Home About us Contact
|
Home About us Contact | ||
|
|
||
Dopaminergic Therapy (dopaminergic + therapy)
Selected AbstractsDopaminergic transplantation for parkinson's disease: Current status and future prospects,ANNALS OF NEUROLOGY, Issue 5 2009C. Warren Olanow MD, FRCPC Cell-based therapies that involve transplantation into the striatum of dopaminergic cells have attracted considerable interest as possible treatments for Parkinson's disease (PD). However, all double-blind, sham-controlled, studies have failed to meet their primary endpoints, and transplantation of dopamine cells derived from the fetal mesencephalon is associated with a potentially disabling form of dyskinesia that persists even after withdrawal of levodopa (off-medication dyskinesia). In addition, disability in advanced patients primarily results from features such as gait dysfunction, freezing, falling, and dementia, which are likely due to nondopaminergic pathology. These features are not adequately controlled with dopaminergic therapies and are thus unlikely to respond to dopaminergic grafts. More recently, implanted dopamine neurons have been found to contain Lewy bodies, suggesting that they are dysfunctional and may have been affected by the PD pathological process. Collectively, these findings do not bode well for the short-term future of cell-based dopaminergic therapies in PD. Ann Neurol 2009;66:591,596 [source] Gamma activity and reactivity in human thalamic local field potentialsEUROPEAN JOURNAL OF NEUROSCIENCE, Issue 5 2009Florian Kempf Abstract Depth recordings in patients with Parkinson's disease on dopaminergic therapy have revealed a tendency for oscillatory activity in the basal ganglia that is sharply tuned to frequencies of ,70 Hz and increases with voluntary movement. It is unclear whether this activity is essentially physiological and whether it might be involved in arousal processes. Here we demonstrate an oscillatory activity with similar spectral characteristics and motor reactivity in the human thalamus. Depth signals were recorded in 29 patients in whom the ventral intermediate or centromedian nucleus were surgically targeted for deep brain stimulation. Thirteen patients with four different pathologies showed sharply tuned activity centred at ,70 Hz in spectra of thalamic local field potential (LFP) recordings. This activity was modulated by movement and, critically, varied over the sleep,wake cycle, being suppressed during slow wave sleep and re-emergent during rapid eye movement sleep, which physiologically bears strong similarities with the waking state. It was enhanced by startle-eliciting stimuli, also consistent with modulation by arousal state. The link between this pattern of thalamic activity and that of similar frequency in the basal ganglia was strengthened by the finding that fast thalamic oscillations were lost in untreated parkinsonian patients, paralleling the behaviour of this activity in the basal ganglia. Furthermore, there was sharply tuned coherence between thalamic and pallidal LFP activity at ,70 Hz in eight out of the 11 patients in whom globus pallidus and thalamus were simultaneously implanted. Subcortical oscillatory activity at ,70 Hz may be involved in movement and arousal. [source] Recognition, diagnosis, and treatment of restless legs syndromeJOURNAL OF THE AMERICAN ACADEMY OF NURSE PRACTITIONERS, Issue 8 2008ARNP (Adult Nurse Practitioner, Jennifer E. Smith MSN, Manager of an Anticoagulation Clinic) Abstract Purpose: To review the symptoms, diagnosis, and treatment of restless legs syndrome (RLS) and its relevance to nurse practitioners (NPs). Data sources: Comprehensive review of the scientific literature on the diagnosis and treatment of RLS in adults. Conclusions: RLS is a chronic neurological disorder that, with varying degrees of severity, affects 5%,10% of the general population. Because of the circadian pattern of onset, the symptoms of RLS may be associated with significant sleep disturbance and may have a negative impact on quality of life. RLS is characterized by a compelling urge to move the legs and usually accompanied or caused by uncomfortable sensations in the legs. Symptoms begin or worsen during periods of rest or inactivity and are worse in the evening or at night. Other features supportive of a diagnosis include a family history, the presence of periodic leg movements in sleep, and the relief of symptoms after treatment with a dopaminergic therapy. Although the etiology of RLS is unknown, it is thought that symptoms result from a central dopaminergic dysfunction and dopamine agonists are considered first-line treatment for moderate-to-severe primary RLS. Nondopaminergic therapies and nonpharmacologic interventions may also be appropriate in the management of less severe cases of RLS. Implications for practice: NPs are often the first healthcare providers to see patients with RLS and therefore need to be able to accurately recognize and diagnose the disorder; this, in turn, will enable them to successfully manage the treatment of RLS. [source] Neuroprotection trials in Parkinson's disease: Systematic review,,MOVEMENT DISORDERS, Issue 5 2009Robert G. Hart MD Abstract Treatments to slow the progression are a major unmet need in Parkinson's disease. Detailed assessment of randomized trials testing putative neuroprotective drugs was undertaken to inform the design, reporting, and interpretation of future studies. This study is a systematic review of trials testing neuroprotective drugs. Data were extracted independently by two coauthors. Fifteen completed, published trials involving 4,087 participants tested 13 different drugs in 18 double-blind comparisons with placebo. Seven comparisons involving 2,000 subjects assessed MAO-B inhibitors. The primary outcome was change in the Unified Parkinson's Disease Rating Scale score in eight trials and time to need for dopaminergic therapy in seven. Mean participant age was 62 years, 35% were women, the interval from diagnosis to entry averaged 11 months, and the number of participants averaged 272 (largest = 806). Follow-up averaged <16 months in all but two trials. Detailed randomization methods and success of double-blinding were reported in 20% and 13%, respectively. Based on the investigators' conclusions, six trials were interpreted as consistent with a neuroprotective effect, three as negative, and five as either confounded or not meeting criteria for futility. Neuroprotection trials have involved relatively uniform groups of participants early in the clinical disease course, with outcomes weighted heavily toward motor deterioration. Future trials should include participants with wider ranges of disease stages and assess broader neurological outcomes. © 2008 Movement Disorder Society [source] Replacement of dopaminergic medication with subthalamic nucleus stimulation in Parkinson's disease: Long-term observation,MOVEMENT DISORDERS, Issue 4 2009Luigi M. Romito MD Abstract Stimulation of the subthalamic nucleus (STN) is an effective treatment for advanced Parkinson's disease (PD), but the medication requirements after implant are poorly known. We performed a long-term prospective evaluation of 20 patients maintained at stable dopaminergic therapy for 5 years after bilateral STN implants, who were evaluated 6 months, 1 year, 3 years, and 5 years after surgery. We measured, during the entire observation period, the effect of deep brain stimulation on motor and functional outcome measures, the levodopa equivalent daily dose and the total electrical energy delivered. At 5 years, the UPDRS motor score had improved by 54.2% and levodopa equivalent dose was reduced by 61.9%, compared with preimplant. Dopaminergic medication remained stable during the observation period, but energy was progressively increased over time. Rest tremor, rigidity, gait, lower and upper limb akinesia, and total axial score were improved in decreasing order. Postural stability and speech improved transiently, whereas on-period freezing of gait, motor fluctuations and dyskinesias recovered durably. Functional measures did not show improvement in autonomy and daily living activities after STN implant. Chronic STN stimulation allows to replace for dopaminergic medications in the long-term at the expense of an increase of the total energy delivered. This is associated with marked improvement of motor features without a matching benefit in functional measures. © 2008 Movement Disorder Society [source] Beta activity in the subthalamic nucleus during sleep in patients with Parkinson's disease,MOVEMENT DISORDERS, Issue 2 2009Elena Urrestarazu MD Abstract The recordings of local field potentials in the subthalamic nucleus in patients with Parkinson's disease (PD), carried out through the stimulators implanted to treat the motor symptoms of the disease, show a prominent basal ("off") activity in the beta range, which is attenuated after dopaminergic therapy. A recent study described improvement of parkinsonian features during rapid eyes movements (REM) sleep. We describe, for the first time, the changes in activity of the subthlamic nucleus (STN) during different sleep stages in Parkinson's disease with special interest in the beta band. Ten patients with PD treated with deep brain stimulation of the STN were studied. Subthalamic local field potentials (LFPs) were recorded through the stimulation electrodes during wakefulness ("off" medication) and different sleep stages. In Stage 2 and slow-wave sleep, a significant decrease of beta activity was recorded. During REM sleep, beta power values were similar to wakefulness values or even higher. These findings indicate that STN activity is modulated and modified during different sleep stages. The increased beta activity during REM sleep is a new but unexpected finding, which requires further analysis. © 2008 Movement Disorder Society [source] Analysis of the course of Parkinson's disease under dopaminergic therapy: Performance of "fast tapping" is not a suitable parameterMOVEMENT DISORDERS, Issue 3 2005Peter H. Kraus MD Abstract In addition to clinical rating scales, instrumental methods are employed frequently for assessment of performance or motor deficits in Parkinson's disease (PD). Many studies have analyzed such parameters in cross-sectional studies. We employed a battery of tests to investigate fine motor performance over a period of 4 years in 411 de novo parkinsonian patients from the Prado study. Specifically, tapping and pegboard testing ("plugging") were evaluated and performance on these tests compared with clinical ratings. Plugging scores correlated well with tapping scores and clinical rating at each assessment timepoint. Both tests also showed significant differences to healthy controls. Nevertheless "fast tapping" was found to be less impaired than was plugging in de novo patients. Over time, it was observed that plugging scores, but not tapping scores, exhibited changes that paralleled movements in clinical score. Plugging scores exhibited a marked response to dopaminergic therapy whereas fast tapping showed no therapeutic response. Fast tapping is certainly not suitable for assessment of bradykinesia or hypokinesia, and does not respond to dopaminergic therapy. © 2004 Movement Disorder Society [source] Continuous dopaminergic therapy in Parkinson disease: Time to stride back?ANNALS OF NEUROLOGY, Issue 1 2010A. Jon Stoessl MD No abstract is available for this article. [source] | ||||||||||