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Query: UMLS:C0030567 (Parkinson's disease)
 63,064 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

While there is no single correct starting dose for levodopa therapy, many individuals can be started on either the 25/100 or controlled-release formula, following the general rule not to attempt to titrate carbidopa-levodopa to the point of "normality," which can lead to toxicity. The physician should also determine the proper use of any adjunctive medications; such combined therapy has become the standard approach to treatment. Following the initial period of therapy, emerging difficulties require a reassessment of therapeutic approaches, such as dosage adjustment or introduction of a dopamine agonist. Other possible adverse effects--such as gastrointestinal disorders, orthostatic hypotension, levodopa-induced psychosis, sleep disturbances or parasomnias, or drug interactions--also require carefully monitored individual treatment. Nonpharmacologic concerns can help the Parkinson's disease patient achieve and maintain optimal functioning, including daily exercise, physical therapy, and involvement with support groups.
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PMID:Optimization of levodopa therapy. 154 99

The cyclic alternations of wakefulness and sleep competing for the domain of brain activity are controlled by neuronal systems contained in the core of the brainstem, hypothalamus, thalamus, and basal forebrain. This organization encompasses complex neuroanatomic, neurophysiologic, and neurochemical mechanisms that are subject to disruption from within, or as a result of incidental alterations of appropriate brain centers. The first section of this article reviews the wake-sleep disturbances that occur with lesions in defined neuroanatomic structures involved in sleep mechanisms, such as the brainstem, hypothalamus, thalamus, and cerebral hemispheres. The second section gives an overview of specific sleep alterations associated with neurologic disorders. These include stroke, Parkinson's disease, degenerative systemic disorders, multiple sclerosis, myotonic dystrophy, myasthenia gravis, brain tumors, head trauma, coma, epilepsy, and headache syndromes.
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PMID:Neuroanatomic and neurologic correlates of sleep disturbances. 163 Jun 35

A consecutive series of patients with Parkinson's disease (PD) were examined for the presence of sleep disturbances, pain, and depression. We found that patients with PD and major depression had significantly more sleep disturbances and severe pain than non-depressed patients with PD. Moreover, depression scores accounted for most of the variance in a stepwise regression analysis of the effect of numerous clinical variables on either sleep disorders or pain severity. These findings suggest that depression is the most important factor associated with the common problems of sleep disorder and pain among patients with PD.
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PMID:Sleep disorders, pain, and depression in Parkinson's disease. 175 57

We report the clinical response of a parkinsonian patient with severe motor fluctuations who was begun on continuous, nighttime-only levodopa infusions accompanied by oral carbidopa/levodopa use during the day. Sleep disturbances improved immediately. There was a gradual reduction in "off" time and severity of dyskinesias during the waking day. Nighttime-only levodopa infusions have a carryover benefit to the waking hours and may be suitable for long-term therapy to reduce daily motor fluctuations in some patients with Parkinson's disease.
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PMID:Nighttime levodopa infusions to treat motor fluctuations in advanced Parkinson's disease: preliminary observations. 178 88

Depressive mood is frequently associated with Parkinson's syndrome, but it may also occur as a precursor of this disease. As regards the subtypes of Parkinson's disease, the frequency of depressive states is significantly higher in the type dominated by akinesia and rigidity than in the type dominated by tremor. On the basis of biochemical changes, certain aspects of the depression can be successfully treated by substitution therapy: L-dopa medication may increase the reduced dopamine values in the striatum, thereby improving drive. Substitution with L-tryptophan raises the lowered serotonin values in the reticular formation, which may influence sleep disturbances. The changes of basic mood, however, which are characteristic of depression, such as cheerlessness and apathy, are the dopamine of antidepressive medication; only these drugs can re-establish the biochemical balance to a large extent.
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PMID:[Depression and Parkinson syndrome]. 287 39

Serotonergic mechanisms have been implicated in levodopa-induced psychiatric toxicity reactions in Parkinson's disease (PD). Although CNS serotonin levels are reduced in Parkinsonian patients, the contribution of this abnormality to the pathophysiology of the motor symptoms of the disease are largely unknown. The following report concerns a 62-year-old female Parkinsonian patient with levodopa-induced "On-Off", depression and sleep disturbances, the severity of which was dramatically reduced by administration of low dosage amitriptyline (a serotonergic agent). The report suggests that impaired central serotonergic functions may be implicated in the pathophysiology of the levodopa-induced "On-Off" and that pharmacologic manipulations of serotonergic functions may be useful in the management of this motor side effect of chronic levodopa therapy.
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PMID:Serotonergic mechanisms in levodopa-induced "on-off" and sleep disorders in Parkinson's disease. 324 78

Nine parkinsonian patients were studied during one night using the static charge sensitive bed (SCSB) method for the monitoring of respiration, ballistocardiogram (BCG) and body movements. The parkinsonian sleep was more restless than that of the controls. As the SCSB-defined levels of autonomic nervous activity were concerned, the amount of motor active wakefulness (MAW) was significantly (P less than 0.05) increased in parkinsonian patients, who also had less quiet sleep (P less than 0.05) than the controls. Parkinsonian tremor was present during 29.8 +/- 15.8% of the time in bed. Usually it was observed during wakefulness; it disappeared when the patient fell asleep. The frequency of turning-over events in bed was smaller in the parkinsonian patients than in the controls (P less than 0.05). When the heart rate changes associated with sleep movements were studied it was found that the parasympathetic deceleration component in the parkinsonian patients was absent. The motor dysfunction associated with Parkinson's disease is reflected in many ways in the sleep movement activity. Sleep disturbances in PD seem to be secondary in character; i.e. they can be due to impaired motor functions like turning around in the bed, or due to impaired arousal mechanisms during sleep.
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PMID:Sleep movements and associated autonomic nervous activities in patients with Parkinson's disease. 363 Jun 47

Progressive supranuclear palsy has been recognized as a distinct nosological entity for about three decades now. Typically, this progressive neurological disease manifests itself late in the sixth decade with a terminal course of approximately four to six years. Well over one hundred cases have been described in the literature and the heterogeneous nature of progressive supranuclear palsy includes the characteristic vertical ophthalmoplegia, frequent falling and a profound nuchal rigidity. Other features are similar in many respects to those found in Parkinson's disease. The present article reviews the literature on progressive supranuclear palsy with particular reference to its clinical manifestations including the ophthalmoplegia, characteristic sleep disturbances and unique dementia. Also addressed, are neuropathological and epidemiological findings. Finally, conclusions and recommendations for further investigation are offered especially with regard to the neuropsychological nature of this neurological disorder.
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PMID:Progressive supranuclear palsy. 676 62

The objective of this questionnaire-based survey was to evaluate the prevalence and causes of sleep disturbances in 90 nondepressive patients with Parkinson's disease (PD) and 71 age-matched healthy subjects. We also assessed the prevalence and characteristics of excessive daytime sleepiness (both groups) and excessive fatigue (PD patients). A high prevalence of sleep disturbances in PD patients was found; this is to a large extent probably the result of aging. As compared with controls, patients had a more severely disturbed sleep maintenance because of nycturia, pain, stiffness, and problems with turning in bed. The prevalence of excessive dreaming is similar in both groups, but altered dream experiences almost exclusively occurred in PD. Patients rated themselves more often to be morning-types than controls. This finding may account for the reported adaptation effects in experimental settings and the reduced REM latency in PD patients. The prevalence of daytime sleepiness was similar in both groups. Excessive daytime sleepiness showed a clear diurnal pattern with a peak in the early afternoon. As for excessive fatigue, the majority of the patients did not report a preferential time for this symptom. Our findings further argue against an association of fatigue with any circadian factor, and instead suggest a relationship with the motor deficits of PD.
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PMID:Sleep, excessive daytime sleepiness and fatigue in Parkinson's disease. 836 3

We converted 158 Parkinson's disease (PD) patients on stable doses of standard carbidopa/levodopa (Std-L) to controlled-release carbidopa/levodopa (L-CR). Of the 141 patients who completed the study, 103 (73%) preferred L-CR, 26 (18.5%) preferred Std-L, and 12 (8.5%) had no preference. One hundred fourteen patients elected to continue L-CR, and we performed the primary data analysis on this group. Following conversion to L-CR, patients reported an increase in length of benefit from each dose and an increased "kick-in" time. There was a decrease in the total number of doses, "off" periods, sleep interruptions per night, dose failures, and sleep disturbances. Conversion to L-CR resulted in a significant increase in total levodopa dose. There was no significant change in the dyskinesias. However, early-morning dystonia resolved in eight of 14 patients. Our findings suggest that L-CR is particularly effective in decreasing motor fluctuations, reducing nocturnal problems, and minimizing levodopa dose failures in PD.
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PMID:Clinical experience with controlled-release carbidopa/levodopa in Parkinson's disease. 825 94


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