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Shujaat F, Soomro N, Khan M. The effectiveness of Kayaking exercises as compared to general mobility exercises in reducing axial rigidity and improve bed mobility in early to mid stage of Parkinson's disease. Pak J Med Sci 2014; 30:1094-8. [PMID: 25225533 PMCID: PMC4163239 DOI: 10.12669/pjms.305.5231] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2014] [Revised: 06/06/2014] [Accepted: 06/08/2014] [Indexed: 11/24/2022] Open
Abstract
Objective: To determine the effectiveness of kayaking exercises in the management of axial rigidity, improve bed mobility by improving trunk rotation in Parkinson’s patients. Methods: Experimental randomized controlled trail conducted at Physiotherapy department of IPM&R, DUHS and neurology Outpatient Department of Civil Hospital Karachi. Sample size of 48 was calculated with the use of openEpi. After baseline assessment 24 participants were assigned to each Kayaking exercise and general mobility exercise groups. Both groups received treatment for 75 minutes, 6 days a week for 4 weeks. Pre and post treatment measurements were determined by goniometer that assessed the cervical and thoracolumbar rotations whereas bed mobility was assessed by Modified Parkinson’s Activity Scale (MPAS). Results: In Kayaking group mean cervical spine left rotation increased from 32.95+ 9.66 to 47.25 + 10.58, right side cervical spine rotation increased from 34.00 + 10.32 to 47.58 + 11.96, left side thoracolumbar rotation increased from 23.67 + 4.70 to 28.16 + 3.44, right side thoracolumbar rotation increased from 20.79 + 5.34 to 26.45 + 4.62. In control group mean cervical spine left rotation increased from 34.66+ 9.26 to 43.08 + 8.70, right side cervical spine rotation increased from 35.37 + 9.77 to 43.83 + 9.59 , left side thoracolumbar rotation increased from 23.70 + 4.77 to 26.87 + 3.73, right side thoracicolumbar rotation increased from 21.16 + 5.29 to 24.95 + 4.53 (P value <0.001).. Bed mobility on MPAS scale also showed significant improvements (P value <0.001). Conclusion: Both Kayaking and general exercises resulted in significant improvements after 4 weeks of treatment. However, Kayaking exercises were slightly more beneficial than general exercises.
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Affiliation(s)
- Faiza Shujaat
- Faiza Shujaat, MSPT, Institute of Physical Medicine & Rehabilitation, Dow University of Health Sciences Karachi Pakistan
| | - Nabila Soomro
- Dr. Nabila Soomro, FCPS, Institute of Physical Medicine & Rehabilitation, Dow University of Health Sciences Karachi Pakistan
| | - Muhammad Khan
- Muhammad Khan, MSc.PT, Institute of Physical Medicine & Rehabilitation, Dow University of Health Sciences Karachi Pakistan
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Val158Met polymorphism of COMT gene and Parkinson’s disease risk in Asians. Neurol Sci 2014; 36:109-15. [DOI: 10.1007/s10072-014-1896-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2014] [Accepted: 07/16/2014] [Indexed: 11/25/2022]
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Tai Chi for improvement of motor function, balance and gait in Parkinson's disease: a systematic review and meta-analysis. PLoS One 2014; 9:e102942. [PMID: 25047456 PMCID: PMC4105461 DOI: 10.1371/journal.pone.0102942] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Accepted: 06/21/2014] [Indexed: 11/19/2022] Open
Abstract
Background Recently, several studies assessed the effectiveness of Tai Chi for Parkinson's disease (PD), but the role of Tai Chi in the management of PD remained controversial. Therefore, the purpose of this systematic review is to evaluate the evidence on the efficacy of Tai Chi for PD. Methods Six English and Chinese electronic databases, up to April 2014, were searched to identify relevant studies. The risk of bias in eligible studies was assessed by Cochrane Collaboration's tools. The primary outcomes were motor function, balance and gait in individuals with PD. Standardized mean difference (SMD) and 95% confidence intervals (CI) of random-effect model were calculated. And heterogeneity was assessed based on the I2statistic. Results 7 randomized controlled trials and 1 non-randomized controlled trial were eligible. The aggregated results suggested that Tai Chi showed beneficial effects in improving motor function (SMD, −0.57; 95% CI −1.11 to −0.04; p = 0.03), balance (SMD, 1.22; 95% CI 0.80 to 1.65; p<0.00001) and functional mobility (SMD, 1.06; 95% CI 0.68 to 1.44; p<0.00001) in patients with PD, but not in improving gait velocity (SMD, −0.02; 95% CI −0.58 to 0.54; p = 0.94), step length (SMD, −0.00; 95% CI −0.57 to 0.56; p = 0.99), or gait endurance (SMD, 0.53; 95% CI −0.07 to 1.12; p = 0.08). Comparing with other active therapies, however, Tai Chi only showed better effects in improving balance (SMD, 0.74; 95% CI 0.38 to 1.10; p<0.0001). Conclusion Tai Chi should be a valid complementary and alternative therapy for PD, especially in improving motor function and balance. However, more studies with long follow-up are warrant to confirm the current finding of Tai Chi for PD.
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Mufaddel AA, Al-Hassani GA. Familial idiopathic basal ganglia calcification (Fahr`s disease). NEUROSCIENCES (RIYADH, SAUDI ARABIA) 2014; 19:171-7. [PMID: 24983277 PMCID: PMC4727649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Familial idiopathic basal ganglia calcification (Fahr`s disease) is a rare neurodegenerative disorder characterized by symmetrical and bilateral calcification of the basal ganglia. Calcifications may also occur in other brain regions such as dentate nucleus, thalamus, and cerebral cortex. Both familial and non-familial cases of Fahr`s disease have been reported, predominantly with autosomal-dominant fashion. The disease has a wide range of clinical presentations, predominantly with neuropsychiatric features and movement disorders. Psychiatric features reported in the literature include: cognitive impairment, depression, hallucinations, delusions, manic symptoms, anxiety, schizophrenia-like psychosis, and personality change. Other clinical features include: Parkinsonism, ataxia, headache, seizures, vertigo, stroke-like events, orthostatic hypotension, tremor, dysarthria, and paresis. Fahr`s disease should be considered in the differential diagnosis of psychiatric symptoms, particularly when associated with movement disorder. The disease should be differentiated from other conditions that can cause intracranial calcification. No specific treatment is currently available. Further research is needed to bridge the gap existing in our current knowledge of the prevalence, etiology, symptoms, and treatment of Fahr`s disease.
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Affiliation(s)
- Amir A Mufaddel
- Community Mental Health Services, Behavioural Sciences Institute, Al-Ain Hospital, PO Box 1006, Al-Ain, United Arab Emirates. E-mail:
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Jacobson SA, Morshed T, Dugger BN, Beach TG, Hentz JG, Adler CH, Shill HA, Sabbagh MN, Belden CM, Sue LI, Caviness JN, Hu C. Plaques and tangles as well as Lewy-type alpha synucleinopathy are associated with formed visual hallucinations. Parkinsonism Relat Disord 2014; 20:1009-14. [PMID: 25027359 DOI: 10.1016/j.parkreldis.2014.06.018] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Revised: 06/12/2014] [Accepted: 06/19/2014] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Previous research has linked complex or formed visual hallucinations (VH) to Lewy-type alpha-synucleinopathy (LTS) in neocortical and limbic areas. As Alzheimer's disease pathology often co-occurs with LTS, we questioned whether this pathology - amyloid plaques and neurofibrillary tangles - might also be linked to VH. METHODS We performed a semi-quantitative neuropathological study across brainstem, limbic, and cortical structures in subjects with a documented clinical history of VH and a clinicopathological diagnosis of Parkinson's disease (PD), Alzheimer's disease (AD), or dementia with Lewy bodies (DLB). 173 subjects - including 50 with VH and 123 without VH - were selected from the Arizona Study of Aging and Neurodegenerative Disorders. Clinical variables examined included the Mini-mental State Exam, Hoehn & Yahr stage, and total dopaminergic medication dose. Neuropathological variables examined included total and regional LTS and plaque and tangle densities. RESULTS A significant relationship was found between the density of LTS and the presence of VH in PD, AD, and DLB. Plaque and tangle densities also were associated with VH in PD (p = .003 for plaque and p = .004 for tangles) but not in AD, where densities were high regardless of the presence of hallucinations. Furthermore, with DLB cases excluded, comorbidity of PD and AD was significantly more prevalent among subjects + VH than subjects -VH (p < .001). CONCLUSION These findings suggest that both AD and PD neuropathology contribute to the pathogenesis of VH. Incident VH could be predictive of concomitant AD/PD pathology even when criteria are not met for a second diagnosis.
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Affiliation(s)
- Sandra A Jacobson
- University of Arizona College of Medicine-Phoenix Campus, Phoenix, AZ, USA; Banner Sun Health Research Institute, Sun City, AZ, USA.
| | - Trisha Morshed
- University of Arizona College of Medicine-Phoenix Campus, Phoenix, AZ, USA
| | | | | | | | | | - Holly A Shill
- University of Arizona College of Medicine-Phoenix Campus, Phoenix, AZ, USA
| | - Marwan N Sabbagh
- University of Arizona College of Medicine-Phoenix Campus, Phoenix, AZ, USA; Banner Sun Health Research Institute, Sun City, AZ, USA
| | | | - Lucia I Sue
- Banner Sun Health Research Institute, Sun City, AZ, USA
| | | | - Chengcheng Hu
- University of Arizona Mel and Enid Zuckerman College of Public Health, Tucson, AZ, USA
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Smits EJ, Tolonen AJ, Cluitmans L, van Gils M, Conway BA, Zietsma RC, Leenders KL, Maurits NM. Standardized handwriting to assess bradykinesia, micrographia and tremor in Parkinson's disease. PLoS One 2014; 9:e97614. [PMID: 24854199 PMCID: PMC4031150 DOI: 10.1371/journal.pone.0097614] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Accepted: 04/22/2014] [Indexed: 11/23/2022] Open
Abstract
Objective To assess whether standardized handwriting can provide quantitative measures to distinguish patients diagnosed with Parkinson's disease from age- and gender-matched healthy control participants. Design Exploratory study. Pen tip trajectories were recorded during circle, spiral and line drawing and repeated character ‘elelelel’ and sentence writing, performed by Parkinson patients and healthy control participants. Parkinson patients were tested after overnight withdrawal of anti-Parkinsonian medication. Setting University Medical Center Groningen, tertiary care, the Netherlands. Participants Patients with Parkinson's disease (n = 10; mean age 69.0 years; 6 male) and healthy controls (n = 10; mean age 68.1 years; 6 male). Interventions Not applicable. Main Outcome Measures Movement time and velocity to detect bradykinesia and the size of writing to detect micrographia. A rest recording to investigate the presence of a rest-tremor, by frequency analysis. Results Mean disease duration in the Parkinson group was 4.4 years and the patients were in modified Hoehn-Yahr stages 1–2.5. In general, Parkinson patients were slower than healthy control participants. Median time per repetition, median velocity and median acceleration of the sentence task and median velocity of the elel task differed significantly between Parkinson patients and healthy control participants (all p<0.0014). Parkinson patients also wrote smaller than healthy control participants and the width of the ‘e’ in the elel task was significantly smaller in Parkinson patients compared to healthy control participants (p<0.0014). A rest-tremor was detected in the three patients who were clinically assessed as having rest-tremor. Conclusions This study shows that standardized handwriting can provide objective measures for bradykinesia, tremor and micrographia to distinguish Parkinson patients from healthy control participants.
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Affiliation(s)
- Esther J. Smits
- Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
- * E-mail:
| | | | - Luc Cluitmans
- VTT Technical Research Centre of Finland, Tampere, Finland
| | - Mark van Gils
- VTT Technical Research Centre of Finland, Tampere, Finland
| | - Bernard A. Conway
- The Department of Biomedical Engineering, University of Strathclyde, Glasgow, United Kingdom
| | | | - Klaus L. Leenders
- Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Natasha M. Maurits
- Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
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PAR2-mediated epigenetic upregulation of α-synuclein contributes to the pathogenesis of Parkinson׳s disease. Brain Res 2014; 1565:82-9. [DOI: 10.1016/j.brainres.2014.04.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Revised: 04/10/2014] [Accepted: 04/11/2014] [Indexed: 12/22/2022]
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de Rus Jacquet A, Subedi R, Ghimire SK, Rochet JC. Nepalese traditional medicine and symptoms related to Parkinson's disease and other disorders: Patterns of the usage of plant resources along the Himalayan altitudinal range. JOURNAL OF ETHNOPHARMACOLOGY 2014; 153:178-189. [PMID: 24556225 DOI: 10.1016/j.jep.2014.02.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Revised: 02/07/2014] [Accepted: 02/08/2014] [Indexed: 06/03/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Nepal is a hotspot for cultural and biological diversities. The tremendous diversity of ecosystems and climates and the blend of medicinal practices inherited from Ayurvedic and Traditional Tibetan Medicine are well suited to a study aimed at discovering information about medicinal plants to treat Parkinson's disease (PD). In addition, this study across Nepal's altitudinal range is relevant to understanding how cultural and ecological environments influence local traditional medicines. The aim of the study is to document the uses of medicinal plants in three different eco-geographical areas of Nepal (Chitwan-Panchase-Mustang) to treat symptoms related to PD. A second goal is to analyze the impact of culture and environment on the evolution of traditional medicine. MATERIALS AND METHODS The study was conducted in five communities located in three different eco-geographical environments and at altitudes ranging from 300m to 3700m. We interviewed a total of 56 participants (local people, folk, Ayurvedic and Amchi healers) across the three research areas. We conducted open-ended interviews to document the uses of medicinal plants to treat PD-related symptoms. Information provided by the interviewees suggested that the medicinal plants are also used to treat symptoms related to other disorders. We determined the informant consensus factor as well as the importance of specific plant species to (i) identify plants that are the best candidates to be analyzed experimentally for their potential to treat PD and (ii) perform a cross-cultural comparison of the three areas of study. RESULTS This study reports the local uses of 35 different plant species along the Chitwan-Panchase-Mustang altitudinal range. We identify a total of eight plant species that were used in all three research areas, and more specifically one species used to treat PD-like symptoms. We identify a potential dual protective activity of medicinal plants used to treat PD-related symptoms as recent literature suggests that these plants also have anti-cancer properties. In addition, we document that the presence of Ayurvedic healers could influence local practices and that local practices could influence local Ayurvedic practices. CONCLUSIONS This study documents the uses of medicinal plants to treat symptoms related to PD and other disorders across the Chitwan-Panchase-Mustang altitudinal range. PD is a neurodegenerative disease affecting a growing number of people worldwide. No cures are available to slow the death of the neurons, and there is a critical need to work towards innovative therapeutic strategies. We identify medicinal plants based on traditional practices to help develop a cure for PD. The three areas of study were chosen for their ecological and cultural diversities, and two of these are included in conservation programs (Panchase Protected Forest and Annapurna Conservation Area). The documentation of community-natural resource relationships is another step in the preservation of traditional practices and local biodiversity and a reflection of communities' rights in the design of conservation programs.
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Affiliation(s)
- Aurélie de Rus Jacquet
- Purdue University, Heine Pharmacy Building, 575 Stadium Mall Drive, West Lafayette, IN 47907, USA.
| | - Rupa Subedi
- Tribhuvan University, Central Department of Botany, Tribhuvan University (TU), Kirtipur, Post Box 26429, Kathmandu, Nepal.
| | - Suresh K Ghimire
- Tribhuvan University, Central Department of Botany, Tribhuvan University (TU), Kirtipur, Post Box 26429, Kathmandu, Nepal.
| | - Jean-Christophe Rochet
- Purdue University, Heine Pharmacy Building, 575 Stadium Mall Drive, West Lafayette, IN 47907, USA.
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Long-term mortality analysis in Parkinson's disease treated with deep brain stimulation. PARKINSONS DISEASE 2014; 2014:717041. [PMID: 24772365 PMCID: PMC3960527 DOI: 10.1155/2014/717041] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2013] [Revised: 01/25/2014] [Accepted: 01/27/2014] [Indexed: 11/18/2022]
Abstract
Background. Few data have been published regarding long-term mortality in patients with Parkinson's disease treated with DBS. Methods. This study analyzed long-term mortality rates, causes, and correlates in PD patients treated with DBS. Results. 184 consecutive patients were included; mean follow-up was 50 months. Fifteen deaths occurred (total 8.15%, annual mortality rate 1.94%). Mean age at disease onset and at surgery was 48 ± 2.4 and 63 ± 1.6 years, respectively. Mean disease duration until death was 21 ± 7.8 years. Most deaths related to stroke, myocardial infarction, other vascular/heart disorders, or severe infection; one suicide was recorded. Deceased PD patients were mostly male and had lower motor benefit after DBS, but univariate analysis failed to show significant differences regarding gender and motor benefit. Survival was 99% and 94% at 3 and 5 years. Conclusions. Long-term survival is to be expected in PD patients treated with DBS, possibly higher than previously expected. Death usually supervenes due to vascular events or infection.
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Xue X, Liu H, Qi L, Li X, Guo C, Gong D, Qu H. Baicalein ameliorated the upregulation of striatal glutamatergic transmission in the mice model of Parkinson's disease. Brain Res Bull 2014; 103:54-9. [PMID: 24576689 DOI: 10.1016/j.brainresbull.2014.02.004] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Revised: 02/15/2014] [Accepted: 02/17/2014] [Indexed: 11/26/2022]
Abstract
Parkinson's disease (PD) is a common neurodegenerative disorder, which is characterized by a loss of projecting dopaminergic neurons in the substantia nigra and diminished dopamine level in the striatum. Dopaminergic deficit consequently leads to the alterations of striatal basal glutamatergic synaptic transmission and plasticity in the medium spiny neurons. The cytokines and neurotoxins released from the reactive immune cells induced the loss of the projecting dopaminergic neurons in the substantia nigra, which triggering the pathogenesis of PD. The present study investigated the effect of treatment with baicalein (5,6,7-trihydroxyflavone) on the central cytokine synthesis, striatal glutamatergic transmission, and behavioral performance in the rotarod task in the mice injected with 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP). Treatment with baicalein significantly attenuated the upregulation of striatal basal glutamatergic strength by decreasing the presynaptic glutamate release and recovering the insertion of postsynaptic glutamate receptor subunit GluR1 induced by MPTP. It also significantly improved the behavioral performance in the rotarod task in the mice injected with MPTP. Treatment with baicalein decreased the upregulation of cytokines (tumor necrosis factor-α and interleukin-1β) in the substantia nigra and striatum in the mice injected with MPTP. These results indicated that baicalein might serve as novel approach for the treatment of the patients with PD.
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Affiliation(s)
- Xinhong Xue
- Department of Neurology, Liaocheng People's Hospital, Liaocheng 252000, Shandong, China
| | - Hong Liu
- Department of Neurology, Liaocheng People's Hospital, Liaocheng 252000, Shandong, China.
| | - Lifeng Qi
- Department of Neurology, Liaocheng People's Hospital, Liaocheng 252000, Shandong, China
| | - Xueli Li
- Department of Neurology, Liaocheng People's Hospital, Liaocheng 252000, Shandong, China
| | - Cunju Guo
- Department of Neurology, Liaocheng People's Hospital, Liaocheng 252000, Shandong, China
| | - Dianrong Gong
- Department of Neurology, Liaocheng People's Hospital, Liaocheng 252000, Shandong, China
| | - Huaiqian Qu
- Department of Neurology, Liaocheng People's Hospital, Liaocheng 252000, Shandong, China
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Lee E, Park HR, Ji ST, Lee Y, Lee J. Baicalein attenuates astroglial activation in the 1-methyl-4-phenyl-1,2,3,4-tetrahydropyridine-induced Parkinson's disease model by downregulating the activations of nuclear factor-κB, ERK, and JNK. J Neurosci Res 2013; 92:130-9. [DOI: 10.1002/jnr.23307] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2012] [Revised: 08/24/2013] [Accepted: 08/30/2013] [Indexed: 12/16/2022]
Affiliation(s)
- Eunjin Lee
- Department of Pharmacy; College of Pharmacy; Molecular Inflammation Research Center for Aging Intervention; Pusan National University; Busan Republic of Korea
| | - Hee Ra Park
- Department of Pharmacy; College of Pharmacy; Molecular Inflammation Research Center for Aging Intervention; Pusan National University; Busan Republic of Korea
| | - Seung Taek Ji
- Department of Pharmacy; College of Pharmacy; Molecular Inflammation Research Center for Aging Intervention; Pusan National University; Busan Republic of Korea
| | - Yujeong Lee
- Department of Pharmacy; College of Pharmacy; Molecular Inflammation Research Center for Aging Intervention; Pusan National University; Busan Republic of Korea
| | - Jaewon Lee
- Department of Pharmacy; College of Pharmacy; Molecular Inflammation Research Center for Aging Intervention; Pusan National University; Busan Republic of Korea
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Faria P, Patrício M, Philipiak G, Caramelo F, Januário C, Freire A, Castelo-Branco M. Tremor modulations across periods with and without voluntary motion and limb load task demands using movement quantification. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2013; 2013:4338-4341. [PMID: 24110693 DOI: 10.1109/embc.2013.6610506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Understanding the neurobiological mechanisms underlying different types of tremor and the altered functional connectivity of the involved areas is a timely goal in clinical neuroscience. If successful, this quest may open new perspectives on how to achieve tremor modulation, which is notably relevant, in Parkinson's disease (PD). Tremor can be characterized by simple parameters such as frequency and amplitude. It is therefore prone to be objectively targeted by neuromodulation and quantitatively investigated using multimodal techniques, such as, accelerometry, EMG and functional Magnetic Resonance Imaging (fMRI). Embarking on the latter challenge requires an a priori knowledge of how effective functional connectivity is altered in PD tremor. This works aims to ascertain which postural and voluntary movement tasks with distinct types of physical load are suitable for designing efficient fMRI protocols, by performing an accelerometry analysis to measure spontaneous and imposed tremor modulation on cohorts of PD patients, essential tremor patients and a group of voluntary healthy controls.
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214
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Rocha H, Cerejo A, Garrett MC, Massano J. Reversible parkinsonism due to a large intracranial tumour. BMJ Case Rep 2012; 2012:bcr-2012-007823. [PMID: 23266782 DOI: 10.1136/bcr-2012-007823] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
A 77-year-old woman presented with progressively worsening apathy, depression, urinary incontinence and slowness of movement for the past 1 year. Asymmetric akinetic-rigid parkinsonism and mild left-sided hyper-reflexia were seen on examination. No ocular movement impairment, cerebellar or sensory signs were noticed. Routine laboratory testing was normal. Brain imaging revealed a large frontal tumour which was subsequently excised and pathologically confirmed as a meningioma. Marked clinical improvement was documented 3 months after surgery, and persistent clinical and imaging remission have been confirmed annually for the following 3 years. There have been some reports of parkinsonism associated with intracranial tumours. Although this is probably an uncommon situation, it is potentially treatable, and symptoms might even remit completely following successful management. Parkinson's disease is a common cause of parkinsonism, but alternative aetiologies should be suspected whenever atypical findings are demonstrated by clinical history or examination.
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Affiliation(s)
- Helena Rocha
- Department of Neurology, Centro Hospitalar de São João, Oporto, Portugal
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215
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Massano J. Cognitive impairment and dementia-an update. Front Neurol 2012; 3:153. [PMID: 23112790 PMCID: PMC3480820 DOI: 10.3389/fneur.2012.00153] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2012] [Accepted: 10/08/2012] [Indexed: 12/03/2022] Open
Affiliation(s)
- João Massano
- Department of Neurology, Centro Hospitalar de São João Porto, Portugal ; Faculty of Medicine, Department of Clinical Neuroscience and Mental Health, University of Porto Porto, Portugal
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Abstract
The resident macrophages of the brain--the microglia--are morphologically activated during the progression of Parkinson's disease. Observational studies in human postmortem material and studies in animal models seek to define the contribution that this innate immune response might make to the pathogenesis and rate of progression of Parkinson's disease. We review here some of the key conceptual issues that need to be considered when performing these studies. We highlight the fact that most postmortem studies have not given due consideration to common comorbidities present in patients with Parkinson's disease and also the limitations of attempting to extrapolate from animal models to a chronic progressive neurodegenerative disease in humans that lasts for many years.
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Affiliation(s)
- V Hugh Perry
- School of Biological Sciences, University of Southampton, Southampton, UK.
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217
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Meireles J, Massano J. Cognitive impairment and dementia in Parkinson's disease: clinical features, diagnosis, and management. Front Neurol 2012; 3:88. [PMID: 22654785 PMCID: PMC3360424 DOI: 10.3389/fneur.2012.00088] [Citation(s) in RCA: 90] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2012] [Accepted: 05/07/2012] [Indexed: 12/15/2022] Open
Abstract
Parkinson’s disease (PD) is a common, disabling, neurodegenerative disorder. In addition to classical motor symptoms, non-motor features are now widely accepted as part of the clinical picture, and cognitive decline is a very important aspect of the disease, as it brings an additional significant burden for the patient and caregivers. The diagnosis of cognitive decline in PD, namely mild cognitive impairment (MCI) and dementia, can be extremely challenging, remaining largely based on clinical and cognitive assessments. Diagnostic criteria and methods for PD dementia and MCI have been recently issued by expert work groups. This manuscript has synthesized relevant data in order to obtain a pragmatic and updated review regarding cognitive decline in PD, from milder stages to dementia. This text will summarize clinical features, diagnostic methodology, and therapeutic issues of clinical decline in PD. Relevant clinical genetic issues, including recent advances, will also be approached.
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Affiliation(s)
- Joana Meireles
- Department of Neurology, Centro Hospitalar de São João Porto, Portugal
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Massano J, Garrett C. Deep brain stimulation and cognitive decline in Parkinson's disease: a clinical review. Front Neurol 2012; 3:66. [PMID: 22557991 PMCID: PMC3337446 DOI: 10.3389/fneur.2012.00066] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2012] [Accepted: 04/09/2012] [Indexed: 11/29/2022] Open
Abstract
Parkinson’s disease is a common and often debilitating disorder, with a growing prevalence accompanying global population aging. Current drug therapy is not satisfactory enough for many patients, especially after a few years of symptom progression. This is mainly due to the motor complications that frequently emerge as disease progresses. Deep brain stimulation (DBS) is a useful therapeutic option in carefully selected patients that significantly improves motor symptoms, functional status, and quality of life. However, cognitive impairment may limit patient selection for DBS, as patients need to have sufficient mental capabilities in order to understand the procedure, as well as its benefits and limitations, and cooperate with the medical team throughout the process of selection, surgery, and postsurgical follow-up. On the other hand it has been observed that certain aspects of cognitive performance may decline after DBS, namely when the therapeutic target is the widely used subthalamic nucleus. These are important pieces of information for patients, their families, and health care professionals. This manuscript reviews these aspects and their clinical implications.
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Affiliation(s)
- João Massano
- Movement Disorders and Functional Surgery Unit, Centro Hospitalar de São João Porto, Portugal
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