Effects of transcranial pulsed electromagnetic field stimulation on quality of life in Parkinson's disease

BACKGROUND AND PURPOSE

Pulsed electromagnetic fields induce a protective and anti-inflammatory effect in the nervous system primarily due to growth factor upregulation that possibly abates neurodegeneration in Parkinson's disease (PD). This study investigated treatment effects of transcranial pulsed electromagnetic fields (T-PEMFs) on quality of life in PD and the feasibility and safety of this treatment.

METHODS

In this double-blinded clinical study, 97 participants with idiopathic PD (Hoehn & Yahr stage I-IV), on optimal medical anti-parkinsonian treatment, were block randomized (3:3) to either active (n = 49) or placebo treatment (n = 48). Treatment with T-PEMFs entailed one daily 30-min home treatment for eight consecutive weeks. The 39-item Parkinson's Disease Questionnaire (PDQ-39) was assessed at baseline and endpoint. A special questionnaire was used to profile adverse events by interviewing the participants over the full treatment period. Treatment compliance was accounted for by daily treatment registration.

RESULTS

The active group improved with respect to clinical effect size for the two dimensions, i.e. mobility and activities of daily living, compared with the placebo group. No between-group differences were found for the remaining PDQ-39 dimensions. There were no between-group difference in adverse events. Treatment compliance was 97.9%.

CONCLUSION

Treatment with T-PEMFs improved mobility and activities of daily living scores for clinical effect size only in the active group, indicating a positive treatment response for motor symptoms. No difference was found between the two groups for the remaining PDQ-39 dimensions. The treatment had no or only mild adverse events and was performed with high compliance.

Parkinson’s disease among Inuit in Greenland: organochlorines as risk factors

OBJECTIVES

In the present study we investigate organochlorines as possible risk factors for Parkinson's disease (PD) in an arctic population. This has never been done before.

STUDY DESIGN

Case-control study of Inuit in Greenland.

MATERIALS AND METHODS

Plasma from 31 PD (20 males and 11 females) (mean age 69 yr) and 122 controls (57 males and 65 females) (mean age 61 yr) was analysed for 31 PCBs and pesticides by dual-column GC-ECD and GC-NCI/MS.

RESULTS

Plasma concentrations of PCBs and pesticides were markedly increased in both PD and controls. The concentrations did not differ between the PD cases and controls. However, the mean DDE concentration was higher in PD than in controls (42.1 and 15.0 microg/l, respectively, and with a wide range among the PD cases). The difference was significant for log transformed DDE values after control for age and sex (p=0.005).

CONCLUSION

A few epidemiological studies indicate a possible connection between exposure to pesticides and PD. The idea that exposure to organochlorines may be an important risk factor for PD among the Inuit in Greenland requires more investigations.

Treatment for Helicobacter pylori infection and risk of Parkinson's disease in Denmark

BACKGROUND AND PURPOSE

It has been speculated that gastrointestinal infection with Helicobacter pylori (HP) contributes to the development of Parkinson's disease (PD). We used nationwide Danish registers to investigate this hypothesis.

METHODS

 We identified 4484 patients with a first time PD diagnosis between 2001 and 2008 from the Danish National Patient Register (DNPR) and 22, 416 population controls from the Danish Civil Registration System (CRS). Information on drug use was obtained from the National Prescription Registry (NPR). We used logistic regression to compute odds ratios (OR) for the association between treatment for HP and risk of PD.

RESULTS

Prescriptions for HP-eradication drugs and proton pump inhibitors (PPI) 5 or more years prior to the diagnosis of PD were associated with a 45% and 23% increase in PD risk, respectively. Hospitalizations and outpatient visits for gastritis and peptic/duodenal ulcers, however, were not associated with PD.

CONCLUSIONS

  Our population-based study suggests that chronic HP infections and/or gastritis contribute to PD or that these are PD-related pathologies that precede motor symptoms.

Prevalence and incidence of Parkinson's disease in The Faroe Islands

OBJECTIVE

A study in The Faroe Islands in 1995 suggested a high prevalence of idiopathic Parkinson's disease (IPD) and total parkinsonism of 187.6 and 233.4 per 100,000 inhabitants respectively.

METHODS

Detailed case-finding methods 10 years later were used and a neurologist has verified the diagnosis.

RESULTS

The crude prevalence of IPD and total parkinsonism was 206.7 per 100,000 and 227.4 per 100,000 respectively. The age-adjusted prevalence is twice as high as data from Norway and Denmark. Age at initiation of treatment and the fatality rate did not explain the increased prevalence. During 1995-2005, the average annual incidence was 21.1 per 100,000 persons for Parkinson's disease, and 22.9 per 100,000 persons, if including atypical parkinsonism.

CONCLUSION

The high prevalence was verified and linked to a high incidence. The cause of the high prevalence is unknown, but neurotoxic contaminants in traditional food may play a role in the pathogenesis in this population, perhaps jointly with genetic predisposition.

Validation of the PHEEM instrument in a Danish hospital setting

The Postgraduate Hospital Educational Environment Measure (PHEEM) has been translated into Danish and then validated with good internal consistency by 342 Danish junior and senior hospital doctors. Four of the 40 items are culturally dependent in the Danish hospital setting. Factor analysis demonstrated that seven items are interconnected. This information can be used to shorten the instrument by perhaps another three items.

A two-fold difference in the age-adjusted prevalences of Parkinson's disease between the island of Als and the Faroe Islands

With the aim of comparing the previously found high prevalence of idiopathic Parkinson's disease (PD) in the Faroe Islands with the prevalence of PD in an area of Denmark, we used the same case-finding methods for case ascertainment and the same strict criteria to diagnose PD on the island of Als. During the last year before the prevalence date (1 January 1998), we found in various registries from pharmacies, hospital, private neurologist and general practitioners 121 patients with suspected Parkinsonism out of 56,839 inhabitants on the island of Als. After exclusion of those who had other diseases, a total of 79 patients were left for further examinations. Among these we found 58 with PD. The overall prevalence of PD was estimated to be 102.0 and the age-adjusted prevalence to be 98.3 per 100,000 persons compared with 187.6 and 209.0 in the Faroe Islands. Compared with the previous results from the Faroe Islands (prevalence date 1 July 1995) we found an even lower mean age at onset of PD symptoms and at onset of treatment, a lower proportion of definite PD and a lower average dose of levodopa. We therefore conclude that the two-fold higher prevalence in the Faroe Islands than on the island of Als was not due to an early diagnosis and a higher ascertainment of cases with mild PD, which was suggested as being one possible explanation for our previous finding of a high prevalence of PD in the Faroe Islands.

Methamphetamine use: hazards and social influences

Use of methamphetamine, a potent central nervous system stimulant, increased in the early- to mid-1990s in the United States, concentrated in the west, midwest, and south. The use and trade of methamphetamine was facilitated by a fairly simple production process and the involvement of numerous small entrepreneurs as well as drug-trafficking syndicates. National data from the 1994 Drug Abuse Warning network revealed that for the period from 1991 to 1994 methamphetamine use among short-stay hospital patients more than tripled, and methamphetamine-related deaths reported by medical examiner offices nearly tripled. In addition, the Treatment Episode Data Set revealed a 43 percent increase in treatment-program admissions in which clients identified methamphetamine as the primary drug of abuse. Nonetheless, methamphetamine use did not become widespread in the U.S. population. Low-income and unemployed young white men continue to be the group most likely to use methamphetamine, but by the mid-1990s the drug had increased in popularity in more diverse populations and regions. Economic and social pressures experienced by a broad array of Americans may partially explain expanded methamphetamine use; for example, depressed economic conditions in rural and semi-rural areas have contributed to methamphetamine's appeal as a source of income. A "war against drugs" approach has characterized the policy response, with increased criminal justice penalties. A public health approach is recommended, including prevention campaigns, harm-reduction outreach and treatment approaches, and pharmacologic and abstinence-based drug treatment approaches.

Tremor frequency patterns in mercury vapor exposure, compared with early Parkinson's disease and essential tremor

A new portable tremometer allows determination of tremor intensities at different tremor frequencies. Based on past studies, two tremor frequency windows of similar size were chosen at 3.0-6.5 Hz and 6.6-10.0 Hz to reflect major tremor intensities in Parkinson's disease and mercury vapor poisoning, respectively. In 81 healthy controls, total tremor intensity was higher for the preferred hand and depended on age. Ten patients treated for Parkinson's disease showed substantially increased tremor intensity, especially within the low-frequency window. This pattern was also apparent in 14 patients with de novo Parkinson's disease whose overall tremor intensity was only mildly elevated. In contrast, ten patients with essential tremor had peak frequencies in both windows, and some patients had increased tremor on one side only. Sixty-three Brazilian gold traders exposed to mercury vapor showed increased tremor predominantly in the high-frequency window. Three of the gold traders had a narrower tremor peak at frequencies of 7-8 Hz. While the urine-mercury concentration was significantly associated with the current number of burning sessions per week, it did not correlate with tremor intensities. However, eight traders had a urinary mercury excretion level above 50 microg and at the same time a greatly increased average tremor intensity within the high-frequency window. These patterns were statistically significant for relative tremor intensities, but were less clear when total intensities were used. These observations suggest that the relative distribution of tremor intensities in specific frequency bands may be a valuable supplement to current diagnostic methods for subjects with mercury vapor exposure.

A double-blind, placebo-controlled, randomized, multi-center study of pramipexole in advanced Parkinson's disease

Pramipexole (SND 919), a potent non-ergot dopamine agonist, or placebo, was administered to 69 patients with advanced Parkinson's disease (33 received placebo, 36 received pramipexole) in a double-blind, randomized, multi-center study in which individually optimized doses of L-dopa plus a dopa decarboxylase inhibitor were associated with dyskinesia, "on-off" fluctuation, dystonia, akinesia, or end-of-dose deterioration. Study medication was titrated over 7 weeks to the maximal tolerated dose or to the maximal dose allowed by the study (5 mg/day in four divided doses). Dosing was maintained for 4 weeks and then tapered during the final week. Total score on the Unified Parkinson's Disease Rating Scale (UPDRS) for the intent-to-treat population was significantly improved in the pramipexole-treated group compared with the placebo-treated group (16.9 +/- 14.9 vs 9.0 +/- 16.1; p = 0.0184). By the end of maintenance, the mean reduction in L-dopa requirement was -150.7 mg for pramipexole-treated patients compared to -10.6 for placebo-treated patients. The most common adverse events (< 10%) were dizziness, insomnia, nausea, and postural hypotension. Aggravated parkinsonism occurred only after withdrawal of the study medication. Treatment with pramipexole in doses up to 5 mg/day was safe and well tolerated by patients with advanced Parkinson's disease.Copyright Lippincott-Raven Publishers

High prevalence of Parkinson's disease in the Faroe Islands

We used several case-findings methods and strict criteria for case ascertainment to diagnose parkinsonism and idiopathic Parkinson's disease (PD) in the Faroe Islands. In the last few years before the prevalence date of July 1, 1995, we searched various registries from pharmacies, hospitals, and general practices, and found 195 patients with suspected parkinsonism out of 43,709 inhabitants. After excluding those who died before the prevalence date or were treated with levodopa (LD) for other diseases, a total of 124 patients remained for study, of whom 122 participated. We found 102 patients with parkinsonism and 82 with PD versus the expected 53 (p < 0.001, age-specific prevalences in the county of Rogaland, Norway). The overall prevalence of PD was estimated to be 187.6 and the age-adjusted prevalence to be 183.3 versus 110.9 per 100,000 inhabitants in the county of Rogaland. Compared to the study from Rogaland, the mean age at onset of PD symptoms, the mean age at the prevalence date, and the duration of PD indicated that the higher prevalence was not due to either an early onset nor to a longer duration of PD. A lower proportion of definite PD, a lower mean score on the Hoehn-Yahr scale, and a lower average dose of LD suggest that the high prevalence may be due to early diagnosis and a higher ascertainment of cases with mild disease. However, a high incidence cannot be excluded.

A study of cognitive functions in young Parkinsonian patients

The purpose of the study was to evaluate the neuropsychological performance of younger Parkinson's disease (PD) patients compared to healthy controls. A group of young optimally treated PD patients younger than 56 years was pair-matched with a group of healthy controls for age, social class and the two WAIS subtests "vocabulary" and "similarities". As a group, the PD patients were satisfactory in verbal logical intelligence, but evaluation of neuropsychological tests showed difficulties in short memory span, constructional function and logical visual sequential cognition. Young PD patients have some cognitive impairment for which they are able to compensate for a time because of preserved intelligence. More attention should be paid to possible problems in their jobs and social life.

Mortality in patients with Parkinson's disease

INTRODUCTION

After the introduction of L-dopa the mortality rate in Parkinson's disease (PD) patients has changed, but is still higher than in the background population.

MATERIAL & METHODS

Mortality, age at death and cause of death in a group of PD patients compared with the background population were studied. The diagnosis on the death certificate were registered. The material consisted of 458 patients who in a period 1.4.1973-31.10.1991 were registered as having PD.

RESULTS

Death in the period amounted to 253 patients. Median age of death was 77.29 years for men and 79.11 years for women. In the background population the median age at death was 80.69 years for men and 84.37 years for women. The SMR for men was 1.92 and for women 2.47. Infections, in particular lung infections, and heart diseases were the most common causes of death. Seventy percent of the death certificates had PD as a diagnosis.

CONCLUSION

It is likely that several factors can influence the changed mortality of PD: more effective treatment, changing diagnostic practice, and inter-disease competition.

[Hemorrhage in cerebral cavernous hemangioma as a cause of hemiballismus]

A 19 year old righthanded woman, without previous neurological symptoms, was examined in April 1993, because of involuntary movements affecting especially the right hand, but also her right leg and the right side of her face. Magnetic Resonance Imagning (MRI), showed a process located in the area of the left subthalamic nucleus, which was recognized as a cavernous haemangioma. A left carotic arteriography in August was normal. The patient had a complete regression of her symptoms, wherefore there was no indication for neurosurgical intervention. The patient is still being followed without treatment.

Sexual problems in young patients with Parkinson's disease

The purpose of this study was to describe sexual function in a representative group of young patients with Parkinson's disease (PD). Twenty-five patients (15 men, 10 women; age range 36-56 yrs) participated in a structured interview on sexual function. Forty percent of the men and 70% of the women reported changed libido while 33.4% of the men and 80% of the women experienced changed sexual activity after onset of PD. A tendency to changes in libido and sexual function was seen with increasing time of treatment and advanced Hoehn-Yahr stages. It is concluded that changes in libido and sexual function occur more frequently than previously reported, especially in women, and more attention should be paid to these problems.

Levodopa use in Denmark: high levels in Greenland and the Faroe Islands. Europarkinson Preparatory Activity Research Group

Levodopa (LD) sales from wholesalers to pharmacies during the periods, 1977-1989 in Denmark, 1981-1989 in Greenland, and April 1988-May 1989 in Danish counties and the Faroe Islands, were evaluated using a reported method and a procedure expressly developed for assessment of random variation comparative levodopa use (LDU) measurements. The reference population for comparison of LDU was the Swedish from 1984. LDU diffusion had stabilized by 1989 in Denmark, but considerable annual increments of LD sales were still seen in Greenland in 1989. Crude LDU in Denmark and most Danish counties amounted to a level similar to that of Sweden. Adjustments for age and infant mortality rates, taken as an indicator of socioeconomic development, disclosed statistically significant twofold levels of LDU in the Faroe Islands and Greenland, and lowest LDU in urban regions. The social or biological factors underlying such differences in drug use remain unknown.

Suicide in patients with Parkinson's disease. An epidemiological study

The purpose of this study was to estimate the risk of suicide for patients with Parkinson's disease (PD) in Denmark compared with that in the background population. The study involved 458 patients with a PD diagnosis, 226 men and 232 women. The follow-up period to either death or end of follow-up on December 31, 1990 was 0 to 17 years, mean 5.7 years. Deaths in the follow-up period amounted to 254, 135 men and 119 women. Two women committed suicide. The number of expected suicides was 1.06 for men and 0.55 for women, a total of 1.62. Neither for men nor for women was the difference between expected and observed suicides statistically significant.

Family functioning as a predictor of progress in substance abuse treatment

This study tested the hypothesis that the level of family functioning is related to changes in the patient's progress while in treatment. We studied the relation of family functioning, as measured by the Family Adaptability and Cohesion Scales' (FACES II) dimensions of cohesion and adaptability, to 7 dimensions of the severity of patient drug use, as measured by the Addiction Severity index (ASI). The results indicated that family functioning, the cohesion dimension in particular, predicts severity of patient's dysfunction resulting from drug use and family and psychological problems. In particular, 28% of the variability in the ASI Drug Problems, 52% of the variability in the ASI Family Problems, and 29% of the variability in the ASI Psychological Problems were accounted for by the FACES II cohesion score. Although the study has several limitations, it supports the relevance of family factors in the treatment of drug-addicted patients.

Families are helped by drug treatment

Twenty-six pairs of heroin addicts applying for methadone maintenance treatment and their family members were interviewed before being admitted to a drug treatment program and 3 months after entry into treatment to determine whether treatment resulted in changes in family or individual functioning. Results revealed a considerable lessening of family and patient problems in the first months of drug treatment. Family members and patients reported significantly fewer family crises and family difficulties with the patient. Both family members and patients reported improvement on several mood indicators and significant lessening of the patient's family/social problems and drug problems.

Clinical course and long-term prognosis of acute transverse myelopathy

The clinical characteristics and course of acute transverse myelopathy (ATM) was studied. One patient developed multiple sclerosis. In 1 patient ATM was caused by tumour-cell embolization of the intramedullar vessels; 30 aged 12-74 years (median 36 years) had ATM of unknown course, of these, 13 had symptoms of a preceding viral-like infection, 18 had back-pain and 10 signs of spinal shock. The time from onset of ATM to maximum deficit varied from less than 1 h to 20 days. The thoracic region was the most common level of cord damage. Follow-up was possible in 29 cases; 2 died (2 and 8 months after onset), of the surviving 27 (follow-up 1-13 years, median 6 years) one third had a good outcome, one third a fair, while one third remained paraplegic, incontinent with severe sensory deficits. Back-pain and signs of spinal shock indicated a poor outcome.

[Brachial irradiation plexopathy]

Irradiation neuropathy is a term for the damage to peripheral nerve tissue due to irradiation. Brachial irradiation plexopathy is irradiation neuropathy affecting the brachial plexus. This is most frequently a complication of irradiation therapy for cancer of the breast. The incidence varies considerably and is lowest with low total doses of irradiation and limited fractions. The latent period varies from months to several years. The neurological manifestations are paraesthesiae in the fingers, pain, hypaesthesia, hypalgesia, disaesthesia, paresis, hyporeflexia, muscular atrophy and possibly vegetative disturbances. Horner's syndrome may occur. Lymphoedema is observed in approximately on third of the patients. The course of brachial irradiation plexopathy is progressive. No specific treatment is available. The diagnosis is based on the case history, clinical picture, electrodiagnosis and CT of the brachial plexus region. The most important differential diagnosis is metastatic infiltration in the brachial plexus. These two conditions are differentiated best by means of CT guided surgical exploration and histological examination of the tissue. The irreversible nature of brachial irradiation plexopathy and its marked resistance to treatment are such that the optimal irradiation hygienic rules must be observed.

[Cerebral infarction in systemic lupus erythematosus]

The case-history of a man aged 31 years with systemic lupus erythematosus and cerebral infarction is presented. Although patients with active disease are young, cerebral infarcts are strikingly frequent among them.

Treatment providers' assessment of dual-prognosis patients: diagnosis, treatment, referral, and family involvement

The problems of patients with dual diagnoses (substance abuse and psychiatric disorders) have only recently come under study. While attempting to assess the feasibility of offering services to family members of dual-diagnosis patients, the authors encountered problems in delivering services to the patients themselves. These problems included inadequate reporting methods, lack of a combined treatment approach, lack of family involvement, and inadequate referral resources. This paper discusses some of the impediments to treatment and areas of needed research.

Outpatient treatment of Parkinson's disease

A retrospective study of the treatment of 148 patients with severe parkinsonism is reported. After dopa preparation was introduced as a treatment for Parkinson's disease the progress of the disease has changed. More patients with first signs after 1970 had mild progression of disease compared to patients with a debut before 1970. In addition, the population with manifestations after 1970 had fewer cases of severe progression. Adverse effects of dopa treatment had been observed in 70% of the patients. After 5 years of treatment with dopa preparation, 62.1% of the patients had momentary peak-dose dyskinesia. After 2 years of treatment 14.2% of the patients had on-off effects with higher incidence after further treatment. One hundred and fifteen patients have been treated with bromocriptine, 27 patients for more than 5 years.

Approval need in self-reports of addicts and family members

Ample evidence documents the tendency of research subjects to attribute to themselves socially desirable traits and to deny having socially undesirable qualities. This tendency is particularly marked among subjects who are defensive, lacking in self-esteem, or sensitive to status differences. Drug addicts often have all of these characteristics. This paper examines the extent to which need for social approval is reflected in methadone patients' and family members' self-reports of personal and family functioning. Results demonstrate the importance of taking the approval motive into account when conducting research with this population. Addicts tend to deny negative things about themselves and their families, while family members tend to exaggerate their own and their families' positive qualities. Implications for drug treatment programs and researchers are discussed.

Bridges and barriers to recovery: clinical observations from an opiate recovery project

Clinical issues are described in opiate addicts attempting to taper off methadone maintenance, and techniques are suggested to help this patient population. The observations were generated in an experimental "Tapering Network" project, in which opiate addicts on methadone maintenance had the opportunity to receive individual and group counseling, relapse prevention training, self-help groups, and other services. Vignettes illustrate clinical problems with intimacy and social isolation, identity as a former addict, and a "post methadone syndrome" characterized by vulnerability, dramatic swings in mood, and disordered thinking for a period of up to six months after detoxification. To counteract these barriers to recovery, a program model is suggested that uses curricula available in the emerging literature on treatment of substance abuse. These techniques can provide bridges to recovery.