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)

Measurement of monoamine metabolites in cerebrospinal fluid (CSF) has been one of the few methods available to study monoamine transmitter function in the human central nervous system (CNS). It has steadily proved to be of much use in clinical research of neurological and psychiatric diseases, in which altered functions of central monoamine neurotransmitters have been identified. In this work 3-methoxy-4-hydroxyphenylethylglycol (MHPG), 3,4-dihydroxyphenylacetic acid (DOPAC), homovanillic acid (HVA) and 5-hydroxyindoleacetic acid (5-HIAA) were quantified in normal CSF and in patients with untreated Parkinson's disease (PD) and olivopontocerebellar atrophy (OPCA). Normal CSF was obtained from 162 patients at the time of spinal anesthesia for surgery. Reference values for monoamine metabolites were established for normal adult lumbar CSF. Up to the age of 70 years no relation of monoamine metabolite concentration with age or sex were encountered. In individuals above 70 years of age higher levels of MHPG, HVA, and 5-HIAA were present in women, while in men only higher levels of MHPG could be detected. A strong correlation between 5-HIAA and HVA concentrations were observed in all groups. PD patients exhibited normal CSF metabolite levels, but an altered 5-HIAA/HVA ratio, favoring 5-HIAA. Dominant and recessive OPCA differed essentially in HVA concentration-diminished in the first group and elevated in the last. Comparing the results obtained in PD and dominant OPCA, we suggest that the decrease of CSF HVA in the latter group might not reflect nigrostriatal degeneration as we previously thought. Possibly another factor influencing dopamine function in the CNS is involved.
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PMID:Monoamine metabolites in normal human cerebrospinal fluid and in degenerative diseases of the central nervous system. 752 Nov 68

In animal models of Parkinson's disease (PD), it is postulated that the excessive output from the subthalamic nucleus (STN) plays a critical role. Selective lesions or high frequency electrical stimulation of the STN can alleviate parkinsonian symptoms in MPTP-treated monkeys. We decided to carry out STN stimulation in patients suffering from severe akinetic forms of PD. After approval of the institutional ethical committee, we operated on a parkinsonian patient aged 51, suffering for 8 years from a strongly disabling akinetorigid form of PD, complicated by an on-off effect (Hoehn and Yahr stage 5 in the worst-off motor phase). Stereotactic surgery was done on one side under local anesthesia. The theoretical target was chosen according to stereotactic atlases, based on ventriculographic landmarks such as anterior and posterior commissures (AC and PC). The final position of the chronic electrodes was optimized using electrophysiological recording and stimulation along with clinical assessment and surface EMG of agonist and antagonist muscles of the examined limbs. A spontaneous increase in neuronal activity was recorded in an area located 2-4 mm under the level of the intercommissural plane, 10 mm from the midline, at mid-distance between AC and PC. Within the same place, a 130-Hz stimulation induced acute and reversible akinesia alleviation mainly on the contralateral limbs, comparable to that obtained with dopaminergic drugs. No dyskinesia, such as hemiballism, was induced by introduction of electrodes or by stimulation. Then a long-term quadripolar DBS Medtronic electrode was inserted in this area. Studies of the effects of chronic stimulation were extensively performed to determine the best spatiotemporal and electrical stimulation variables.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Acute and long-term effects of subthalamic nucleus stimulation in Parkinson's disease. 763 Oct 92

There were 54 patients entered into this study of the UroLume permanent prostatic stent, most of whom were unfit for conventional prostatic surgery. The stents were inserted with the patient under local or regional anesthesia. Of the patients 34 presented in acute retention, 12 had chronic retention, 4 had severe and worsening symptoms, and 4 had symptoms and urodynamic evidence of obstruction occurring in the presence of Parkinson's disease. Following stent insertion 50 patients were able to void satisfactorily, while the remaining 4 presented with chronic retention and detrusor failure. The 40 patients who had no or minimal remaining symptoms were satisfied with the stent. Most patients experienced frequency and urgency of micturition for 1 to 3 months, which resolved in all but 9 patients with persistent severe detrusor instability. Symptom scores decreased to 6.5 (total) at 1 year for nonretention patients and 6.0 for retention patients. Stents were covered with epithelium within 6 to 9 months. However, when the stent was positioned with any part of the proximal end within the bladder or when the stent could not be epithelialized incrustation occurred (14 cases, all of which were asymptomatic). No serious urosepsis was noted in any patient in this study. Six stents were removed endoscopically without difficulty or damage to the urethra at up to 18 months. The implications of these findings to the potential role of the UroLume stent in the management of a wider range of patients with prostatic obstruction are discussed.
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PMID:The UroLume stent in the management of benign prostatic hyperplasia. 769

Eighteen patients with medically intractable Parkinson's disease that was characterized by bradykinesia, rigidity, and marked "on-off" fluctuations underwent stereotactic ventral pallidotomy under local anesthesia. Targeting was aided by anatomic coordinates derived from the MRI, intraoperative cell recordings, and electrical stimulation prior to lesioning. A nonsurgically treated group of seven similarly affected individuals was also followed. Assessment of motor function was made at baseline and at 3-month intervals for 1 year. Following the lesioning, patients improved in bradykinesia, rigidity, resting tremor, and balance with resolution of medication-induced contralateral dyskinesia. When compared with preoperative baseline, all quantifiable test scores after surgery improved significantly with the patients off medications for 12 hours: UPDRS by 65%, and CAPIT subtest scores on the contralateral limb by 38.2% and the ipsilateral limb by 24.2%. Walk scores improved by 45%. Medication requirements were unchanged, but the patients who had had surgery were able to tolerate larger doses because of reduced dyskinesia. Ventral pallidotomy produces statistically significant reduction in parkinsonism and contralateral "on" dyskinesia without morbidity or mortality and with a short hospitalization in Parkinson's disease patients for whom medical therapy has failed.
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PMID:Stereotactic ventral pallidotomy for Parkinson's disease. 772 66

Numerous developments have improved the safety and efficacy of electroconvulsive therapy (ECT) in recent years, so that ECT is now one of the safest forms of treatment under anesthesia. The indications for psychiatric patients are clearly defined. ECT is also under discussion with respect to certain neurological disorders. This discussion has, however, been largely ignored by the German medical profession. Critical evaluation of previous experience, especially in the United States and in Scandinavia, reveals some clinical situations (e.g., akinetic crisis in Parkinson's disease) in which a primary neurological indication for ECT might be present. ECT is frequently indicated in other brain diseases if pronounced psychopathological disturbances (especially of a depressive type) occur and fail to respond to conventional treatment with psychotropic drugs. ECT may then be indicated on a case-by-case basis. ECT should not be withheld from such patients; on the other hand, there is the risk of uncontrolled expansion of these indications for ECT.
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PMID:[Electroconvulsive therapy in neurologic diseases]. 778 10

A pharmacological study using monkeys, in which parkinsonism was induced by 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP), was undertaken to elucidate the mechanism underlying urinary bladder dysfunctions in Parkinson's disease. Under ketamine anesthesia, cystometrograms showed that, in MPTP-treated monkeys, a contraction of the urinary bladder was induced with smaller bladder volume than that in normal monkeys. In MPTP-treated monkeys, subcutaneously injected SKF 38393, a dopamine D1 receptor agonist, significantly increased the bladder volume and pressure thresholds for inducing the micturition reflex without affecting those in normal monkeys. In contrast, subcutaneous injections of quinpirole, a dopamine D2 receptor agonist, and apomorphine, a dopamine D1 and D2 receptor agonist, slightly, but significantly reduced the volume threshold of the bladder for the micturition reflex in both normal and MPTP-treated groups. These results indicate that, in parkinsonism, the degeneration of dopaminergic neurons in the substantia nigra leads to the detrusor hyperreflexia, probably due to a failure of activation of dopamine D1 receptors.
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PMID:The dopamine D1 receptor agonist SKF 38393 suppresses detrusor hyperreflexia in the monkey with parkinsonism induced by 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP). 809 60

Stereotactic thalamotomy of the VIM (ventral intermediate) nucleus is considered as the best neurosurgical treatment for Parkinsonian and essential tremors. However, this surgery, especially when bilateral, still presents a risk of recurrence and neurological complications. We observed that acute VIM stimulation at frequencies higher than 60 Hz during the mapping phase of the target suppressed the tremor of Parkinson's disease (PD) and essential tremor (ET). This effect was immediately reversible at the end of the stimulation. This was initially proposed as an additional treatment for patients already thalamotomized on the contralateral side, and then extended as a regular procedure for extra-pyramidal dyskinesias. Since January 1987, we implanted 126 thalami in 87 patients (61 PD, 13 ET, 13 dyskinesias of various origins). Deep brain stimulation electrodes were stereotactically implanted under local anaesthesia, using stimulation and micro-recording to delineate the best site of stimulation. Electrodes were subsequently connected to implantable programmable stimulators. The optimal frequency was around 130 to 185 Hz. The results (evaluated by a neurologist from 0 = no effect to 4 = perfect relief) are related to the type of tremor. Altogether, 71% of the 80 patients benefited from the procedure with grade 3 and 4 results. In 88% of the PD cases, the results were good (grade 3) or excellent (grade 4) and stable with time. Rigidity was moderately for a long improved but akinesia was not. The same level of improvement was observed in 68% of the ET patients and only in 18% of the other types of dyskinesias.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Chronic VIM thalamic stimulation in Parkinson's disease, essential tremor and extra-pyramidal dyskinesias. 810 99

In Parkinson's disease, experimental studies favour a neuronal hyperactivity of the subthalamic nucleus. We carried out a subthalamic nucleus electrical stimulation in a patient aged 51, suffering for 8 years from a severe akineto-rigid form of Parkinson's disease, complicated with an on-off effect. Stereotaxic surgery was done under local anaesthesia on one side. Within the theoretical target, a 130 Hz stimulation induced akinesia alleviation mainly on the contralateral limbs. No abnormal movement was noticed. Then a long-term quadripolar DBS Medtronic electrode was inserted in that area. The study of the effects of chronic stimulation is in progress to determine the best temporal and electrical stimulation variables.
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PMID:[Effects of the stimulation of the subthalamic nucleus in Parkinson disease]. 823 8

Comparative studies of the differences in elderly patients with and without cardiovascular disorders were made in regard to complications occurring during and after operation. The subjects included 38 patients (6 men and 32 women) aged 70 to 99 years (mean: 84 years) at Nagoya City Kouseiin Geriatric Hospital who had orthopedic surgery under general anesthesia, between March 1990 and October 1992. Diseases identified in these subjects were sequelae of cerebrovascular disease (38 subjects), heart disease (22 subjects), hypertension (9 subjects), senile dementia (6 subjects), Parkinson's disease (5 subjects), malignant disease (3 subjects) and diabetes mellitus (2 subjects). They were initially divided into 2 groups according to ultrasonic cardiography: a normal group comprising 20 patients without cardiovascular abnormalities, and a disorder group comprising 18 patients with reduction of left ventricule function, left ventricular hypertrophy and/or valvular disease (more than moderate). All subjects were examined with regard to age, weight, the nutrition index proposed by Onodera, activity of daily living (ADL), cardiac output, left ventricular ejection fraction, serum level of BUN and albumin etc. Moreover, the disorder group subjects were divided into 2 groups according to the presence or absence of heart failure occurring after surgery. In addition to the above-mentioned, we also studied the duration of surgery and anesthesia, and water balance during and after surgery. Results showed that the ADL and nutrition index in the disorder group were lower compared to the normal group.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Comparative studies on complications occurring during and after surgery in elderly patients with and without cardiovascular disorders]. 829 52

In a case-control study, we investigated the possible etiologic relevance to Parkinson's disease (PD) of rural factors such as farming activity, pesticide exposures, well-water drinking, and animal contacts; toxicologic exposures such as wood preservatives, heavy metals, and solvents; general anesthesia; head trauma; and differences in the intrauterine environment. We recruited 380 patients in nine German clinics, 379 neighborhood control subjects, and 376 regional control subjects in the largest case-control study investigating such factors and collected data in structured personal interviews using conditional logistic regression to control for educational status and cigarette smoking. The latter was strongly inversely associated with PD. There were significantly elevated odds ratios (OR) for pesticide use, in particular, for organochlorines and alkylated phosphates, but no association was present between PD and other rural factors. A significantly elevated OR was present for exposure to wood preservatives. Subjective assessment by the probands indicated that exposure to some heavy metals, solvents, exhaust fumes, and carbon monoxide was significantly more frequent among patients than control subjects, but this was not confirmed by a parallel assessment of job histories according to a job exposure matrix. Patients had undergone general anesthesia and suffered severe head trauma more often than control subjects, but a dose-response gradient was not present. Patients reported a significantly larger number of amalgam-filled teeth before their illness than control subjects. The frequency of premature births and birth order did not differ between patients and control subjects. Patients reported significantly more relatives affected with PD than control subjects. These results support a role for environmental and genetic factors in the etiology of PD.
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PMID:Possible environmental, occupational, and other etiologic factors for Parkinson's disease: a case-control study in Germany. 862 66


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