Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0030567 (Parkinson's disease)
 63,064 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The concept of arteriosclerotic parkinsonism has created some confusion due to the absence of a precise definition of the parkinsonian syndrome and to a prolonged absence of knowledge concerning the topography of the lesions in "idiopathic" Parkinson's disease as well as the anatomic relations of the basal nuclei. Although certain authors at the beginning of the century suggested that Parkinson's disease could have a vascular origin, an opposition rapidly developed between Parkinson's disease and arteriosclerotic parkinsonism, largely based on the work by Cricthley (1929). The concept of arteriosclerotic parkinsonism is a quite ambiguous notion, but was generally accepted up to the sixties before severe criticisms were made when the anatomo-clinical characteristics of Parkinson's disease were identified. Recent work has again suggested that parkinsonism can be of vascular origin but the observations reported show a heterogeneous collection of lesions with different localizations, clinical expression and clinical courses. Clinically, two rare circumstances can be identified (vascular parkinsonism similar to Parkinson's disease and unilateral vascular parkinsonism due to contralateral lesions) and inversely much more frequent "atypical" parkinsonism syndromes. These differ from Parkinson's disease by their parkinsonism symptomatology (no resting tremor, predominance of gait disorders), the presence of associated neurological signs and lower sensitivity to levodopa. The attribution of the parkinsonism disorders to vascular lesions identified at imaging is often quite hazardous, but a few anatomo-clinical observations have confirmed that vascular parkinsonism does exist. The heterogeneous nature of the observations hinders the development of diagnostic criteria.
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PMID:[Vascular Parkinson syndromes: a controversial concept]. 977 57

Quetiapine is an atypical antipsychotic with clozapine-like pharmacology but without associated agranulocytosis. We report our complete experience with quetiapine for the treatment of drug-induced psychosis (DIP) in Parkinson's disease (PD). Thirty-five patients with PD and DIP aged 75 years (range, 58-89) with a mean PD duration of 8.4 years on an average of 427 mg levodopa per day received a mean dose of 40.6 mg quetiapine daily. Twenty of 24 neuroleptic-naive patients reported marked improvement of psychosis without a decline in motor function as assessed by the Unified Parkinson's Disease Rating Scale (UPDRS-motor). Ten patients had a baseline and 4-week follow-up assessment using the Mini-Mental Status Examination (MMSE) and Brief Psychiatric Rating Scale (BPRS). The improvement in BPRS score (32.6 versus 22.8) was clinically and statistically significant (p = 0.024). Three of 24 were unable to tolerate quetiapine because of orthostatic hypotension, headache, nausea, and persistence of hallucinations. One patient died of an unrelated cause. We also tried to switch 11 psychiatrically stable patients on clozapine (eight) and olanzapine (three). Five patients made this transition without a loss of effect as measured on BPRS and MMSE. Six did not (five on clozapine, one on olanzapine) because of confusion, erratic behavior, and increased hallucinations. No crossover failure had worsened PD except for increased tremor in one. Quetiapine is useful and well-tolerated as a first drug to treat DIP in PD but must be used cautiously to replace other atypical antipsychotic drugs.
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PMID:Quetiapine for the treatment of drug-induced psychosis in Parkinson's disease. 1034 74

Behavioral disturbances in Parkinson's disease (PD) are a common source of disability to both patients and their families, but there is a considerable controversy regarding their frequency and their neuropathological and neurochemical bases. Since they are so common, the disorders associated with PD should be well recognized, and proper management by neurologists is required. The most frequent behavioral disturbances encountered in patients with PD are depression, anxiety, cognitive impairment and dementia. Also frequent are sleep disorders such as sleep fragmentation, REM sleep behavior disorder, insomnia and altered dreaming. The most troublesome situations come from drug-induced psychiatric states, such as delusional states, hallucinations, paranoid ideation, delirium, and confusion. The treatment of these behaviors is reviewed here.
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PMID:Therapy of behavioral disorders in Parkinson's disease. 1034 4

Traumatic brain injury (TBI) is found in many sports. A mild head injury (concussion of brain) is found in more than 80%, mainly in sports with contact to others. Especially affected by death are air sports, horse riding and cycling, whereby brain damage often is the leading injury. With the example of a cycling accident the possible processing dynamics of a mild head injury with secondary brain damage through an intracranial hematoma is demonstrated in the following. For the assessment of sports ability, there is often made the division with symptoms as confusion, amnesia and unconsciousness after a mild head injury (scale 1-3). According to the gravitational scale of cerebral concussion, an adequate sports break should be kept. Postcommotional symptoms prove sports inability. A chronic brain damage is not rarely found in some combative sports. In this case the injury may result in a traumatic encephalopathia with the evaluation of dementia and in some cases also Parkinson's disease is observed. To prevent a TBI there should be worn an adequate protective headgear especially by children in training and in sports contests concerning risk sports. Further recommendations for prevention are presented and with them there will also be responded to sports ability in neurosurgical diseases.
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PMID:[Craniocerebral trauma in sports. With recommendations for prevention]. 1040 62

Although Lewy body dementia (LBD) has received a considerable amount of interest in the last decade, there still exists a certain level of confusion concerning the clinical and neuropathological features associated with this disorder. According to many researchers, LBD represents a distinct dementing illness with specific clinical features. The neuropathological hallmark for this disorder is the Lewy body, a spherical intraneuronal cytoplasmic inclusion originally described in brainstem nuclei in Parkinson's disease. In LBD, Lewy bodies are found in subcortical nuclei, such as the substantia nigra, as well as diffusely in the neocortex. Recently, a consortium on dementia with Lewy bodies was held that established consensus guidelines for the clinical and pathological diagnosis of LBD. This review will focus on the newest developments in LBD, addressing specifically clinical and neuropathological features, diagnostic classification, genetics and potential pharmacotherapy.
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PMID:Lewy body dementia. 1044 73

There are many difficulties associated with the late stages of Parkinson's disease (PD), but psychosis and agitation may be the most disturbing for both patients and care givers, and often precipitate the pivotal decision for long-term nursing home placement. While the addition of antipsychotic drugs or the withdrawal of antiparkinsonian drugs may improve the behavioral problem, these strategies usually worsen the motor difficulties. Clozapine has been studied in PD for over a decade, and while it appears to be effective, there are safety and tolerability concerns associated with it. In addition, in New Jersey, Medicaid no longer pays for the home blood draws that are required for home-bound patients. This led to a situation in which we had patients who needed to stop clozapine and begin an alternative therapy. Because quetiapine seems particularly well suited to patients with PD based on in vitro and in vivo studies we have begun to try this medication in PD patients who need to stop clozapine. This article reports three case histories of patients with PD, confusion and dopamimetic psychosis who had been previously managed with clozapine and who were successfully switched to quetiapine. At doses from 12.5 to 150 mg/day quetiapine was well tolerated, resulting in behavioral improvement and no real increase in parkinsonism. These case histories raise the possibility that quetiapine may represent a viable alternative to clozapine in PD patients with dopamimetic psychosis and behavioral disturbances.
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PMID:Quetiapine as an alternative to clozapine in the treatment of dopamimetic psychosis in patients with Parkinson's disease. 1048 24

Orphenadrine is an anticholinergic drug used mainly in the treatment of Parkinson's disease. It has a peripheral and central effect and a known cardiotoxic effect when taken in large doses. We report the successful outcome of the treatment of a 2 1/2-year-old girl who accidentally ingested 400 mg of orphenadrine hydrochloride (Disipal). One hour after ingestion she presented neurological symptoms: confusion, ataxic walking, and periods of severe agitation. Generalized tonic-clonic seizures appeared resistant to the administration of multiple antiepileptics. They ceased after a supplementary dose of intravenous diazepam, endotracheal intubation, and mechanical ventilation. An episode of ventricular tachycardia responded well to i. v. lidocaine. Physostigmine was administered in three successive doses. The initial orphenadrine plasma level (3,55 microg/ml) was in the toxic range, associated with high mortality. The calculated elimination half-life was 10.2 h and the molecule and/or its metabolites were found up to 90 h after ingestion.
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PMID:Orphenadrine poisoning in a child: clinical and analytical data. 1055 71

Parkinson's disease (PD) is a chronic progressive neurological disorder characterized by tremor, muscle rigidity, slowness of movement (bradykinesia), and gait instability. In early disease, PD is well managed in an office setting, however, as the disease progresses, a variety of syndromes may result in emergency department visits. The scenarios most likely to require an emergent evaluation are severe motor "off" periods with immobility, involuntary movements (dyskinesia), psychosis, acute confusion, panic disorder, and pain. Other less frequent presentations are also discussed. This article uses illustrative cases to provide a framework to discuss emergency department diagnosis and management issues in caring for these patients.
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PMID:Emergency department presentations of patients with Parkinson's disease. 1075 Sep 35

A review of stereotactic medial pallidotomy of the 1950s in five neurosurgical centers is presented. The surgical technique varied from one center to the other. The results of surgery, however, seemed to be quite equal, being positive in 70-90% of the patients. The surgical mortality ranged from 0 to 13%. Behavioral complications were adequately analyzed and reported from one center only and published by three independent neurologists. The side effects included drowsiness (12%), confusion (13.6%), mental deterioration (5%), memory deficit (13.6%), and dysphasia (7.5-24%, the rate depending on the concomitant brain atrophy). Among permanent side effects, 5% of the patients presented with a mild postoperative mental deterioration, whereas 13.6% had a severe memory deficit. In the four other centers, the results and side effects were analyzed only by the surgeons and were more biased. A comparison of the results and complications between Leksell's early medial pallidotomy of 1951-1957 and recent medial pallidotomies of the 1990s from two centers showed that 40 years ago Leksell had at least as good results as, and less serious complications than, two representative neurosurgeons of today. Even when positive clinical results of GPi pallidotomy have recently been reported from several centers, the patients seem to have improved relatively little, the dyskinesias excepted, and the rate of side effects has been quite high. The author is afraid that medial pallidotomy will soon be abandoned as a method of choice in the surgical treatment of Parkinson's disease, as in fact happened 40 years ago. One should look for better surgical alternatives and targets outside of the medial pallidum.
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PMID:Behavioral complications of early pallidotomy. 1075 82

After levodopa, dopaminergic agonists are the most powerful agents in idiopathic Parkinson's disease treatment. Used in monotherapy or rather in early combination with levodopa, they allow a dramatic reduction of long-term motor side effects of the latter: onset and peak-dose dyskinesias, early morning dystonias. Their gastro-intestinal (nauseas) and moreover psychiatric (confusion and hallucinations) side effects limit their use, notably in geriatric populations. Superiority of so-called "second generation" agonists (ropinirole, pramipexole) on "first generation" agonists (bromocriptine, pergolide) remains to be proved.
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PMID:[Dopaminergic agonists in the treatment of Parkinson's disease]. 1119 95


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