controls, with an area under the curve of 0.961 3 (95%CI: 92.42-99.84, P<0.000 1). CNFD was negatively correlated with H-Y stage and UPDRS-Ⅲ (r=-0.501 and -0.399, both P<0.05). CNBD was significantly negatively associated with H-Y stage, UPDRS-Ⅲ and UPDRS-Total (r=-0.622, -0.394 and -0.354, respectively, all P<0.05). CNFL was negatively correlated with H-Y stage, UPDRS-Ⅲ and UPDRS-total (r=-0.574, -0.484 and -0.422, respectively, all P<0.05). Conclusion: Small nerve fiber injuries exist in PD patients. Corneal nerve fibers negatively correlates with motor symptoms. CNFD have a good discriminative power to distinguish PD patients from healthy controls and may serve as a marker for PD.


Assuntos
Doença de Parkinson , Córnea , Humanos , Levodopa , Microscopia Confocal , Fibras Nervosas
7.
J Parkinsons Dis ; 11(1): 3-8, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33523021

RESUMO

Several COVID-19 vaccines have recently been approved for emergency use according to governmental immunization programs. The arrival of these vaccines has created hope for people with Parkinson's disease (PD), as this can help to mitigate their risk of becoming infected with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which can lead to serious, life-threatening disease, at least among those with more advanced PD. However, both persons with PD and physicians looking after these individuals have expressed concerns about the vaccine's efficacy and safety in the specific context of PD and its symptomatic treatment. Here, we discuss our perspective on these concerns, based on our interpretation of the literature plus the unfolding experience with widespread vaccination in the population at large. Because the benefits and risks of COVID-19 vaccines do not appear to be different than in the general population, we recommend COVID-19 vaccination with approved vaccines to persons with PD, unless there is a specific contraindication. Some caution seems warranted in very frail and terminally ill elderly persons with PD living in long-term care facilities.


Assuntos
/uso terapêutico , Doença de Parkinson , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Vacinação
8.
Medicine (Baltimore) ; 100(4): e24191, 2021 Jan 29.
Artigo em Inglês | MEDLINE | ID: mdl-33530211

RESUMO

BACKGROUND: Parkinson disease (PD), the second most common neurodegenerative disease, has no cure or applicable disease-modifying approach, only symptomatic therapy. Oxidative stress and mitochondrial dysfunction play key roles in PD pathophysiology. Animal studies have demonstrated that photobiomodulation (PBM) may enhance mitochondrial function and boost adenosine triphosphate production, thus alleviating PD symptoms; however, this process can cause increased reactive oxygen species (ROS) production. Molecular hydrogen (H2) is a potent and possibly therapeutic antioxidant that can mitigate the effect of ROS. PBM targeting the brainstem may facilitate neuronal activity, and the concomitant H2 may clear additional ROS produced by PBM. Therefore, this study aimed to determine the safety and effectiveness of PBM + H2 in patients with PD. METHODS: We included 18 patients with PD (age 30-80 years) who were at Hoehn and Yahr stages II-III. All the participants received daily PBM + H2 therapy for 2 weeks. The adverse event and the Unified Parkinson Disease Rating Scale (UPDRS) scores were recorded. RESULTS: We noted that the UPDRS scores began significantly decreasing from the first week, and this improvement persisted until the end of therapy. Moreover, no adverse event was recorded. After 1 week of therapy cessation, UPDRS scores slightly increased but the improvement remained significant compared with the baseline. CONCLUSION: This novel, proof-of-concept study demonstrated that PBM+H2 therapy is safe and reduces disease severity. A larger-scaled clinical trial is warranted to completely investigate the effects of PBM + H2 therapy on PD.


Assuntos
Antioxidantes/uso terapêutico , Terapia com Luz de Baixa Intensidade/métodos , Doença de Parkinson/terapia , Água/administração & dosagem , Água/química , Adulto , Idoso , Idoso de 80 Anos ou mais , Antioxidantes/administração & dosagem , Antioxidantes/efeitos adversos , Terapia Combinada , Método Duplo-Cego , Feminino , Humanos , Hidrogênio/química , Terapia com Luz de Baixa Intensidade/efeitos adversos , Masculino , Pessoa de Meia-Idade , Estresse Oxidativo/fisiologia , Projetos Piloto , Índice de Gravidade de Doença , Água/efeitos adversos
9.
Medicine (Baltimore) ; 100(3): e23010, 2021 Jan 22.
Artigo em Inglês | MEDLINE | ID: mdl-33545923

RESUMO

BACKGROUND: Parkinson disease (PD) is a worldwide spread neurodegenerative disorder. Dopamine replacement therapy is currently the mainstream treatment, which can alleviate the symptoms but induces motor complications. Electroacupuncture (EA) is beneficial for PD as an alternative medicine. However, few reliable clinical trials or objective systematic reviews are available to give a verdict on the effectiveness of EA in the treatment of PD. Thus, we evaluate the evidence for EA in PD patients by conducting this meta-analysis. METHODS: PubMed, Cochrane Library, EMBASE, China National Knowledge Infrastructure, Chinese Scientific and Technology Journal database, WanFang Digital Periodicals, and Chinese Biomedical Literature Database (SinoMed) will be systematically searched for evidence by 2 authors individually. The analysis will be conducted by RevMan 5.3 software according to Cochrane Handbook. RESULTS: The efficacy and safety of EA for PD will be comprehensively assessed from the outcomes, including the effectiveness rate, scores of Unified Parkinson Disease Rating Scale, and Webster scale, superoxide dismutase, lipid peroxides, and dopamine content. CONCLUSION: This systematic review will provide evidence for whether EA can treatment PD. REGISTRATION INFORMATION: PROSPERO CRD42019120956.


Assuntos
Eletroacupuntura , Doença de Parkinson/terapia , Humanos , Metanálise como Assunto , Revisões Sistemáticas como Assunto , Resultado do Tratamento
10.
Zhen Ci Yan Jiu ; 46(1): 21-6, 2021 Jan 25.
Artigo em Chinês | MEDLINE | ID: mdl-33559421

RESUMO

OBJECTIVE: To observe the effect of electroacupuncture (EA) on behavior, tyrosine hydroxylase (TH), mitochondrial complexes Ⅰ-Ⅳ, mitochondrial membrane potential and mitochondrial ultrastructure of Parkinson's disease (PD) mice, so as to explore its mechanism underlying improvement of PD. METHODS: C57BL/6 mice were randomly divided into normal, model, medication (Madopar) and EA groups (n=11 in each group). PD model was duplicated by intraperitoneal injection of 1-methyl-4-phenyl-1, 2, 3, 6-tetrahydropyridine (MPTP, 30 mg·kg-1·d-1) for consecutively 5 d. EA was performed on the chorea tremor areas on both sides of the head of mice for 15 min, once a day for 14 d. The behavioral changes of mice were observed. The expression of TH in substantia nigra compacta of midbrain was detected by immunohistochemistry. The activities of mitochondrial complexes Ⅰ-Ⅳ were measured. The changes of mitochondrial membrane potential were detected by JC-1 staining method. The ultrastructural changes of striatum mitochondria were observed by transmission electron microscope. RESULTS: After modeling, the mice showed obvious behavioral abnormalities such as tremor, vertical hair and tail warping, and the pole test time in the model group was significantly longer than that in the normal group (P<0.01). After 7 and 14 days of the treatment, the pole test time in the EA and medication groups was shorter than that in the model group (P<0.05,P<0.01). Compared with the normal group, the number of TH positive cells of the substantia nigra, the mitochondrial membrane potential and the activity of mitochondrial complex I were decreased significantly in the model group (P<0.01), and EA and medication intervention reversed these changes (P<0.01). The mitochondrial structure of mice in the model group was obviously damaged, and the damage of mitochondrial structure was alleviated and the number of damaged mitochondria was decreased in the EA and medication groups. CONCLUSION: EA can protect and promote the recovery of mitochondrial structure and function in MPTP-induced PD mice, which may play a neuroprotective effect on PD mice by improving mitochondrial dysfunction, balancing cell homeostasis and reducing dopaminergic neuron damage.


Assuntos
Eletroacupuntura , Doença de Parkinson , Animais , Modelos Animais de Doenças , Camundongos , Camundongos Endogâmicos C57BL , Mitocôndrias , Doença de Parkinson/genética , Doença de Parkinson/metabolismo , Doença de Parkinson/terapia , Substância Negra/metabolismo
11.
Drugs Today (Barc) ; 57(1): 5-16, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33594386

RESUMO

Parkinson's disease is one of the commonest neurodegenerative disorders, particularly in those over 60 years of age. Although the introduction of levodopa was a tremendous advance in its treatment, the condition is a progressive one. It has been found that the longer patients have the condition and are treated with levodopa, the more likely they are to develop OFF episodes in which their ability to do things becomes increasingly limited. The development of a sublingual apomorphine hydrochloride film (APL-130277, Kynmobi) was designed to alleviate this OFF condition by allowing the patients to experience rapid relief of their OFF episodes up to 5 times a day.


Assuntos
Apomorfina , Doença de Parkinson , Idoso , Antiparkinsonianos/efeitos adversos , Apomorfina/efeitos adversos , Humanos , Levodopa , Pessoa de Meia-Idade , Doença de Parkinson/tratamento farmacológico , Comprimidos
12.
Nat Commun ; 12(1): 779, 2021 02 03.
Artigo em Inglês | MEDLINE | ID: mdl-33536430

RESUMO

MR-guided focused ultrasound (MRgFUS), in combination with intravenous microbubble administration, has been applied for focal temporary BBB opening in patients with neurodegenerative disorders and brain tumors. MRgFUS could become a therapeutic tool for drug delivery of putative neurorestorative therapies. Treatment for Parkinson's disease with dementia (PDD) is an important unmet need. We initiated a prospective, single-arm, non-randomized, proof-of-concept, safety and feasibility phase I clinical trial (NCT03608553), which is still in progress. The primary outcomes of the study were to demonstrate the safety, feasibility and reversibility of BBB disruption in PDD, targeting the right parieto-occipito-temporal cortex where cortical pathology is foremost in this clinical state. Changes in ß-amyloid burden, brain metabolism after treatments and neuropsychological assessments, were analyzed as exploratory measurements. Five patients were recruited from October 2018 until May 2019, and received two treatment sessions separated by 2-3 weeks. The results are set out in a descriptive manner. Overall, this procedure was feasible and reversible with no serious clinical or radiological side effects. We report BBB opening in the parieto-occipito-temporal junction in 8/10 treatments in 5 patients as demonstrated by gadolinium enhancement. In all cases the procedures were uneventful and no side effects were encountered associated with BBB opening. From pre- to post-treatment, mild cognitive improvement was observed, and no major changes were detected in amyloid or fluorodeoxyglucose PET. MRgFUS-BBB opening in PDD is thus safe, reversible, and can be performed repeatedly. This study provides encouragement for the concept of BBB opening for drug delivery to treat dementia in PD and other neurodegenerative disorders.


Assuntos
Barreira Hematoencefálica/diagnóstico por imagem , Demência/diagnóstico por imagem , Doença de Parkinson/diagnóstico por imagem , Ultrassonografia/métodos , Idoso , Doença de Alzheimer/diagnóstico por imagem , Doença de Alzheimer/terapia , Barreira Hematoencefálica/metabolismo , Neoplasias Encefálicas/diagnóstico por imagem , Neoplasias Encefálicas/terapia , Meios de Contraste , Demência/terapia , Estudos de Viabilidade , Humanos , Imagem por Ressonância Magnética/métodos , Masculino , Microbolhas , Avaliação de Resultados em Cuidados de Saúde/métodos , Doença de Parkinson/terapia , Tomografia por Emissão de Pósitrons/métodos , Estudos Prospectivos
13.
Medicine (Baltimore) ; 100(6): e24631, 2021 Feb 12.
Artigo em Inglês | MEDLINE | ID: mdl-33578580

RESUMO

RATIONALE: The Pisa syndrome (PS) is defined as a kind of reversible postural deformity which causes a lateral trunk flexion of 10 degrees or more. A prevalence of approximately 7.4% to 10.3% of patients with Parkinson disease (PD) also have PS. Though unbalanced function of the basal ganglia network and impaired visual-spatial functions including parietal cortices in PS is known, the pathophysiology of PS remains to be unclear. PATIENT CONCERNS: A 67-year-old male patient with PD visited our Rehabilitation outpatient department because of his trunk which involuntarily deviated to the left side when he stood up. DIAGNOSES: Based on the history, physical examination, X-ray images, Tc-99m brain TRODAT-1 single-photon emission computed tomography (SPECT), and regional cerebral perfusion Tc-99m ethyl cysteinate dimer SPECT, the patient was diagnosed with PD with PS. INTERVENTIONS: The patient refused our recommendation of admission for pharmaceutical treatment due to personal reasons and was only willing to accept physical training programs at our outpatient department. OUTCOMES: We arranged functional neuroimaging of the brain to survey possible neurologic deficits. The patient's images of ethyl cysteinate dimer SPECT and TRODAT SPECT showed abnormalities, including hypoperfusion and diminished dopamine transporter uptake, in the areas of the basal ganglia network and other brain regions. LESSONS: Based on previous literature and the imaging of our patient, we hypothesize that PS results from unbalanced function of the basal ganglia network and impaired visual-spatial functions of bilateral parietal cortices.


Assuntos
Doença de Parkinson/diagnóstico por imagem , Idoso , Humanos , Masculino , Neuroimagem , Compostos de Organotecnécio , Doença de Parkinson/reabilitação , Compostos Radiofarmacêuticos , Síndrome , Tomografia Computadorizada de Emissão de Fóton Único , Tropanos
14.
Medicine (Baltimore) ; 100(5): e24348, 2021 Feb 05.
Artigo em Inglês | MEDLINE | ID: mdl-33592882

RESUMO

ABSTRACT: Gait automaticity is reduced in patients with Parkinson disease (PD) due to impaired habitual control. The aim of this study was to investigate the effect of robot-assisted gait training (RAGT) on gait automaticity as well as gait speed and balance in patients with PD.This study was a prospective, open-label, single-arm, pilot study. We planned to recruit 12 patients with idiopathic PD. Participants received 12 sessions of RAGT using exoskeleton-type robotic device. Sessions were 45-minute each, 3 days a week, for 4 consecutive weeks using an exoskeleton-type gait robot. The primary outcome was the percentage of dual-task interference measured by the 10-Meter Walk Test (10MWT) under single and dual-task (cognitive and physical) conditions. Secondary outcomes were the Berg Balance Scale and Korean version of the Falls Efficacy Scale-International. All measures were evaluated before treatment (T0), after treatment (T1), and 1-month post-treatment (T2).Twelve patients were enrolled and 1 dropped out. Finally, 11 patients with idiopathic PD were analyzed. The mean age of 11 patients (5 males) was 66.46 ±â€Š5.66 years, and disease duration was 112.91 ±â€Š50.19 months. The Hoehn and Yahr stages were 2.5 in 8 patients and 3 in 3 patients. Linear mixed-effect model analysis showed a significant change over time only in single-task gait speed of the 10MWT (P = .007), but not in dual-task gait speed, dual-task interferences, and Korean version of the Falls Efficacy Scale-International. Cognitive dual-task interference significantly increased (P = .026) at T1, but not at T2 (P = .203). No significant changes were observed for physical dual-task interference at T1 and T2. Single-task gait speed of the 10MWT was significantly increased at T1 (P = .041), but not at T2 (P = .445). There were no significant changes in the dual-task gait speed of 10MWT. A significant improvement was observed in Berg Balance Scale score at T1 and T2 (P = .004 and P = .024, respectively).In this pilot study, despite improvement in walking speed and balance, gait automaticity in patients with PD was not improved by RAGT using an exoskeleton-type robot. Additional therapeutic components may be needed to improve gait automaticity using RAGT in patients with PD.


Assuntos
Terapia por Exercício/instrumentação , Exoesqueleto Energizado , Transtornos Neurológicos da Marcha/terapia , Doença de Parkinson/terapia , Robótica/instrumentação , Idoso , Terapia por Exercício/métodos , Feminino , Marcha/fisiologia , Análise da Marcha , Transtornos Neurológicos da Marcha/etiologia , Transtornos Neurológicos da Marcha/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Doença de Parkinson/complicações , Doença de Parkinson/fisiopatologia , Projetos Piloto , Estudos Prospectivos , República da Coreia , Robótica/métodos , Resultado do Tratamento
17.
Bratisl Lek Listy ; 122(2): 158-160, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33502886

RESUMO

OBJECTIVE: Polypharmacy and multiple diseases are common in geriatric practice; however, such kind of multiple interventions might result in adverse effects. Some previous studies have found the association of polypharmacy and Parkinson's disease, to confirm this relationship, we conducted a meta-analysis to analyze this issue quantitively. MATERIALS AND METHODS: In total, we included 8 studies, 165,689 polypharmacy subjects and 373,660 non-polypharmacy controls, and 5644 PD patients among these subjects and controls. RESULTS: For model without any adjustment, polypharmacy group has a significantly higher prevalence than control, OR = 2.53, 95 %CI [2.00, 3.20] (p < 0.001). However, this model showed a very high heterogeneity (I2 = 91 %, p < 0.001). In age, gender and disease history adjusted model, polypharmacy group has a significantly higher prevalence than control, OR = 1.43, 95 %CI [1.35, 1.52], p < 0.001. The heterogeneity decreased to zero (I2 = 0 %, p < 0.45). CONCLUSION: In this study we have found an association between PD risk and polypharmacy, a better designed prospective long-term cohort study might be required for further discussion on this issue (Tab. 1, Fig. 5, Ref. 14).


Assuntos
Doença de Parkinson , Estudos de Coortes , Humanos , Doença de Parkinson/tratamento farmacológico , Doença de Parkinson/epidemiologia , Polimedicação , Prevalência , Estudos Prospectivos
18.
Nihon Yakurigaku Zasshi ; 156(1): 14-20, 2021.
Artigo em Japonês | MEDLINE | ID: mdl-33390474

RESUMO

Recently, it has been reported that dysfunction of astrocytes is involved vulnerability of neuronal cells in several neurological disorders. Glutathione (GSH) is the most abundant intrinsic antioxidant in the central nervous system, and its substrate cysteine is readily becomes the oxidized dimeric cystine. Since neurons lack a cystine transport system, neuronal GSH synthesis depends on cystine uptake via the cystine/glutamate exchange transporter (xCT), GSH synthesis and release in/from surrounding astrocytes. The expression and release of the zinc-binding protein metallothionein (MT) in astrocytes, which is a strong antioxidant, is induced and exerts neuroprotective in the case of dopaminergic neuronal damage. In addition, the transcription factor Nrf2 induces expression of MT-1 and GSH related molecules. We previously revealed that several antiepileptic drugs, serotonin 5-HT1A receptor agonists, plant-derived chemicals (phytochemicals) increased xCT expression, Nrf2 activation, GSH or MT expression and release in/from astrocytes, and exerted a neuroprotective effect against dopaminergic neurodegeneration in Parkinson's disease model. Our serial studies on neuroprotection via antioxidant defense mechanism of astrocytes have found three target molecular systems of astrocytes for neuroprotection: (1) xCT-GSH synthetic system, (2) Nrf2 system and (3) 5-HT1A receptor-Nrf2-MT system, 5-HT1A-S100ß system. In this article, possible neuroprotective strategy for Parkinson's disease has been reviewed targeting antioxidative molecules in astrocytes.


Assuntos
Fármacos Neuroprotetores , Doença de Parkinson , Antioxidantes/farmacologia , Astrócitos , Glutationa , Humanos , Neuroproteção , Fármacos Neuroprotetores/farmacologia , Doença de Parkinson/tratamento farmacológico
19.
Fortschr Neurol Psychiatr ; 89(1-02): 56-65, 2021 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-33465811

RESUMO

Deep brain stimulation is an established and evidence-based therapeutic option for the treatment of advanced Parkinson's disease. Main indication and inclusion criteria are the presence of idiopathic Parkinsonism with motor fluctuations and / or dyskinesias and / or with medication refractory tremor, a significant improvement of akinesia / rigidity in response to dopaminergic medication, the absence of relevant cognitive deficits and other significant comorbidities. DBS neurosurgery has a low risk of complications. The clinical programming should follow an established monopolar review algorithm. Regular follow-up visits are required for stimulation monitoring.


Assuntos
Estimulação Encefálica Profunda , Discinesias , Doença de Parkinson , Humanos , Doença de Parkinson/terapia , Resultado do Tratamento , Tremor/terapia
20.
Neurology ; 96(7): e1036-e1044, 2021 02 16.
Artigo em Inglês | MEDLINE | ID: mdl-33443131

RESUMO

OBJECTIVE: To establish the significance of glucocerebrosidase gene (GBA) carrier status on motor impairment in a large cohort of patients with incident Parkinson disease (PD). METHODS: Three European population-based studies followed 528 patients with PD from diagnosis. A total of 440 with genomic DNA from baseline were assessed for GBA variants. We evaluated motor and functional impairment annually using the Unified Parkinson's Disease Rating Scale (UPDRS) motor and activities of daily living (ADL) sections. Differential effects of classes of GBA variants on disease progression were evaluated using mixed random and fixed effects models. RESULTS: A total of 387 patients with idiopathic disease (age at baseline 70.3 ± 9.5 years; 60.2% male) and 53 GBA carriers (age at baseline 66.8 ± 10.1 years; 64.2% male) were included. The motor profile of the groups was clinically indistinguishable at diagnosis. GBA carriers showed faster annual increase in UPDRS scores measuring ADL (1.5 point per year, 95% confidence interval [CI] 1.1-2.0) and motor symptoms (2.2 points per year, 95% CI 1.3-3.1) compared to noncarriers (ADL, 1.0 point per year, 95% CI 0.9-1.1, p = 0.003; motor, 1.3 point per year, 95% CI 1.1-1.6, p = 0.007). Simulations of clinical trial designs showed that recruiting only GBA carriers can reduce trial size by up to 65% compared to a trial recruiting all patients with PD. CONCLUSION: GBA variants are linked to a more aggressive motor disease course over 7 years from diagnosis in patients with PD. A better understanding of PD progression in genetic subpopulations may improve disease management and has direct implications for improving the design of clinical trials.


Assuntos
Atividades Cotidianas , Genótipo , Glucosilceramidase/genética , Mutação , Doença de Parkinson/genética , Idoso , Idoso de 80 Anos ou mais , Progressão da Doença , Feminino , Predisposição Genética para Doença , Humanos , Masculino , Testes de Estado Mental e Demência , Pessoa de Meia-Idade , Doença de Parkinson/fisiopatologia
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