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Madan A, Brown T, Ray S, Agarwal P, Roy-Faderman I, Burdick D. A Novel Trial of Mirabegron and Behavioral Modification Including Pelvic Floor Exercise for Overactive Bladder in Parkinson's Disease (MAESTRO). Cureus 2022; 14:e31818. [PMCID: PMC9682970 DOI: 10.7759/cureus.31818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2022] [Indexed: 11/24/2022] Open
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2
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Xu Z, Elrashidy RA, Li B, Liu G. Oxidative Stress: A Putative Link Between Lower Urinary Tract Symptoms and Aging and Major Chronic Diseases. Front Med (Lausanne) 2022; 9:812967. [PMID: 35360727 PMCID: PMC8960172 DOI: 10.3389/fmed.2022.812967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 02/14/2022] [Indexed: 11/13/2022] Open
Abstract
Aging and major chronic diseases are risk factors for lower urinary tract symptoms (LUTS). On the other hand, oxidative stress (OS) is one of the fundamental mechanisms of aging and the development of chronic diseases. Therefore, OS might be a candidate mechanism linking these two clinical entities. This article aims to summarize the studies on the prevalence of LUTS, the role of OS in aging and chronic diseases, and the potential mechanisms supporting the putative link. A comprehensive literature search was performed to identify recent reports investigating LUTS and OS in major chronic diseases. In addition, studies on the impact of OS on the lower urinary tract, including bladder, urethra, and prostate, were collected and summarized. Many studies showed LUTS are prevalent in aging and major chronic diseases, including obesity, metabolic syndrome, diabetes, cardiovascular disease, hypertension, obstructive sleep apnea, autoimmune diseases, Alzheimer’s disease, and Parkinson’s disease. At the same time, OS is a key component in the pathogenesis of those chronic diseases and conditions. Recent studies also provided evidence that exacerbated OS can cause functional and/or structural changes in the bladder, urethra, and prostate, leading to LUTS. The reviewed data support the concept that OS is involved in multiple risk factors-associated LUTS, although further studies are needed to confirm the causative relationship. The specific ROS/RNS and corresponding reactions/pathways involved in chronic diseases and associated LUTS should be identified in the future and could serve as therapeutic targets.
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Affiliation(s)
- Zhenqun Xu
- Department of Surgery, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, United States
- Department of Urology, Shengjing Hospital, China Medical University, Shenyang, China
| | - Rania A. Elrashidy
- Department of Biochemistry, Faculty of Pharmacy, Zagazig University, Zagazig, Egypt
| | - Bo Li
- Department of Surgery, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, United States
- Department of Urology, Shengjing Hospital, China Medical University, Shenyang, China
| | - Guiming Liu
- Department of Surgery, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, United States
- *Correspondence: Guiming Liu,
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3
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Auffret M, Meuric V, Boyer E, Bonnaure-Mallet M, Vérin M. Oral Health Disorders in Parkinson's Disease: More than Meets the Eye. JOURNAL OF PARKINSONS DISEASE 2021; 11:1507-1535. [PMID: 34250950 PMCID: PMC8609694 DOI: 10.3233/jpd-212605] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Despite clinical evidence of poor oral health and hygiene in Parkinson’s disease (PD) patients, the mouth is often overlooked by both patients and the medical community, who generally focus on motor or psychiatric disorders considered more burdensome. Yet, oral health is in a two-way relationship with overall health—a weakened status triggering a decline in the quality of life. Here, we aim at giving a comprehensive overview of oral health disorders in PD, while identifying their etiologies and consequences. The physical (abnormal posture, muscle tone, tremor, and dyskinesia), behavioral (cognitive and neuropsychiatric disorders), and iatrogenic patterns associated with PD have an overall detrimental effect on patients’ oral health, putting them at risk for other disorders (infections, aspiration, pain, malnutrition), reducing their quality of life and increasing their isolation (anxiety, depression, communication issues). Interdisciplinary cooperation for prevention, management and follow-up strategies need to be implemented at an early stage to maintain and improve patients’ overall comfort and condition. Recommendations for practice, including (non-)pharmacological management strategies are discussed, with an emphasis on the neurologists’ role. Of interest, the oral cavity may become a valuable tool for diagnosis and prognosis in the near future (biomarkers). This overlooked but critical issue requires further attention and interdisciplinary research.
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Affiliation(s)
- Manon Auffret
- Behavior & Basal Ganglia Research Unit (EA 4712), University of Rennes 1, Rennes, France.,Institut des Neurosciences Cliniques de Rennes (INCR), Rennes, France
| | - Vincent Meuric
- INSERM, INRAE, Université de Rennes 1, CHU de Rennes, Nutrition Metabolisms and Cancer, Rennes, France
| | - Emile Boyer
- INSERM, INRAE, Université de Rennes 1, CHU de Rennes, Nutrition Metabolisms and Cancer, Rennes, France
| | - Martine Bonnaure-Mallet
- INSERM, INRAE, Université de Rennes 1, CHU de Rennes, Nutrition Metabolisms and Cancer, Rennes, France
| | - Marc Vérin
- Behavior & Basal Ganglia Research Unit (EA 4712), University of Rennes 1, Rennes, France.,Institut des Neurosciences Cliniques de Rennes (INCR), Rennes, France.,Movement Disorders Unit, Neurology Department, Pontchaillou University Hospital, Rennes, France
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4
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Duncan D. Role of the community nurse in Parkinson's disease and lower urinary disorders. Br J Community Nurs 2021; 26:251-254. [PMID: 33939461 DOI: 10.12968/bjcn.2021.26.5.251] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Parkinson's disease (PD) is an incurable and progressive neurodegenerative disorder. People with PD also have increased muscle weakness and the typical symptoms of tremor, stiffness, slowness, balance problems and/or gait disorders. Other symptoms may include an overactive bladder, urgency and nocturia which can often lead to incontinence. Treatment options vary are dependent on the cause of the incontinence and should focus on improving Quality of life with a multi-pronged diagnosis-specific approach that takes into consideration a patient's ability to comply with treatment. The article looks at the role of the community nurse in caring for patients with PD and lower urinary disorders. They have a key role in assessment of patients and supporting families with tailor made bladder training such as establish a regular toilet routine, education about pelvic floor exercises or supply of incontinence products.
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Affiliation(s)
- Debbie Duncan
- Lecturer (Education), School of Nursing and Midwifery, Queen's University, Belfast
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5
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Gupta A, LaFaver K, Duque KR, Lingaiah A, Meriwether KV, Gaskins J, Gomes J, Espay AJ, Mahajan A. Pelvic Floor Health in Women with Parkinson's Disease. JOURNAL OF PARKINSONS DISEASE 2021; 11:857-864. [PMID: 33579875 DOI: 10.3233/jpd-202491] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Urinary dysfunction and constipation, manifestations of pelvic floor dysfunction are common sources of disability and impaired quality of life in women with Parkinson's disease (PD). OBJECTIVE We sought to evaluate the pelvic floor health amongst women with PD and their reporting of bladder and bowel symptoms. METHODS We surveyed women with PD and age-matched controls about pelvic floor health using validated questionnaires. All participants completed the Pelvic Floor Disability Index (PFDI-20), the Pelvic Floor Impact Questionnaire (PFIQ-7) and the Patient-Reported Outcomes Measurement Information System (PROMIS) short form version 2.0 Cognitive Function 8a. Additionally, PD patients underwent the Movement Disorders Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS) scale and the Montreal Cognition Assessment (MoCA). RESULTS Women with PD (n = 59; age, 70.4±8.6 years, PROMIS cognitive score, 52.0±7.8) self-reported urinary symptoms to a greater extent than controls (n = 59; age, 70.2±8.7 years, PROMIS cognitive score, 51.0±10) (68% vs 43%, p < 0.01). The difference was mirrored by higher (worse) scores on both PFDI-20 (35.4 vs 15.6; p = 0.01) and PFIQ-7 (4.8 vs 0; p < 0.01) for PD women compared to controls. Only 63% of all participants with self-reported pelvic floor symptoms had previously reported these symptoms to a health care provider. There was no difference in utilization of specialty care between the two groups (30% vs 46%, p = 0.2). CONCLUSION Pelvic floor dysfunction, more common amongst women with PD, is underreported and undertreated. Our study identifies a key gap in care of women with PD.
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Affiliation(s)
- Ankita Gupta
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics & Gynecology, University of Louisville School of Medicine, Louisville, KY, USA
| | - Kathrin LaFaver
- Division of Movement disorders, Department of Neurology, University of Louisville School of Medicine, Louisville, KY, USA
| | - Kevin R Duque
- James J. and Joan A. Gardner Center for Parkinson's Disease and Movement Disorders, University of Cincinnati, Cincinnati, OH, USA
| | - Anushree Lingaiah
- Division of Movement disorders, Department of Neurology, University of Louisville School of Medicine, Louisville, KY, USA
| | - Kate V Meriwether
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics & Gynecology, University of Louisville School of Medicine, Louisville, KY, USA
| | - Jeremy Gaskins
- Department of Bioinformatics & Biostatistics, School of Public Health and Information Sciences, University of Louisville, Louisville, KY, USA
| | - Josephine Gomes
- Department of Family and Geriatric Medicine, University of Louisville, Louisville, KY, USA
| | - Alberto J Espay
- James J. and Joan A. Gardner Center for Parkinson's Disease and Movement Disorders, University of Cincinnati, Cincinnati, OH, USA
| | - Abhimanyu Mahajan
- James J. and Joan A. Gardner Center for Parkinson's Disease and Movement Disorders, University of Cincinnati, Cincinnati, OH, USA
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Mitchell SD, Sidiropoulos C. Therapeutic Applications of Botulinum Neurotoxin for Autonomic Symptoms in Parkinson's Disease: An Updated Review. Toxins (Basel) 2021; 13:226. [PMID: 33808714 PMCID: PMC8003355 DOI: 10.3390/toxins13030226] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 03/17/2021] [Accepted: 03/17/2021] [Indexed: 12/04/2022] Open
Abstract
Parkinson's disease is the most common age-related motoric neurodegenerative disease. In addition to the cardinal motor symptoms of tremor, rigidity, bradykinesia, and postural instability, there are numerous non-motor symptoms as well. Among the non-motor symptoms, autonomic nervous system dysfunction is common. Autonomic symptoms associated with Parkinson's disease include sialorrhea, hyperhidrosis, gastrointestinal dysfunction, and urinary dysfunction. Botulinum neurotoxin has been shown to potentially improve these autonomic symptoms. In this review, the varied uses of botulinum neurotoxin for autonomic dysfunction in Parkinson's disease are discussed. This review also includes discussion of some additional indications for the use of botulinum neurotoxin in Parkinson's disease, including pain.
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Affiliation(s)
- Steven D. Mitchell
- Department of Neurology, Michigan State University, East Lansing, MI 48824-7015, USA;
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Rukavina K, Batzu L, Boogers A, Abundes-Corona A, Bruno V, Chaudhuri KR. Non-motor complications in late stage Parkinson's disease: recognition, management and unmet needs. Expert Rev Neurother 2021; 21:335-352. [PMID: 33522312 DOI: 10.1080/14737175.2021.1883428] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Introduction: The burden of non-motor symptoms (NMS) is a major determinant of health-related quality of life in Parkinson's disease (PD), particularly at its late stage.Areas covered: The late stage is usually defined as the period from unstable advanced to the palliative stage, characterized by a combination of emerging treatment-resistant axial motor symptoms (freezing of gait, postural instability, falls and dysphagia), as well as both non-dopaminergic and dopaminergic NMS: cognitive decline, neuropsychiatric symptoms, aspects of dysautonomia, pain and sleep disturbances (insomnia and excessive day-time sleepiness). Here, the authors summarize the current knowledge on NMS dominating the late stage of PD and propose a pragmatic and clinically focused approach for their recognition and treatment.Expert opinion: The NMS progression pattern is complex and remains under-researched. While dopamine-dependent NMS may improve with dopamine replacement therapy, non-dopamine dependent NMS worsen progressively and culminate at the late stages of PD. Furthermore, some PD specific features could interact negatively with other comorbidities, multiple medication use and frailty - the evaluation of these aspects is important in the creation of personalized management plans in the late stage of PD.
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Affiliation(s)
- Katarina Rukavina
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology & Neuroscience at King's College and King's College Hospital NHS Foundation Trust, London, UK.,Parkinson Foundation Centre of Excellence, King's College Hospital, London, UK
| | - Lucia Batzu
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology & Neuroscience at King's College and King's College Hospital NHS Foundation Trust, London, UK.,Parkinson Foundation Centre of Excellence, King's College Hospital, London, UK
| | - Alexandra Boogers
- Department of Neurology, University Hospital Leuven, Leuven, U.Z, Belgium
| | - Arturo Abundes-Corona
- Department of Neurology, Clinical Laboratory of Neurodegenerative Diseases, National Institute of Neurology and Neurosurgery, Mexico City, México.,Neurology Department, American British Cowdray Medical Center IAP, Mexico City, Mexico
| | - Veronica Bruno
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - K Ray Chaudhuri
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology & Neuroscience at King's College and King's College Hospital NHS Foundation Trust, London, UK.,Parkinson Foundation Centre of Excellence, King's College Hospital, London, UK
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Gómez-López A, Sánchez-Sánchez A, Natera-Villalba E, Ros-Castelló V, Beltrán-Corbellini Á, Fanjul-Arbós S, Pareés Moreno I, López-Sendon Moreno JL, Martínez Castrillo JC, Alonso-Canovas A. SURINPARK: Safinamide for Urinary Symptoms in Parkinson's Disease. Brain Sci 2021; 11:57. [PMID: 33418858 PMCID: PMC7825064 DOI: 10.3390/brainsci11010057] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 12/22/2020] [Accepted: 01/04/2021] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Urinary symptoms are common, disabling and generally unresponsive to treatment in Parkinson´s disease (PD). Safinamide is approved as an add-on therapy to levodopa to improve fluctuations. METHODS Retrospective analysis of electronic records of nondemented PD patients seen consecutively in a Movement Disorders Unit (November 2018-February 2019). All were assessed with Scale for Outcomes in Parkinson's disease for Autonomic Symptoms-Urinary subscale (SCOPA-AUT-U) by the attending neurologist, and a month afterwards by an independent researcher blinded to treatment and clinical records in a routine clinical practice setting. Clinical variables were compared among patients who were prescribed safinamide (SA+) for the treatment of motor fluctuations and those with different treatment regimes (SA-). RESULTS From 169 patients screened initially, 54 were excluded due to severe incontinence, absence of urinary symptoms or previous safinamide treatment. Thirty-five patients were included in SA+ and 79 in SA-. Both groups were comparable in terms of clinical variables, except in basal urinary symptoms, with more severity in the SA+ group. In the follow-up assessment, total SCOPA-AUT-U, as well as urgency, incontinence, frequency and nocturia subscales improved significantly in the SA+ group, while the SA- group remained unchanged. CONCLUSIONS Safinamide could be helpful in the improvement of urinary symptoms in PD.
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Affiliation(s)
- Ana Gómez-López
- Neurology Department, Hospital Universitario Ramon y Cajal, 28034 Madrid, Spain; (A.S.-S.); (E.N.-V.); (V.R.-C.); (Á.B.-C.); (S.F.-A.); (I.P.M.); (J.L.L.-S.M.); (J.C.M.C.); (A.A.-C.)
| | - Arantxa Sánchez-Sánchez
- Neurology Department, Hospital Universitario Ramon y Cajal, 28034 Madrid, Spain; (A.S.-S.); (E.N.-V.); (V.R.-C.); (Á.B.-C.); (S.F.-A.); (I.P.M.); (J.L.L.-S.M.); (J.C.M.C.); (A.A.-C.)
| | - Elena Natera-Villalba
- Neurology Department, Hospital Universitario Ramon y Cajal, 28034 Madrid, Spain; (A.S.-S.); (E.N.-V.); (V.R.-C.); (Á.B.-C.); (S.F.-A.); (I.P.M.); (J.L.L.-S.M.); (J.C.M.C.); (A.A.-C.)
| | - Victoria Ros-Castelló
- Neurology Department, Hospital Universitario Ramon y Cajal, 28034 Madrid, Spain; (A.S.-S.); (E.N.-V.); (V.R.-C.); (Á.B.-C.); (S.F.-A.); (I.P.M.); (J.L.L.-S.M.); (J.C.M.C.); (A.A.-C.)
| | - Álvaro Beltrán-Corbellini
- Neurology Department, Hospital Universitario Ramon y Cajal, 28034 Madrid, Spain; (A.S.-S.); (E.N.-V.); (V.R.-C.); (Á.B.-C.); (S.F.-A.); (I.P.M.); (J.L.L.-S.M.); (J.C.M.C.); (A.A.-C.)
| | - Samira Fanjul-Arbós
- Neurology Department, Hospital Universitario Ramon y Cajal, 28034 Madrid, Spain; (A.S.-S.); (E.N.-V.); (V.R.-C.); (Á.B.-C.); (S.F.-A.); (I.P.M.); (J.L.L.-S.M.); (J.C.M.C.); (A.A.-C.)
- Movement Disorder Unit, Neurology Department, Hospital Universitario Ramon y Cajal, 28034 Madrid, Spain
| | - Isabel Pareés Moreno
- Neurology Department, Hospital Universitario Ramon y Cajal, 28034 Madrid, Spain; (A.S.-S.); (E.N.-V.); (V.R.-C.); (Á.B.-C.); (S.F.-A.); (I.P.M.); (J.L.L.-S.M.); (J.C.M.C.); (A.A.-C.)
- Movement Disorder Unit, Neurology Department, Hospital Universitario Ramon y Cajal, 28034 Madrid, Spain
| | - José Luis López-Sendon Moreno
- Neurology Department, Hospital Universitario Ramon y Cajal, 28034 Madrid, Spain; (A.S.-S.); (E.N.-V.); (V.R.-C.); (Á.B.-C.); (S.F.-A.); (I.P.M.); (J.L.L.-S.M.); (J.C.M.C.); (A.A.-C.)
- Movement Disorder Unit, Neurology Department, Hospital Universitario Ramon y Cajal, 28034 Madrid, Spain
| | - Juan Carlos Martínez Castrillo
- Neurology Department, Hospital Universitario Ramon y Cajal, 28034 Madrid, Spain; (A.S.-S.); (E.N.-V.); (V.R.-C.); (Á.B.-C.); (S.F.-A.); (I.P.M.); (J.L.L.-S.M.); (J.C.M.C.); (A.A.-C.)
- Movement Disorder Unit, Neurology Department, Hospital Universitario Ramon y Cajal, 28034 Madrid, Spain
| | - Araceli Alonso-Canovas
- Neurology Department, Hospital Universitario Ramon y Cajal, 28034 Madrid, Spain; (A.S.-S.); (E.N.-V.); (V.R.-C.); (Á.B.-C.); (S.F.-A.); (I.P.M.); (J.L.L.-S.M.); (J.C.M.C.); (A.A.-C.)
- Movement Disorder Unit, Neurology Department, Hospital Universitario Ramon y Cajal, 28034 Madrid, Spain
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Relationship between Lower Urinary Tract Dysfunction and Dementia. Dement Neurocogn Disord 2020; 19:77-85. [PMID: 32985147 PMCID: PMC7521953 DOI: 10.12779/dnd.2020.19.3.77] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 08/25/2020] [Indexed: 12/11/2022] Open
Abstract
Lower urinary tract dysfunction (LUTD) is a common health challenge in dementia patients with significant morbidity and socioeconomic burden. It often causes lower urinary tract (LUT) symptoms, restricts activities of daily life, and impairs quality of life. Among several LUT symptoms, urinary incontinence (UI) is the most prominent storage symptom in the later stages of dementia. UI in patients with dementia results not only from cognitive impairment, but also from urological defects such as detrusor overactivity. Management of LUTD in patients with dementia is based on multiple factors, including cognitive state, functional impairment, concurrent comorbidities, polypharmacy and urologic condition. Behavioral therapy under caregiver support represents appropriate treatment strategy for UI in these patients. Pharmacological treatment can be considered in patients refractory to behavioral therapy, but it is more effective when combined with behavioral therapy. Antimuscarinics and mirabegron, a beta-3 receptor agonist, are effective for managing storage symptoms involving the LUT. However, anticholinergic side effects in elderly subjects are a concern, particularly when there is a risk of exacerbating cognitive impairment with prolonged use of antimuscarinics. Proper recognition and treatment of LUTD in dementia can improve quality of life in these patients.
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10
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Zong H, Meng F, Zhang Y, Wei G, Zhao H. Clinical study of the effects of deep brain stimulation on urinary dysfunctions in patients with Parkinson's disease. Clin Interv Aging 2019; 14:1159-1166. [PMID: 31417246 PMCID: PMC6599892 DOI: 10.2147/cia.s204368] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 05/11/2019] [Indexed: 11/23/2022] Open
Abstract
Purpose: To evaluate the effect of deep brain stimulation (DBS) on urinary dysfunctions in Parkinson’s patients. Patients and methods: A total of 416 patients, diagnosed with Parkinson’s disease (PD) based on the UK Parkinson’s Disease Society Brain Bank Diagnostic Criteria, were enrolled in the study, including 307 males and 109 females. The effects of DBS treatment on urinary functions during urination and bladder storage of these patients were evaluated using testing and assessment scales, such as the American Urological Association Symptom Index (AUA-SI), Overactive Bladder Symptom Scores (OAB-SS), Quality Of Life Scale (QOL), and urodynamic tests. The data were statistically analyzed with the chi-square test and both independent-samples t-test and paired-samples t-test were used in this study. Results: Symptoms of urinary dysfunctions, such as urinary frequency, urgency, and incontinence, in the patients with PD were notably relieved by DBS treatment (P<0.05), and the OAB-SS and bladder storage problems were greatly improved as well (P<0.05). Compared with those in male patients, DBS surgery significantly improved the AUA-SI, urinary symptom scores, and QOL in female PD patients (P<0.05), as well as other functional indicators related to the urinary tract, including the maximum urinary flow rate, detrusor pressure at peak flow, and residual urine volume in female PD patients (P<0.05). Conclusion: DBS surgery is effective in improving urinary functions in PD patients, as primarily reflected by the alleviation of urinary symptoms such as urinary frequency, urgency, and incontinence. Female PD patients displayed better urinary function outcomes from DBS treatment than did male patients.
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Affiliation(s)
- Huantao Zong
- Department of Urology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Fangang Meng
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Yong Zhang
- Department of Urology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Guangzhu Wei
- Department of Urology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Huiqing Zhao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
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11
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Ye Q, Yuan XL, Yuan CX, Zhang HZ, Yang XM. Zishenpingchan granules for the treatment of Parkinson's disease: a randomized, double-blind, placebo-controlled clinical trial. Neural Regen Res 2018; 13:1269-1275. [PMID: 30028337 PMCID: PMC6065246 DOI: 10.4103/1673-5374.235075] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Levodopa preparations remain the preferred drug for Parkinson’s disease. However, long-term use of levodopa may lead to a series of motor complications. Previous studies have shown that the combination of levodopa and Zishenpingchan granules (consisting of Radix Rehmanniae preparata, Lycium barbarum, Herba Taxilli, Rhizoma Gastrodiae, Stiff Silkorm, Curcuma phaeocaulis, Radix Paeoniae Alba, Rhizoma Arisaematis, Scorpio and Centipede) can markedly improve dyskinesia and delay the progression of Parkinson’s disease, with especially dramatic improvements of non-motor symptoms. However, the efficacy of this combination has not been confirmed by randomized controlled trials. The current study was approved by the Hospital Ethics Committee and was registered in the Chinese Clinical Trial Register (registration number: ChiCTR-INR-1701194). From December 2014 to December 2016, 128 patients (72 males and 56 females, mean age of 65.78 ± 6.34 years) with Parkinson’s disease were recruited from the Department of Neurology of Longhua Hospital and Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine in China. Patients were equally allocated into treatment and control groups. In addition to treatment with dopamine, patients in treatment and control groups were given Zishenpingchan granules or placebo, respectively, for 24 weeks. Therapeutic efficacy was assessed using the Unified Parkinson’s Disease Rating Scale, on-off phenomenon, Hoehn-Yahr grade, Scales for Outcomes in Parkinson’s disease–Autonomic, Parkinson’s disease sleep scale, Hamilton Anxiety Scale, Hamilton Depression Scale, Mini-Mental State Examination, and the Parkinson’s Disease Quality of Life Questionnaire. Artificial neural networks were used to determine weights at which to scale these parameters. Our results demonstrated that Zishenpingchan granules significantly reduced the occurrence of motor complications, and were useful for mitigating dyskinesia and non-motor symptoms of Parkinson’s disease. This combination of Chinese and Western medicine has the potential to reduce levodopa dosages, and no obvious side effects were found. These findings indicate that Zishenpingchan granules can mitigate symptoms of Parkinson’s disease, reduce toxic side effects of dopaminergic agents, and exert synergistic and detoxifying effects.
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Affiliation(s)
- Qing Ye
- Department of Neurology, LONGHUA Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xiao-Lei Yuan
- Department of Neurology, LONGHUA Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Can-Xing Yuan
- Department of Neurology, LONGHUA Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Hong-Zhi Zhang
- Department of Neurology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xu-Ming Yang
- Acupuncture and Tuina College of Shanghai University of Traditional Chinese Medicine, Shanghai, China
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