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1.
Emerg Med Clin North Am ; 39(1): 47-65, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33218662

RESUMO

The diagnosis and management of neurologic conditions are more complex at the extremes of age than in the average adult. In the pediatric population, neurologic emergencies are somewhat rare and some may require emergent consultation. In older adults, geriatric physiologic changes with increased comorbidities leads to atypical presentations and worsened outcomes. The unique considerations regarding emergency department presentation and management of stroke and altered mental status in both age groups is discussed, in addition to seizures and intracranial hemorrhage in pediatrics, and Parkinson's disease and meningitis in the geriatric population.


Assuntos
Emergências , Doenças do Sistema Nervoso/diagnóstico , Doença Aguda , Fatores Etários , Idoso , Criança , Demência/diagnóstico , Demência/terapia , Serviço Hospitalar de Emergência , Humanos , Hemorragias Intracranianas/diagnóstico , Hemorragias Intracranianas/terapia , Meningite/diagnóstico , Meningite/terapia , Doenças do Sistema Nervoso/terapia , Doença de Parkinson/diagnóstico , Doença de Parkinson/terapia , Convulsões/diagnóstico , Convulsões/terapia , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/terapia
2.
Einstein (Sao Paulo) ; 18: eRW5233, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-33263679

RESUMO

Parkinson's disease is the second most common neurodegenerative disorder in old age. Aging process for elders with Parkinson's disease can induce gait disturbances with more functional disabilities than for elders without the disease. Treadmill training as a therapy has resulted in notable effects on the gait of patients with Parkinson's disease and may be a resource for geriatric neurological rehabilitation. This review aimed to study the effects on gait after treadmill training in elderly patients with Parkinson's disease. The search was performed in the databases PubMed®, LILACS, PEDro and EMBASE, with the following keywords: "Parkinson's disease", "elderly", "treadmill training" and "gait evaluation". The quality of the studies included was assessed by PEDro Scale. Eleven studies met the inclusion and exclusion criteria. Eight studies were randomized, and only one did a follow-up. One can observe in this review that treadmill training with or without weight support (at least 20 minutes, two to three times a week, with progressive increase of loads, for minimum of 6 weeks) in elderly patients with the Parkinson's disease was effective to improve gait. In addition, both were considered safe (since some studies described the use of belts, even in unsupported training) and can be associated with therapies complementary to gait, such as repetitive transcranial magnetic stimulation, visual cues or anodal transcranial direct current stimulation. Treadmill training in elderly patients with Parkinson's disease is an intervention that improves gait outcomes, but further studies are required for better proofs.


Assuntos
Teste de Esforço/métodos , Transtornos Neurológicos da Marcha/terapia , Doença de Parkinson/terapia , Idoso , Terapia por Exercício , Transtornos Neurológicos da Marcha/etiologia , Humanos , Resultado do Tratamento
3.
PLoS One ; 15(12): e0243051, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33264321

RESUMO

BACKGROUND: The concerns of people with Parkinson's disease (PD) about their disease are often different from the objective clinical picture and subject to various influencing factors, including disease progression. Currently our understanding of these concerns is limited, particularly in Asian countries. METHODS: A 50-item survey on Parkinson's Disease Patients' Concerns (PDPC Survey) was developed by a multidisciplinary care team. The subjective greatest concerns (most commonly concerning symptoms) of patients at a specialist centre in Bangkok, Thailand, were explored and categorised according to disease stage and age at onset of PD. RESULTS: Data for 222 patients showed concerns varied widely. Motor symptoms giving the greatest concern were problems with walking and/or balance (40.5% of patients), while the most commonly concerning non-motor symptom (NMS) was constipation (41.0%). Patterns were observed amongst different patient subgroups. Early PD patients (H&Y stage 1) were more concerned about NMS than motor symptoms, while the reverse was true for advanced PD patients. Young-onset PD patients showed significantly greater concerns than typical-onset patients about motor symptoms relating to social functioning, working and stigmatisation, such as speech (p = 0.003). CONCLUSIONS: This study, in an Asian patient cohort, provides an assessment of a wide range of PD patients' concerns, encompassing not only motor symptoms and NMS, but also treatment-related adverse events, care in the advanced stage, and the need for assistive devices. Identifying the concerns of individual PD patients and implementing a patient-centred approach to care is critical to their wellbeing and optimal outcomes. The PDPC survey can help healthcare teams build a more accurate picture of patients' experiences to inform clinical management.


Assuntos
Doença de Parkinson/epidemiologia , Idade de Início , Idoso , Estudos de Coortes , Feminino , Pessoal de Saúde/estatística & dados numéricos , Humanos , Masculino , Doença de Parkinson/diagnóstico , Doença de Parkinson/patologia , Doença de Parkinson/terapia
4.
Arq Neuropsiquiatr ; 78(12): 811-814, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33331516

RESUMO

The authors review the role of Jules Bernard Luys in the discovery of the subthalamic nucleus (STN) over 150 years ago. The relationships between the STN and movement disorders, particularly hemiballismus and Parkinson's disease, are well known. The academic life of Jules Bernard Luys can be divided into two periods: a brilliant start as a neuroanatomist, culminating in the discovery of the STN, followed by a second period marked by a shift in his academic activity and an increased interest in topics such as hysteria, hypnotism and, eventually, esotericism.


Assuntos
Estimulação Encefálica Profunda , Discinesias , Hipnose , Doença de Parkinson , Núcleo Subtalâmico , Humanos , Histeria , Doença de Parkinson/terapia
5.
Mol Biol (Mosk) ; 54(6): 939-954, 2020.
Artigo em Russo | MEDLINE | ID: mdl-33276357

RESUMO

Parkinson's disease is a widespread neurodegenerative disease, which is characterized by the death of dopaminergic neurons in the substantia nigra of the midbrain. Clinically, the disease is manifested by tremor, bradykinesia, muscle rigidity, and other motor and non-motor symptoms that ultimately lead to disability. To date, there are only symptomatic treatment options for Parkinson's disease; therefore, the search for new approaches is one of the most important directions of therapy for this disease. In the 1970's the idea of using cell replacement therapy based on the local nature and specificity of damage to a particular type of neuron in Parkinson's disease originated. The selection of the source of cells, the method and place of introduction, indications for this operation, and peculiarities of patient management have been in development for a long time. The efficiency of cell replacement therapy has been confirmed by a number of studies on animal models. Clinical trials have already begun and several more are planned soon. This review describes the main prerequisites for the use of cell replacement therapy in Parkinson's disease, the stages of development of this method, and clinical trials that have started in the last few years.


Assuntos
Terapia Baseada em Transplante de Células e Tecidos , Doença de Parkinson , Animais , Neurônios Dopaminérgicos/patologia , Humanos , Mesencéfalo/patologia , Doença de Parkinson/terapia , Substância Negra/patologia
7.
Am Fam Physician ; 102(11): 679-691, 2020 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-33252908

RESUMO

Parkinson disease is a progressive neurodegenerative disorder with significant morbidity and mortality. Most patients consult with their primary care physician about Parkinson disease symptoms before seeking care from a specialist. The diagnosis of Parkinson disease is clinical, and key disease features are bradykinesia, rigidity, and tremor. The main diagnostic signs of Parkinson disease are motor symptoms; however, Parkinson disease is also associated with nonmotor symptoms, including autonomic dysfunction, depression, and hallucinations, which can make the initial diagnosis of Parkinson disease difficult. Disease progression is variable and clinical signs cannot be used to predict progression accurately. Therapies, including levodopa, have not demonstrated the ability to slow disease progression. Motor symptoms are managed with carbidopa/levodopa, monoamine oxidase-B inhibitors, and nonergot dopamine agonists. Prolonged use and higher doses of levodopa result in dyskinesias and motor symptom fluctuations over time. Deep brain stimulation surgery is performed for patients who do not achieve adequate control with levodopa therapy. Deep brain stimulation is most effective for significant motor fluctuations, dyskinesias, and tremors. Nonmotor symptom therapies target patient-specific conditions during the disease course. Interdisciplinary team care can alleviate multiple symptoms of Parkinson disease.


Assuntos
Medicina de Família e Comunidade/métodos , Doença de Parkinson/diagnóstico , Doença de Parkinson/terapia , Antiparkinsonianos/uso terapêutico , Carbidopa/uso terapêutico , Terapia Combinada/métodos , Estimulação Encefálica Profunda , Progressão da Doença , Combinação de Medicamentos , Humanos , Levodopa/uso terapêutico , Doença de Parkinson/tratamento farmacológico , Modalidades de Fisioterapia
8.
PLoS One ; 15(11): e0241752, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33156830

RESUMO

OBJECTIVE: Intraoperative microelectrode recording (MER) and test-stimulation are regarded as the gold standard for proper placement of subthalamic (STN) deep brain stimulation (DBS) electrodes in Parkinson's disease (PD), requiring the patient to be awake during the procedure. In accordance with good clinical practice, most attending neurologists will request the clinically most efficacious trajectory for definite lead placement. However, the necessity of microelectrode-test-stimulation is disputed, as it may limit the access to DBS therapy, excluding those not willing or incapable of undergoing awake surgery. METHODS: We retrospectively analyzed the MERs and microelectrode-test-stimulation results with regard to the decision on definite lead placement and clinical outcome in a cohort of 67 PD-patients with STN-DBS. All patients received bilateral quadripolar ring electrodes. To ascertain overall procedural efficacy, we calculated the surgical index (SI) by comparing preoperative motor improvement induced by levodopa to that induced by stimulation 7 to 18 months after surgery, measured as the relative difference between ON and OFF-states on the Unified Parkinson's Disease Rating Scale motor part (UPDRS-3). Additionally, a side-specific surgical index (SSSI) was calculated using the unilateral assessable items of the UPDRS-3. The SSSI where microelectrode-test-stimulation overruled MER were compared to those where the result of microelectrode-test-stimulation was congruent to MER results. RESULTS: A total of 134 electrodes were analyzed. For final lead placement, the central trajectory was chosen in 54% of patient hemispheres. The mean SI was 0.99 (± 0.24). SSSI averaged 1.04 (± 0.45). In 37 lead placements, microelectrode-test-stimulation overruled MER in the final trajectory selection, in 27 of these lead placements adverse effects during microelectrode-test-stimulation were decisive. Neither the number of test electrodes used nor the STN-signal length had an impact on the SSSI. The SSSI did not differ between lead placements with MER/microelectrode-test-stimulation congruency and those where the results of microelectrode-test-stimulation initiated lead placement in a trajectory with shorter STN signal. CONCLUSION: Intraoperative testing is mandatory to ensure an optimal motor outcome of STN DBS in PD-patients when using quadripolar ring electrodes. However, we also demonstrated that neither the length of the STN-signal on MER nor the number of test electrodes influenced the motor outcome.


Assuntos
Estimulação Encefálica Profunda/instrumentação , Levodopa/uso terapêutico , Atividade Motora/efeitos dos fármacos , Doença de Parkinson/terapia , Núcleo Subtalâmico/cirurgia , Tomada de Decisão Clínica , Feminino , Humanos , Levodopa/efeitos adversos , Masculino , Microeletrodos , Pessoa de Meia-Idade , Doença de Parkinson/fisiopatologia , Guias de Prática Clínica como Assunto , Estudos Retrospectivos , Resultado do Tratamento
9.
Brain Nerve ; 72(11): 1159-1171, 2020 Nov.
Artigo em Japonês | MEDLINE | ID: mdl-33191295

RESUMO

Network disorders of the basal ganglia may underlie the pathophysiology of movement disorders, such as Parkinson's disease and dystonia. The following models have been proposed to explain network disorders: (1) the firing rate model: an activity imbalance between the direct, indirect, and hyperdirect pathways induces changes in the mean firing rate of the output nuclei of the basal ganglia and causes hypokinetic or hyperkinetic movement disorders, (2) the firing pattern model: oscillatory and/or synchronized activity in the basal ganglia disturbs information processing in this area, resulting in motor symptoms and, (3) the dynamic activity model: abnormal neuronal modulations through the direct, indirect, and hyperdirect pathways disrupt the balance between movement-related inhibition and surrounding excitation in the output nuclei, which leads to motor symptoms. We present a critical analysis of these models in this review. Stereotactic surgery, which involves the application of high-frequency electrical stimulation (deep brain stimulation) or coagulation of a small area in the basal ganglia is an effective therapeutic strategy to treat movement disorders. We have also discussed the mechanism underlying the beneficial effects of stereotactic surgery.


Assuntos
Doença de Parkinson , Gânglios da Base , Humanos , Movimento , Neurônios , Doença de Parkinson/terapia
10.
Brain Nerve ; 72(11): 1239-1246, 2020 Nov.
Artigo em Japonês | MEDLINE | ID: mdl-33191301

RESUMO

I describe quadripulse stimulation (QPS) briefly, and show several examples of its applications, such as rTMS treatment of Parkinson's disease, gait induction by lumbar rTMS, and roles of presupplementary motor area (pre-SMA) and SMA in visuo-motor sequence learning, role of SMA in negative compatibility effect, and role of dendritic back propagation potential in I-wave generation.


Assuntos
Córtex Motor , Doença de Parkinson , Humanos , Doença de Parkinson/terapia , Estimulação Magnética Transcraniana
11.
Zh Nevrol Psikhiatr Im S S Korsakova ; 120(10. Vyp. 2): 5-15, 2020.
Artigo em Russo | MEDLINE | ID: mdl-33205925

RESUMO

Palliative care is traditionally associated with cancer and pain relief: however, the range of diseases requiring palliative care is much wider and includes many neurodegenerative diseases (Alzheimer's disease and Parkinson's disease (PD)). Provision of palliative care to patients with PD and other neurodegenerative diseases, such as multisystem atrophy, progressive supranuclear palsy, dementia with Lewy bodies, etc. is «terra incognita¼ for many neurologists who are not acknowledged with palliative medicine as well as for specialists in palliative medicine, who are mainly trained in providing care to patients with oncological profile and do not know the intricacies of managing patients in the late stages of PD and other neurodegenerative diseases. The aim of the article is to systematize modern knowledge in the field of palliative medicine and neurodegenerative diseases.


Assuntos
Doença de Alzheimer , Atrofia de Múltiplos Sistemas , Doença de Parkinson , Paralisia Supranuclear Progressiva , Humanos , Cuidados Paliativos , Doença de Parkinson/terapia
12.
Parkinsonism Relat Disord ; 80: 203-205, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33046384

RESUMO

Palliative care emphasizes expertise in handling difficult conversations, discussing patients' wishes and supporting the caregiver(s). Here we outline the palliative approach of hoping for the best while preparing for the worst in several "what if" scenarios for people with Parkinson disease and their families during the COVID-19 pandemic.


Assuntos
/epidemiologia , Esperança , Cuidados Paliativos/tendências , Doença de Parkinson/epidemiologia , Doença de Parkinson/terapia , Cuidadores/tendências , Humanos , Cuidados Paliativos/métodos , Pandemias , Assistência Terminal/tendências
15.
Parkinsonism Relat Disord ; 80: 148-151, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33002722

RESUMO

INTRODUCTION: The coronavirus disease 2019 (COVID-19) pandemic has disrupted everyday life of Parkinson's disease (PD) patients, but its clinical impact has not been illustrated. In this study, we investigated the change in physical activity and subsequently clinical symptoms of PD during the COVID-19 pandemic. METHODS: We enrolled PD patients who were able to ambulate independently and had visited our clinic at Samsung Medical Centre from December 2019 to January 2020 (baseline) and in May 2020 (follow-up during the COVID-19 crisis), and divided them into either 'the sustained exercise group' or 'the reduced exercise group'. Then, we assessed the change in the exercise and clinical features between these two groups over the study period. RESULTS: A total of 100 subjects were recruited. During the COVID-19 pandemic, the amount, duration and frequency of exercise were reduced. There was decrease in number of patients who do indoor-solo exercise and increase in that of patients who do not exercise. One third reported subjective worsening of both motor and non-motor features, although Unified PD Rating Scale (UPDRS) part 3 score was similar. Additionally, the reduced exercise group reported more motor and non-motor aggravation than the sustained exercise group, despite lack of significant difference in the UPDRS part 3 score. CONCLUSION: The COVID-19 pandemic had a clear impact on exercise and subjective symptoms in PD patients, with reduced exercise being related to a subjective increase in both motor and non-motor symptoms of PD. Maintaining exercise should therefore be emphasized even in situations like the COVID-19 pandemic.


Assuntos
/epidemiologia , Terapia por Exercício/tendências , Exercício Físico/fisiologia , Doença de Parkinson/epidemiologia , Doença de Parkinson/terapia , Idoso , Exercício Físico/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Doença de Parkinson/psicologia , Qualidade de Vida/psicologia
16.
Adv Exp Med Biol ; 1266: 1-8, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33105491

RESUMO

Neurodegenerative diseases (NDs) are a group of neurological diseases caused by the progressive degeneration of neurons and glial cells in the brain and spinal cords. Usually there is a selective loss of specific neuronal cells in a restricted brain area from any neurodegenerative diseases, such as dopamine (DA) neuron death in Parkinson disease (PD) and motor neuron loss in amyotrophic lateral sclerosis (ALS), or a widespread degeneration affecting many types of neurons in Alzheimer's disease (AD). As there is no effective treatment to stop the progression of these neurodegenerative diseases, stem cell-based therapies have provided great potentials for these disorders. Currently transplantation of different stem cells or their derivatives has improved neural function in animal models of neurodegenerative diseases by replacing the lost neural cells, releasing cytokines, modulation of inflammation, and mediating remyelination. With the advance in somatic cell reprogramming to generate induced pluripotent stem cells (iPS cells) and directly induced neural stem cells or neurons, pluripotent stem cell can be induced to differentiate to any kind of neural cells and overcome the immune rejection of the allogeneic transplantation. Recent studies have proved the effectiveness of transplanted stem cells in animal studies and some clinical trials on patients with NDs. However, some significant hurdles need to be resolved before these preclinical results can be translated to clinic. In particular, we need to better understand the molecular mechanisms of stem cell transplantation and develop new approaches to increase the directed neural differentiation, migration, survival, and functional connections of transplanted stem cells in the pathological environment of the patient's central nerve system.


Assuntos
Células-Tronco Pluripotentes Induzidas , Doenças Neurodegenerativas , Células-Tronco Pluripotentes , Transplante de Células-Tronco , Esclerose Amiotrófica Lateral/terapia , Animais , Humanos , Células-Tronco Neurais , Doenças Neurodegenerativas/terapia , Doença de Parkinson/terapia
17.
Adv Exp Med Biol ; 1266: 21-38, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33105493

RESUMO

Parkinson's disease (PD) is one of the most common neurodegenerative diseases caused by specific degeneration and loss of dopamine neurons in substantia nigra of the midbrain. PD is clinically characterized by motor dysfunctions and non-motor symptoms. Even though the dopamine replacement can improve the motor symptoms of PD, it cannot stop the neural degeneration and disease progression. Electrical deep brain stimulation (DBS) to the specific brain areas can improve the symptoms, but it eventually loses the effectiveness. Stem cell transplantation provides an exciting potential for the treatment of PD. Current available cell sources include neural stem cells (NSCs) from fetal brain tissues, human embryonic stem cells (hESCs) isolated from blastocyst, and induced pluripotent stem cells (iPSCs) reprogrammed from the somatic cells such as the fibroblasts and blood cells. Here, we summarize the research advance in experimental and clinical studies to transplant these cells into animal models and clinical patients, and specifically highlight the studies to use hESCs /iPSCs-derived dopaminergic precursor cells and dopamine neurons for the treatment of PD, at last propose future challenges for developing clinical-grade dopaminergic cells for treating the PD.


Assuntos
Células-Tronco Embrionárias , Células-Tronco Pluripotentes Induzidas , Doença de Parkinson , Transplante de Células-Tronco , Animais , Neurônios Dopaminérgicos/patologia , Humanos , Doença de Parkinson/terapia
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