Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 2.892
Filtrar
2.
Can Assoc Radiol J ; 71(1): 100-109, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32062996

RESUMO

BACKGROUND AND PURPOSE: This study aimed to assess the sensitivity and specificity of brain stem morphologic changes to differentiate the progressive supranuclear palsy (PSP) from Parkinson disease (PD) and multiple system atrophy (MSA), by single and combined magnetic resonance imaging (MRI) measurements. MATERIALS AND METHODS: Peduncle angle (PA), pons area (P), mesencephalon area (M), middle cerebellar peduncles (MCPs), and superior cerebellar peduncles (SCPs) were measured in 14 PSP, 43 PD, 8 MSA patients, and 45 age-matched control participants on T1-weighted MRI. Neurologists clinically diagnosed all patients. Additionally, P/M ratio, MCPs/SCPs ratio, the previously defined Magnetic Resonance Parkinsonism Index, MRPI: (P/M) · (MCP/SCP), and also the Akdeniz Index (AKI) that we termed were calculated, AKI: (P/M) · (PA/180). Two blinded radiologists evaluated all MR images and inter-/intraobserver variations were measured. RESULTS: Both M and SCPs were significantly lower and P/M, MCPs/SCPs, and PA were significantly higher in PSP patients than the other groups (P < .001). This significance was related to patients with PSP and PD. But all single measurements showed some overlapping values. Therefore, previously defined MRPI was calculated and shown to distinguish patients (negative predictive values: 92%, sensitivity: 78%, specificity: 82%). In this study, interobserver correlation (0.68) was found low for MRPI. Therefore, we identified a more practical index: the Akdeniz Index, which has same diagnostic power with MRPI and higher interobserver correlation (0.91). CONCLUSION: The Akdeniz Index identified in our study is a practical index with high diagnostic power and can reinforce radiological distinguishing of PSP and PD, which are clinically difficult to distinguish.


Assuntos
Imagem por Ressonância Magnética/métodos , Mesencéfalo/diagnóstico por imagem , Atrofia de Múltiplos Sistemas/diagnóstico por imagem , Doença de Parkinson/diagnóstico por imagem , Paralisia Supranuclear Progressiva/diagnóstico por imagem , Idoso , Estudos de Casos e Controles , Diagnóstico Diferencial , Feminino , Humanos , Interpretação de Imagem Assistida por Computador , Masculino , Mesencéfalo/patologia , Atrofia de Múltiplos Sistemas/patologia , Doença de Parkinson/patologia , Estudos Retrospectivos , Sensibilidade e Especificidade , Paralisia Supranuclear Progressiva/patologia
3.
Clin Nucl Med ; 45(2): 95-99, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31876812

RESUMO

PURPOSE: The present study investigated possible associations between cortical dysfunction/degeneration as measured by F-FDG PET and nigrostriatal degeneration according to the specific I-FP-CIT binding ratio (SBR) in striatal subregions defined by striato-cortical anatomical connectivity in Parkinson disease (PD) patients. MATERIALS AND METHODS: The study included 41 patients (61.4 ± 12.8 years) with PD-typical reduction of striatal FP-CIT SBR and no sign of atypical parkinsonian syndrome on FDG PET. FP-CIT SBR was determined separately in the cognitive (composite of executive and limbic) and sensorimotor part of the striatum according to the Oxford-GSK-Imanova Striatal Connectivity Atlas. Scaled FDG uptake was tested voxelwise for correlation with FP-CIT SBR (familywise error corrected P < 0.05). RESULTS: A large cluster (17.6 mL) of significant correlation of scaled FDG uptake with FP-CIT SBR in the cognitive part of the striatum, corrected for SBR in the sensorimotor part, was detected in the bilateral medial frontal cortex and the anterior cingulate cortex (partial correlation coefficient R = 0.767); small clusters were detected in ipsilateral caudate and ipsilateral thalamus. There was a small contralateral occipital cluster (3.0 mL) of significant correlation between FDG uptake and sensorimotor SBR corrected for cognitive SBR (R = 0.709). CONCLUSIONS: The correlation between nigrostriatal degeneration in the cognitive striatum and reduced cerebral glucose metabolism in the medial parts of the frontal cortex including the anterior cingulate suggests that nigrostriatal degeneration is specifically involved in the pathogenesis of cognitive deficits associated with medial frontal dysfunction such as impaired inhibitory control.


Assuntos
Cognição , Neostriado/metabolismo , Doença de Parkinson/metabolismo , Idoso , Proteínas da Membrana Plasmática de Transporte de Dopamina/metabolismo , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neostriado/patologia , Neostriado/fisiopatologia , Doença de Parkinson/diagnóstico por imagem , Doença de Parkinson/patologia , Doença de Parkinson/fisiopatologia , Tomografia Computadorizada de Emissão de Fóton Único , Tropanos
4.
BMC Neurol ; 19(1): 260, 2019 Oct 28.
Artigo em Inglês | MEDLINE | ID: mdl-31660902

RESUMO

BACKGROUND: Parkinsonism is a complex multifactorial neurodegenerative disorder, in which genetic and environmental risk factors may both play a role. Among environmental risk factors cocaine was earlier ambiguously linked to Parkinsonism. Former single case reports described Parkinsonism in chronic cocaine users, but an epidemiological study did not confirm an increased risk of Parkinson's disease. Here we report a patient, who developed Parkinsonism in young age after chronic cocaine use, in whom a homozygous LRRK2 risk variant was also detected. CASE PRESENTATION: The patient was investigated because of hand tremor, which started after a 1.5-year period of cocaine abuse. Neurological examination suggested Parkinsonism, and asymmetrical pathology was confirmed by the dopamine transporter imaging study. The genetic investigations revealed a homozygous risk allele in the LRRK2 gene. After a period of cocaine abstinence, the patient's symptoms spontaneously regressed, and the dopamine transporter imaging also returned to near-normal. CONCLUSIONS: This case report suggests that cocaine abuse indeed might be linked to secondary Parkinsonism and serves as an example of a potential gene-environmental interaction between the detected LRRK2 risk variant and cocaine abuse. The reversible nature of the DaTscan pathology is a unique feature of this case, and needs further evaluation, whether this is incidental or can be a feature of cocaine related Parkinsonism.


Assuntos
Transtornos Relacionados ao Uso de Cocaína/complicações , Interação Gene-Ambiente , Serina-Treonina Proteína Quinase-2 com Repetições Ricas em Leucina/genética , Doença de Parkinson/etiologia , Adulto , Encéfalo/diagnóstico por imagem , Encéfalo/patologia , Proteínas da Membrana Plasmática de Transporte de Dopamina/metabolismo , Humanos , Masculino , Neuroimagem/métodos , Doença de Parkinson/diagnóstico por imagem , Doença de Parkinson/patologia , Fatores de Risco , Tomografia Computadorizada com Tomografia Computadorizada de Emissão de Fóton Único
5.
Curr Med Sci ; 39(5): 831-835, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31612404

RESUMO

Recent researches have found that 7 Tesla SWI can detect the alteration of substantia nigra hyperintensity in Parkinson's disease (PD), multiple system atrophy (MSA), and progressive supranuclear palsy (PSP). The aim of this study was to investigate whether 3 Tesla SWI (3T SWI) can visualize anatomical alterations occurring in a hyperintense structure of the substantia nigra in PD and vascular parkinsonism (VP), and whether the evaluation of abnormal signal can be used as a factor in the differential diagnosis of PD and VP. Using 3 Tesla MRI, we evaluated 38 healthy subjects, 33 patients with PD and 34 patients with VP. Two blinded readers independently assessed the images. We found that the dorsolateral nigral hyperintensity was absent in 31 of 33 patients with PD and 15 of 34 patients with VP. The dorsolateral nigral hyperintensity was present in 19 of 34 patients with VP and 35 of 38 healthy controls. Group comparisons of absence of dorsolateral nigral hyperintensity revealed significant differences between the patients with PD and those with VP (P<0.001). The sensitivity of SWI for PD was 93.9% and the specificity was 92.1%. Visual assessment of dorsolateral nigral hyperintensity on high-field SWI scans may serve as a new simple diagnostic imaging marker for PD. And our study results indicate that 3T SWI can be used as a tool to identify PD and VP.


Assuntos
Demência por Múltiplos Infartos/diagnóstico por imagem , Imagem por Ressonância Magnética/estatística & dados numéricos , Doença de Parkinson/diagnóstico por imagem , Substância Negra/diagnóstico por imagem , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/análise , Estudos de Casos e Controles , Demência por Múltiplos Infartos/patologia , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doença de Parkinson/patologia , Sensibilidade e Especificidade , Substância Negra/irrigação sanguínea , Substância Negra/patologia
6.
Nucl Med Commun ; 40(11): 1187-1192, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31568269

RESUMO

Asymmetric motor symptoms and the contralateral side of dopaminergic deficits are commonly observed in patients with Parkinson's disease. The laterality of the specific binding ratio (SBR) for dopamine transporter single-photon emission computed tomography may be useful for estimation of reduced dopamine transporter density in striatum of patients with Parkinson's disease. SBR with Southampton method (S-SBR) is widely used to evaluate in our country, but the results occasionally contradict with that of motor symptoms or visual evaluation in clinical practice, thus preventing a confident diagnosis. We reported dopamine transporter evaluation with distance-weighted histogram (DWH). We hypothesized that the SBR calculated using DWH (DWH-SBR) may also be useful to evaluate the laterality. The purpose of this study was to investigate the laterality of the SBR versus the asymmetry of motor symptoms, and versus visual evaluation. In total, 100 adult patients with Parkinson's disease were enrolled in our study. The symptom-affected side, the visual-affected side, and the lower SBR side were evaluated. The evaluation was performed in a blinded manner. Correlations between the Hoehn and Yahr scale (HY scale) and both the SBRs were also investigated. Concordance of lower DWH-SBR side for visual-affected side was significantly higher (99.0%) than it of lower S-SBR side (86.0%, P < 0.01). The HY scale was significantly related to both lower S-SBR and DWH-SBR (P < 0.01). The DWH method might minimize the disagreement of laterality between the SBR and visual evaluation, and be useful for making a confident diagnosis in patients with Parkinson's disease.


Assuntos
Proteínas da Membrana Plasmática de Transporte de Dopamina/metabolismo , Doença de Parkinson/metabolismo , Adulto , Idoso , Idoso de 80 Anos ou mais , Encéfalo/diagnóstico por imagem , Encéfalo/metabolismo , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Doença de Parkinson/diagnóstico por imagem , Tomografia Computadorizada de Emissão de Fóton Único
7.
Stereotact Funct Neurosurg ; 97(3): 195-201, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31553992

RESUMO

BACKGROUND: The Six Sigma concept allows for the evaluation of quality changes after the implementation of new technical equipment or adjustment of perioperative procedures. Exemplarily, we applied this method for quality assessment in deep brain stimulation surgery (DBS) for Parkinson's disease. METHODS: The medical procedure and possible errors were registered. Then, 6 critical-to-quality characteristics regarding clinical outcome, surgical precision, and the surgical process were measured. The surgical procedure was then optimized in 2 steps, and its measurement, along with the analysis, was repeated twice. RESULTS: By optimizing perioperative settings, the operation time could be reduced, and the precision of the lead placement could be increased. Clinical outcome, as measured by improvement in UPDRS-III, IV, and reduction of medication could also be improved with smaller required stimulation voltage. With directional leads considerable reduction of medication was achieved in 97% of patients (σ-value 3.39) compared to 83.7% (σ-value 2.53) with nondirectional leads. CONCLUSION: This study shows that the Six Sigma concept is a suitable quality tool to analyze and improve treatment quality of complex medical procedures such as lead positioning in DBS surgery in clinical routine. Our results suggest that directional leads in subthalamic nucleus DBS may have a favorable impact on patients' outcome.


Assuntos
Estimulação Encefálica Profunda/normas , Doença de Parkinson/diagnóstico por imagem , Doença de Parkinson/terapia , Melhoria de Qualidade/normas , Núcleo Subtalâmico/diagnóstico por imagem , Núcleo Subtalâmico/cirurgia , Idoso , Estimulação Encefálica Profunda/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Reprodutibilidade dos Testes , Gestão da Qualidade Total/métodos , Gestão da Qualidade Total/normas , Resultado do Tratamento
8.
Clin Nucl Med ; 44(11): 855-859, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31490312

RESUMO

PURPOSE OF THE REPORT: Oxidative stress is a leading factor in the pathogenesis of idiopathic Parkinson disease (IPD). Two intrinsic antioxidative molecules, bilirubin and uric acid, are known to protect dopaminergic neurons from oxidative stress in IPD. The objective of this study was to determine the relationship between basal serum levels of 2 molecules and dopaminergic deficit assessed by dopamine transporter imaging with F-fluorinated-N-3-fluoropropyl-2-ß-carboxymethoxy-3-ß-(4-iodophenyl)nortropane ([F]FP-CIT) PET/CT in patients with early-stage drug-naive IPD. METHODS: Cases of IPD patients who possess the levels of uric acid and bilirubin within a month from [F]FP-CIT PET/CT from January 2011 to December 2016 were retrospectively reviewed. As a control, the same criteria applied to patients with essential tremor (ET). PET images were analyzed using volume-of-interest templates for 12 striatal subregions and 1 occipital area, and the specific-to-nonspecific binding ratio (SNBR) was calculated. RESULTS: One hundred five patients with drug-naive, early-stage IPD and 62 patients with ET were finally included. Levels of bilirubin were significantly higher in the IPD group than in controls (P = 0.026), and bilirubin level was the factor showing the most correlations with SNBR in IPD (P < 0.001), whereas uric acid showed no such difference or relationship. Furthermore, levels of bilirubin showed a positive correlation with SNBR in more affected posterior putamen in the IPD group (Pearson correlation coefficient, ρ = 0.456; P < 0.001), but a negative one in the ET group (ρ = -0.440, P < 0.001). CONCLUSIONS: Bilirubin, not uric acid, was the most significant antioxidant marker for dopaminergic deficit in early-stage drug-naive IPD assessed by [F]FP-CIT PET/CT.


Assuntos
Bilirrubina/metabolismo , Neostriado/metabolismo , Doença de Parkinson/metabolismo , Tropanos/metabolismo , Adulto , Idoso , Idoso de 80 Anos ou mais , Proteínas da Membrana Plasmática de Transporte de Dopamina/metabolismo , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neostriado/diagnóstico por imagem , Doença de Parkinson/diagnóstico por imagem , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Estudos Retrospectivos , Adulto Jovem
9.
Acta Neurol Scand ; 140(4): 274-280, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31389003

RESUMO

OBJECTIVES: Vitamin D deficiency is widespread in patients with Parkinson's disease (PD). Our aim was to determine whether serum vitamin D levels correlated with bone mineral density (BMD) and non-motor symptoms in patients with PD. MATERIALS & METHODS: A consecutive series of 182 patients with PD and 185 healthy controls were included. Serum 25-hydroxyvitamin D (25[OH]D) levels were measured by immunoassay, while BMD of the lumbar spine and femoral neck was measured by dual-energy X-ray absorptiometry. Associations between serum vitamin D levels and clinical data were evaluated using partial correlation analysis. RESULTS: Patients with PD had significantly lower serum 25(OH)D levels relative to healthy controls (49.75 ± 14.11 vs 43.40 ± 16.51, P < 0.001). Furthermore, PD patients with lower vitamin D levels had a significantly higher frequency of falls (P = 0.033) and insomnia (P = 0.015). They also had significantly higher scores for the Pittsburgh Sleep Quality Index (PSQI; P = 0.014), depression (P = 0.020), and anxiety (P = 0.009). Finally, patients with PD also had a significantly lower mean BMD of the lumbar spine (P = 0.011) and femoral neck (P < 0.001). After adjusting for age, sex, and body mass index, vitamin D levels significantly correlated with falls, insomnia, and scores for the PSQI, depression, and anxiety. CONCLUSIONS: In patients with PD, vitamin D levels significantly correlated with falls and some non-motor symptoms. However, no associations were found between BMD and the serum 25(OH)D levels in patients with PD. Thus, vitamin D supplementation is a potential therapeutic for non-motor PD symptoms.


Assuntos
Densidade Óssea/fisiologia , Doença de Parkinson/sangue , Deficiência de Vitamina D/sangue , Vitamina D/análogos & derivados , Absorciometria de Fóton/métodos , Acidentes por Quedas/prevenção & controle , Idoso , Feminino , Colo do Fêmur/diagnóstico por imagem , Humanos , Vértebras Lombares/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Doença de Parkinson/diagnóstico por imagem , Vitamina D/sangue , Deficiência de Vitamina D/diagnóstico por imagem
10.
Stereotact Funct Neurosurg ; 97(3): 153-159, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31430753

RESUMO

BACKGROUND: 7.0-T T2-weighted MRI offers excellent visibility of the subthalamic nucleus (STN), which is used as a target for deep brain stimulation (DBS) in Parkinson's disease (PD). A comparison of 7.0-T MRI to microelectrode recordings (MER) for STN border identification has not been performed. OBJECTIVE: To compare representation of STN borders on 7.0-T T2 MRI with the borders identified during MER in patients undergoing DBS for PD and to evaluate whether STN identification on 7.0-T T2 MRI leads to alterations in stereotactic target planning. DESIGN/METHODS: STN border identification was done using volumetric 7.0-T T2 MRI acquisitions. This was compared to the STN borders identified by MER. STN target planning was independently performed by 3 DBS surgeons on T2 imaging using 1.5-, 3.0-, and 7.0-T MRI. RESULTS: A total of 102 microelectrode tracks were evaluated in 19 patients. Identification of the dorsal STN border was well feasible on 7-T T2, whereas the ventral STN was un-distinguishable from the substantia nigra. The dorsal STN border on MRI was located more dorsal than MER in 73% of trajectories. The average distance from MRI to MER border was 0.9 mm (range -4.4 to +3.5 mm). STN target planning showed high correspondence between the 3 field strengths. CONCLUSION: 7.0-T T2 MRI offers the possibility of easy identification of the dorsal border of the STN. However, higher field strength MRI does not change the planning of the target. Compared to MER, the dorsal border on MRI was located more dorsal in the majority of cases, situating MER activity within STN representation.


Assuntos
Estimulação Encefálica Profunda/instrumentação , Estimulação Encefálica Profunda/métodos , Imagem por Ressonância Magnética/instrumentação , Imagem por Ressonância Magnética/métodos , Doença de Parkinson/diagnóstico por imagem , Núcleo Subtalâmico/diagnóstico por imagem , Idoso , Feminino , Humanos , Imagem Tridimensional/instrumentação , Imagem Tridimensional/métodos , Masculino , Microeletrodos , Pessoa de Meia-Idade , Doença de Parkinson/cirurgia , Doença de Parkinson/terapia , Núcleo Subtalâmico/cirurgia
11.
J Clin Neurosci ; 68: 235-242, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31420273

RESUMO

This study used Voxel-based morphometry (VBM) and resting-state functional magnetic resonance imaging (rs-fMRI) to investigate changes in brain structure and networks functional connectivity, respectively. We tried to identify the potential biomarkers in Parkinson's disease (PD) progression. We recruited nine idiopathic PD patients and seven healthy control participants (HC group) who were age-matched to undergo T1-weighted images and rs-fMRI on 1.5 T. Brain structure differences were analyzed by VBM. Topological properties of networks functional connectivity were analyzed by graph theory. Thirty-two nodes of 8 networks and 133 nodes of interest then were identified with graph theory approaches. VBM examinations showed significant decreases of brain gray matter regions including the left temporal lobe, left middle temporal, middle temporal gyrus, parietal lobe, postcentral gyrus, left inferior parietal gyrus, medial frontal gyrus and supplement motor area in PD patients compared to the HC group. The 32 ROI of networks topological metrics measurement in PD demonstrated increases of global efficiency, cost, and degree in frontoparietal PPC (R) network, but decreases of local efficiency, clustering coefficient, and average path length in salience ACC, dorsal attention FEF (L), and salience aInsula (R) networks, respectively. All 165 ROI connectomes showed eight connections intensity changes, that decrease in OP r to frontoparietal PPC, putamen r to cereb11, and SFG l to Ver8 in PD. These results suggest that the graph theory and the network topological metrics measurement may be the potential biomarkers in PD to evaluate the disease progress and to monitor the therapeutic results.


Assuntos
Encéfalo/fisiopatologia , Interpretação de Imagem Assistida por Computador/métodos , Imagem por Ressonância Magnética/métodos , Modelos Teóricos , Doença de Parkinson/fisiopatologia , Idoso , Encéfalo/diagnóstico por imagem , Encéfalo/patologia , Conectoma/métodos , Feminino , Humanos , Pessoa de Meia-Idade , Modelos Neurológicos , Doença de Parkinson/diagnóstico por imagem , Doença de Parkinson/patologia
12.
Postgrad Med ; 131(7): 509-522, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31422718

RESUMO

Objectives: Visual hallucinations (VH) are common in Lewy body disease (LBD), and have been associated with cognitive and structural brain alterations. Evidence so far concerns mainly Parkinson's disease (PD), but little is known about symptom-specific pathophysiological mechanisms across the LBD spectrum, especially related to the presence of dementia. The aim of the present pilot study was to investigate the neuroanatomical, and neuropsychological characteristics related to VH in two forms of LBD, namely dementia with Lewy bodies (DLB) and PD without dementia. Methods: Whole brain voxel-based morphometry (VBM) analyses on 3D MRI acquired structural brain scans, and neuropsychological testing were performed on 28 clinically diagnosed DLB (11 with VH, 17 NVH), and 24 PD (9 with VH, and 15 NVH) patients. In order to assess differences in gray matter (GM) regional volumes, and cognitive performance, hallucinating patients for each group were compared with corresponding non-hallucinating ones. Results: DLB patients with VH presented significantly worse visual attention deficits compared to those without, which persisted even when controlling for visual perception. Whole brain VBM analysis revealed decreased GM volume in DLB with VH in the right superior and medial frontal gyri, putamen, caudate nucleus and insula. Subcortical regional volumes were also significantly associated with visual attention performance. Hallucinating PD patients, instead, presented more severe executive dysfunction, but VBM showed no volumetric differences between the two PD subgroups. Post hoc region of interest analyses revealed striatal GM loss in PD with VH. Conclusion: Frontal and striatal GM atrophy may contribute to the emergence of VH in DLB, which may be fostered by the more severe attention deficits. Striatal GM loss and executive dysfunction, instead, appeared to underlie VH in PD without dementia.


Assuntos
Núcleo Caudado/diagnóstico por imagem , Lobo Frontal/diagnóstico por imagem , Substância Cinzenta/diagnóstico por imagem , Alucinações/diagnóstico por imagem , Doença por Corpos de Lewy/diagnóstico por imagem , Doença de Parkinson/diagnóstico por imagem , Putamen/diagnóstico por imagem , Idoso , Idoso de 80 Anos ou mais , Atenção , Estudos de Casos e Controles , Núcleo Caudado/patologia , Córtex Cerebral/diagnóstico por imagem , Córtex Cerebral/patologia , Feminino , Lobo Frontal/patologia , Substância Cinzenta/patologia , Alucinações/psicologia , Humanos , Doença por Corpos de Lewy/psicologia , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Testes Neuropsicológicos , Tamanho do Órgão , Doença de Parkinson/psicologia , Putamen/patologia , Percepção Visual
13.
World Neurosurg ; 130: e786-e793, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31295615

RESUMO

BACKGROUND: Interleaving stimulation (ILS) is a stimulation strategy that can help the physician manage more challenging cases of patients with deep brain stimulation (DBS) for Parkinson disease (PD). It consists of altering 2 different programs on the electrode with the same frequency. OBJECTIVES: Our objective was to overview our patients' experience with ILS and explore clinical scenarios in which ILS should be considered when programming DBS in patients with PD. METHODS: We retrospectively reviewed medical charts from 120 patients with PD treated with DBS between 2011 and 2018. RESULTS: Eighteen patients received ILS. One was excluded because of the medical chart was incomplete. The remaining 17 patients had subthalamic nucleus DBS (n = 14) and globus pallidus internus DBS (n = 3). Eight patients (47%) received ILS to improve rigidity and bradykinesia, 4 to improve dyskinesias, 4 because of refractory tremor, and 1 for gait management. Until the end of data collection, 13 of 17 patients (70%) were still on ILS, with a mean duration time of 28.8 months (range, 2-44 months). Four patients reported no benefit from ILS and had their program changed. CONCLUSIONS: Overall, ILS is useful 1) to use 2 contacts that optimally improve 2 specific symptoms but have different therapeutic windows; 2) to avoid side effects related to current spreading to nearby areas; 3) to increase frequency in a small region; or 4) to stimulate a larger target area.


Assuntos
Estimulação Encefálica Profunda/instrumentação , Estimulação Encefálica Profunda/métodos , Neuroestimuladores Implantáveis , Doença de Parkinson/diagnóstico por imagem , Doença de Parkinson/terapia , Adulto , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
15.
Int J Occup Med Environ Health ; 32(4): 503­526, 2019 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-31309787

RESUMO

Objectives: Veterans of the 1991 Gulf War (GW) were exposed to a myriad of potentially hazardous chemicals during deployment. Epidemiological data suggest a possible link between chemical exposures and Parkinson's disease (PD); however, there have been no reliable data on the incidence or prevalence of PD among GW veterans to date. This study included the following 2 questions: 1. Do deployed GW veterans display PD-like symptoms? and 2. Is there a relationship between the occurrence and quantity of PD-like symptoms, and the levels of deployment-related exposures in GW veterans? Material and Methods: Self-reports of symptoms and exposures to deployment-related chemicals were filled out by 293 GW veterans, 202 of whom had undergone 3 Tesla volumetric measurements of basal ganglia volumes. Correlation analyses were used to examine the relationship between the frequency of the veterans' self-reported exposures to deployment-related chemicals, motor and non-motor symptoms of PD, and the total basal ganglia volumes. Results: Healthy deployed GW veterans self-reported few PD-like non-motor symptoms and no motor symptoms. In contrast, GW veterans with Gulf War illness (GWI) self-reported more PD-like motor and non-motor symptoms, and more GW-related exposures. Compared to healthy deployed veterans, those with GWI also had lower total basal ganglia volumes. Conclusions: Although little is known about the long-term consequences of GWI, findings from this study suggest that veterans with GWI show more symptoms as those seen in PD/prodromal PD, compared to healthy deployed GW veterans. Int J Occup Med Environ Health. 2019;32(4):503­26


Assuntos
Guerra do Golfo , Exposição Ocupacional/efeitos adversos , Doença de Parkinson/epidemiologia , Veteranos/estatística & dados numéricos , Gânglios da Base/diagnóstico por imagem , Disfunção Cognitiva/epidemiologia , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Doença de Parkinson/diagnóstico por imagem , Síndrome do Golfo Pérsico/induzido quimicamente , Síndrome do Golfo Pérsico/epidemiologia , Praguicidas/efeitos adversos , Prevalência , Autorrelato , Tremor/epidemiologia
16.
Neurology ; 93(5): e476-e484, 2019 07 30.
Artigo em Inglês | MEDLINE | ID: mdl-31243072

RESUMO

OBJECTIVE: To develop imaging biomarkers of diseases in the Lewy body spectrum and to validate these markers against postmortem neuropathologic findings. METHODS: Four cognitively normal participants with Parkinson disease (PD), 4 with PD with cognitive impairments, and 10 with dementia with Lewy bodies underwent amyloid imaging with [11C]Pittsburgh compound B (PiB) and dopamine transporter (DAT) imaging with [11C]Altropane. All 18 had annual neurologic examinations. All cognitively normal participants with PD developed cognitive impairment before death. Neuropathologic examinations assessed and scored Braak Lewy bodies, Thal distribution of amyloid, Consortium to Establish a Registry for Alzheimer's Disease neuritic amyloid plaques, Braak neurofibrillary tangles, and cerebral amyloid angiopathy, as well as total amyloid plaque burden in the superior frontal, superior parietal, occipital, and inferior temporal cortical regions. PET data were expressed as the standardized uptake value ratio with cerebellar reference. Analyses accounted for the interval between imaging and autopsy. RESULTS: All 18 patients met neuropathologic criteria for Lewy body disease; the DAT concentration was low in each case. All patients with elevated [11C]PiB retention measured in a neocortical aggregate had ß-amyloid deposits at autopsy. [11C]PiB retention significantly correlated with neuritic plaque burden and with total plaque burden. [11C]PiB retention also significantly correlated with the severity of both Braak stages of neurofibrillary tangle and Lewy body scores. Neuritic plaque burden was significantly associated with neurofibrillary tangle pathology. CONCLUSION: Antemortem [11C]Altropane PET is a sensitive measure of substantia nigra degeneration. [11C]PiB scans accurately reflect cortical amyloid deposits seen at autopsy. These findings support the use of molecular imaging in the evaluation of patients with Lewy body diseases.


Assuntos
Peptídeos beta-Amiloides/metabolismo , Encéfalo/diagnóstico por imagem , Encéfalo/patologia , Proteínas da Membrana Plasmática de Transporte de Dopamina/metabolismo , Doença por Corpos de Lewy/diagnóstico por imagem , Doença por Corpos de Lewy/patologia , Doença de Parkinson/diagnóstico por imagem , Doença de Parkinson/patologia , Idoso , Idoso de 80 Anos ou mais , Compostos de Anilina , Autopsia , Encéfalo/metabolismo , Cocaína/análogos & derivados , Meios de Contraste , Feminino , Humanos , Doença por Corpos de Lewy/metabolismo , Masculino , Pessoa de Meia-Idade , Tomografia por Emissão de Pósitrons , Tiazóis
17.
PLoS One ; 14(5): e0217922, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31150514

RESUMO

To meet the need for Parkinson's disease biomarkers and evidence for amount and distribution of pathological changes, MRI diffusion tensor imaging (DTI) has been explored in a number of previous studies. However, conflicting results warrant further investigations. As tissue microstructure, particularly of the grey matter, is heterogeneous, a more precise diffusion model may benefit tissue characterization. The purpose of this study was to analyze the diffusion-based imaging technique restriction spectrum imaging (RSI) and DTI, and their ability to detect microstructural changes within brain regions associated with motor function in Parkinson's disease. Diffusion weighted (DW) MR images of a total of 100 individuals, (46 Parkinson's disease patients and 54 healthy controls) were collected using b-values of 0-4000s/mm2. Output diffusion-based maps were estimated based on the RSI-model combining the full set of DW-images (Cellular Index (CI), Neurite Density (ND)) and DTI-model combining b = 0 and b = 1000 s/mm2 (fractional anisotropy (FA), Axial-, Mean- and Radial diffusivity (AD, MD, RD)). All parametric maps were analyzed in a voxel-wise group analysis, with focus on typical brain regions associated with Parkinson's disease pathology. CI, ND and DTI diffusivity metrics (AD, MD, RD) demonstrated the ability to differentiate between groups, with strongest performance within the thalamus, prone to pathology in Parkinson's disease. Our results indicate that RSI may improve the predictive power of diffusion-based MRI, and provide additional information when combined with the standard diffusivity measurements. In the absence of major atrophy, diffusion techniques may reveal microstructural pathology. Our results suggest that protocols for MRI diffusion imaging may be adapted to more sensitive detection of pathology at different sites of the central nervous system.


Assuntos
Diagnóstico por Imagem , Imagem de Tensor de Difusão , Degeneração Neural/diagnóstico , Doença de Parkinson/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Tronco Encefálico/diagnóstico por imagem , Tronco Encefálico/patologia , Imagem de Difusão por Ressonância Magnética , Feminino , Substância Cinzenta/diagnóstico por imagem , Substância Cinzenta/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Degeneração Neural/diagnóstico por imagem , Degeneração Neural/patologia , Doença de Parkinson/diagnóstico por imagem , Doença de Parkinson/patologia , Substância Negra/diagnóstico por imagem , Substância Negra/patologia , Tálamo/diagnóstico por imagem , Tálamo/patologia
18.
J Neurol ; 266(7): 1756-1770, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31161388

RESUMO

BACKGROUND: Drug-based therapeutic approaches for Parkinson's disease dementia (PDD) and dementia with Lewy bodies (DLB) are moderately effective and not always tolerated. Tailoring psychosocial approaches in PDD and DLB may offer additional support and improve outcomes. We adapted home-based, care partner-delivered Cognitive Stimulation Therapy (CST) for individuals with PDD or DLB and their care partners (CST-PD). OBJECTIVES: To evaluate the feasibility, acceptability, and tolerability of CST-PD. METHODS: This randomised controlled trial used mixed methods, including a process evaluation. People with PDD, DLB or mild cognitive impairment in PD (PD-MCI) and their care partners were randomised to 12 weeks of treatment as usual (TAU) or CST-PD. Outcomes were feasibility of the study conduct (i.e., recruitment, retention rate) and acceptability and tolerability of the intervention. Measures included rating scales, researcher field notes, therapy diaries, and exploratory clinical and care partner efficacy measures. RESULTS: The recruitment target was met with 76 consenting participant-dyads. Retention in both arms was high at over 70%. More than 90% of dyads undertook discrete sessions greater than 20 min duration, but the average number of sessions completed was lower than the recommended dose. Acceptability ratings (i.e., interest, motivation and sense of achievement) of the intervention were high. Participants reported no serious adverse events related to the intervention. CONCLUSIONS: The field of psychosocial interventions for PDD and DLB is newly emerging, and we demonstrated that this type of intervention is acceptable and well tolerated. Evaluating its clinical effectiveness in a full-scale randomized controlled clinical trial is warranted. TRIAL REGISTRATION NUMBER: The trial is a psychosocial intervention with an allocated ISRCTN number 11455062.


Assuntos
Terapia Cognitivo-Comportamental/métodos , Doença por Corpos de Lewy/psicologia , Doença por Corpos de Lewy/terapia , Doença de Parkinson/psicologia , Doença de Parkinson/terapia , Idoso , Estudos de Viabilidade , Feminino , Humanos , Doença por Corpos de Lewy/diagnóstico por imagem , Masculino , Doença de Parkinson/diagnóstico por imagem , Projetos Piloto , Método Simples-Cego , Resultado do Tratamento
19.
A A Pract ; 12(11): 406-408, 2019 Jun 03.
Artigo em Inglês | MEDLINE | ID: mdl-31162170

RESUMO

Magnetic resonance-guided focused ultrasound thalamotomy is an innovative minimally invasive treatment for medication-resistant tremor in patients with essential tremor and Parkinson disease. Sedation with common hypnotic agents is discouraged because the patient's cooperation is required during the procedure, and these drugs interact with the patient's tremor, interfering with the results of intraprocedural neurological evaluations. Dexmedetomidine may be the best choice for sedation during magnetic resonance-guided focused ultrasound thalamotomy, which can be prolonged and poorly tolerated by the awake patient. We report the first use of dexmedetomidine for sedation in magnetic resonance-guided focused ultrasound thalamotomy in 3 patients: none of them experienced relevant hemodynamic changes or apnea.


Assuntos
Dexmedetomidina/administração & dosagem , Hipnóticos e Sedativos/administração & dosagem , Transtornos dos Movimentos/cirurgia , Tálamo/cirurgia , Idoso , Tremor Essencial/diagnóstico por imagem , Tremor Essencial/cirurgia , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Transtornos dos Movimentos/diagnóstico por imagem , Doença de Parkinson/diagnóstico por imagem , Doença de Parkinson/cirurgia , Psicocirurgia , Tálamo/diagnóstico por imagem , Resultado do Tratamento , Ultrassonografia
20.
Acta Neurol Scand ; 140(4): 268-273, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31190374

RESUMO

OBJECTIVE: This study primarily aims to explore the value of combining the measurement of plasma α-synuclein oligomer levels with enhanced T2 star-weighted angiography (ESWAN) in the early diagnosis of Parkinson's disease. METHODS: Sixty patients with early Parkinson's disease and 30 normal adults, with similar ages and genders, were enrolled in the study. Their levels of plasma α-synuclein oligomers were measured, and ESWAN was performed. The amplitudes, phases and R2* values of the head, body and tail of the ipsilateral and contralateral substantia nigra pars compacta (SNc) were measured, at the side of the limb with severe symptoms or early symptoms. The receiver operating characteristic (ROC) curve was used to explore the value of these indexes in the early diagnosis of Parkinson's disease. RESULTS: The plasma level of α-synuclein oligomer was significantly higher in the experimental group than in the control group (P < 0.05). The amplitude values of the head and tail of contralateral SNcs were significantly lower in the experimental group than in the control group (P < 0.05). In the single-index assessment, the serum α-synuclein oligomer had the highest specificity (70%), while the sensitivity of the amplitude of the head and tail of the contralateral SNc was 75% and 80%, respectively. The area under the curve, for the combination of these three indicators, was 0.827, diagnostic efficiency was particularly high, and sensitivity and specificity both reached 80%. CONCLUSION: The combined detection of plasma α-synuclein oligomer and amplitude of the head and tail of the SNc has high diagnostic specificity and sensitivity.


Assuntos
Doença de Parkinson/sangue , Doença de Parkinson/diagnóstico por imagem , Parte Compacta da Substância Negra/diagnóstico por imagem , alfa-Sinucleína/sangue , Adulto , Idoso , Biomarcadores/sangue , Diagnóstico Precoce , Feminino , Humanos , Angiografia por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA