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)

To assess the long-term outcome following unilateral pallidotomy for advanced Parkinson's disease, we performed nonblinded Core Assessment Program for Intracerebral Transplantations protocol assessments in 10 of the original 15 patients in our pilot study for 4 years following surgery. Although Unified Parkinson's Disease Rating Scale motor examination scores returned to baseline levels at 3 and 4 years, most patients continued to show sustained improvements in contralateral tremor, akinesia, and drug-induced dyskinesias. Contralateral tremor was absent at 4 years in all seven patients with preoperative tremor. Contralateral "off" arm movement times (averaged for three tasks) decreased by 37% at 1 year and by 30% at 4 years. Contralateral dyskinesia scores improved by 82% at 1 year and by 64% at 4 years. In contrast, after reaching speeds equal to the contralateral side at 1 year, ipsilateral "off" movement times increased by 13% over baseline levels at 4 years. Although most gait and postural stability measures showed modest initial improvement followed by a return to baseline values, "on" stand-walk-sit task performance declined significantly at 4 years. Despite the restriction of our surgeries to one side and the expected natural progression of Parkinson's disease, the results of patient self-assessments suggest that 4 years after unilateral pallidotomy, most patients continue to experience a quality of life above preoperative levels.
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PMID:Treatment of advanced Parkinson's disease by unilateral posterior GPi pallidotomy: 4-year results of a pilot study. 1075 71

Parkinson's disease (PD) is associated with particular difficulties rising from a seated position. Little is known about the mechanisms of sit-to-stand in this condition. We sought to define trunk movement during sit-to-stand in a group of patients with PD. Six patients and seven normal volunteers were studied using a six camera ELITE motion analysis system (BTS, Milan, Italy), which permitted data collection in the coronal, sagittal, and transverse planes. Retroreflective markers were positioned along the spine at C7, T3, T6, T9, T12, L3, and the sacrum. Whole-trunk kinematics and the movement at the six different trunk markers were recorded during rising. PD patients have a significantly greater degree of trunk flexion than controls, showing a significant increase in angular velocity of the trunk in the sagittal plane. The total range of movement of trunk rotation was significantly smaller in the PD group, but lateral movement in the trunk was greater than normal. These data suggest that patients with early PD compensate for their difficulties rising from a chair by generating greater trunk flexion at higher angular velocity, thus developing greater forward momentum. This process results in a decrease in the duration of the unstable transitional phase of sit-to-stand, allowing PD patients to reach the upright position as easily and safely as possible. Small rotational movements are an effective way to maintain the centre of mass within the base of support during sit-to-stand. This mechanism appears to be denied to the PD patients who may use increased movements in the coronal plane as an alternative strategy.
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PMID:Trunk movement in Parkinson's disease during rising from seated position. 1192 Nov 12

Interest in alternative medical treatments, including acupuncture, is increasing. Alternative treatments must be subjected to the same objective standards as all medical treatments. A non-blinded pilot study of the safety, tolerability, and efficacy of acupuncture (ACUPX) for the symptoms of (PD) was performed. Twenty PD patients (mean age, 68 years; disease duration, 8.5 years; Hoehn and Yahr [H&Y] stage, 2.2; Unified Parkinson's Disease Rating Scale score [UPDRS], 38.7) each received acupuncture treatments by a licensed acupuncturist. All patients were treated with two acupuncture treatment sessions per week. The first seven patients received 10 treatments and the last 13 patients 16 treatments. Patients were evaluated before and after ACUPX with the Sickness Impact Profile (SIP); UPDRS; H & Y; Schwab and England (S & E); Beck Anxiety Inventory (BAI); Beck Depression Inventory (BDI); quantitative motor tests, including timed evaluations of arm pronation supination movements, finger dexterity, finger movements between two fixed measured points, and the stand-walk-sit test; and a patient questionnaire designed for the study. Following ACUPX, there were no significant changes in the UPDRS, H&Y, S&E, BAI, BDI, quantitative motor tests, total SIP or the two SIP Dimension scores. Analysis of the 12 SIP categories not corrected for multiple comparisons revealed a post-ACUPX improvement in the sleep and rest category only (P = 0.03). On the patient questionnaire, 85% of patients reported subjective improvement of individual symptoms including tremor, walking, handwriting, slowness, pain, sleep, depression, and anxiety. There were no adverse effects. ACUPX therapy is safe and well tolerated in PD patients. A range of PD and behavioral scales failed to show improvement following ACUPX other than sleep benefit, although patients reported other discrete symptomatic improvements. A broad battery of tests in PD patients suggested that ACUPX resulted in improvement of sleep and rest only. This finding needs to be verified using more in-depth and controlled evaluation of ACUPX for PD-related sleep disturbance.
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PMID:Acupuncture therapy for the symptoms of Parkinson's disease. 1221 Aug 79

Patients with Parkinson's disease (PD) are known to manifest slowness in movements. We sought to identify the particular kinematic and kinetic disorders that contribute to the slowness in performing sit-to-stand in these patients. Two inter-related studies were carried out. In the first study, 20 patients with PD and 20 control subjects were instructed to perform sit-to-stand at a natural speed. In the second study, 15 control subjects were instructed to simulate the slower speed of sit-to-stand of the patients identified in the first study. Kinematic and kinetic data were recorded by a PEAK motion analysis system and two force platforms. The results showed that patients with PD generated smaller peak horizontal and vertical velocities during the task. They took a longer time to complete each individual phase as well as the whole movement of sit-to-stand. Patients also produced smaller peak hip flexion and ankle dorsiflexion joint torques and had prolonged time-to-peak torques from sit-to-stand onset. When control subjects simulated the patients' speed of sit-to-stand, there was no difference in all the kinematic and kinetic data between groups. The only exception was that they exhibited a shorter transition time between peak horizontal velocity (flexion phase) and seat-off (extension phase) than the patients. This study demonstrated that the slowness of PD patients during sit-to-stand at a natural speed could be attributed to inadequate peak hip flexion and ankle dorsiflexion torques, a prolonged torque production, as well as a difficulty in switching from the flexion to extension direction during sit-to-stand. As the latter difficulty persisted when the control subjects performed the task at a speed similar to that of the patients, our findings suggest that a fundamental problem of patients with Parkinson's disease could be a switch between movement directions.
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PMID:Switching of movement direction is central to parkinsonian bradykinesia in sit-to-stand. 1246 56

Individuals with Parkinson's disease (PD) have difficulties rising from a chair; however, factors contributing to this inability have never been investigated. We compared lower extremity strength between individuals with PD and healthy controls and quantified the relationships between strength and the ability to rise from a chair. Ten men with mild PD and 10 sex- and age-matched controls performed maximal concentric, isokinetic knee and hip extensor torque on an isokinetic dynamometer to quantify muscle strength. Subjects also rose from a chair at their comfortable pace without the use of their arms and the duration of this task provided a measure of sit-to-stand (STS) ability. Subjects with PD were tested in an on- and off-medication state on different days. Mean hip and knee extensor torques were lower in subjects with PD, with greater deficits found at the hip. Greater hip strength was related to better STS ability in subjects with PD while greater knee strength was related to better STS ability in controls. These results show that individuals with mild PD generate smaller extremity forces compared to controls. Reduced strength, particularly at the hip, may be one factor that contributes to the difficulty of persons with PD to rise from a chair.
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PMID:Leg muscle strength is reduced in Parkinson's disease and relates to the ability to rise from a chair. 1253 8

Animal studies indicate that beta(2)-adrenergic receptor agonists enhance transport of levodopa across the blood-brain barrier. Preliminary studies showed improved response to levodopa in patients with Parkinson disease (PD) who were given albuterol as adjunctive therapy. Beta(2)-adrenergic agonists may offer additional benefits to PD patients via their skeletal muscle anabolic effects, particularly those who experience decreased muscle strength and weight loss. Nondemented, fluctuating PD patients receiving levodopa but not experiencing severe dyskinesias underwent the following tests at baseline and 14 weeks after treatment with albuterol sulfate (4 mg four times a day, orally): Unified Parkinson's Disease Rating Scale motor, tapping, and stand-walk-sit tests every 30 minutes between 8 am and 5 pm; body composition analyses using whole-body plethysmography and computed tomography of the thigh; muscle strength tests; and the Parkinson's Disease Questionnaire (PDQ-39). Results were analyzed using paired t-tests (2 tailed), repeated-measures analysis of variance, and the Wilcoxon signed-rank test. Seven of 8 enrolled patients completed the study; 1 patient withdrew because of headache and anxiety. The area under the curve for all-day UPDRS motor scores improved by 9.8 +/- 9.1% (mean +/- standard deviation; P < 0.05) and tapping improved by 7.6 +/- 8.1% (P < 0.05). The effect was more pronounced when only the response to the first levodopa dose (area under the curve, 8-11 am) was analyzed: 13.0 +/- 9.8% and 9.8 +/- 9.6% respectively. Thigh muscle cross-sectional area increased significantly as measured by computed tomography (5.3 +/- 3.2%, P < 0.01), as did fat-free mass by whole-body plethysmography combined with total-body water determination (9.5 +/- 2.9%, P < 0.05). There was no significant improvement in the stand-walk-sit test, muscle strength tests, other UPDRS sections, daily OFF time, or PDQ-39. Four patients were rated as having a mild global improvement (+1 point) on a -3 to +3-point scale, and 3 of them chose to continue albuterol beyond the termination of the study. The mean heart rate increased from 78.3 +/- 9.3 beats/minute to 85.6 +/- 8.7 beats/minute (P < 0.05). No laboratory abnormalities or electrocardiographic changes were induced by albuterol in any subject. This open-label pilot study suggests that albuterol increases muscle mass and improves the therapeutic response to levodopa in patients with fluctuating PD. A double-blind, placebo-controlled study is needed to confirm the effects and safety profile of beta(2)-agonists in PD.
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PMID:Albuterol improves response to levodopa and increases skeletal muscle mass in patients with fluctuating Parkinson disease. 1289 42

Individuals with Parkinson's disease (PD) typically have difficulty rising from a chair. A major contributing factor may be altered anticipatory postural control; this hypothesis has been fueled by reports of altered function of the supplementary motor area in PD, an area linked to the preparation of movements. This study tested the hypothesis that individuals with PD would exhibit altered anticipatory postural control which would include a reduced preparatory hip flexion and decreased forward displacement of the COM prior to lift-off of the buttocks from the chair. Ten male subjects with PD and ten male age-matched controls were instructed to rise from a chair without the use of their arms at their comfortable pace on two separated days during on and off-medication states. Body movements were recorded with an optoelectronic device, in addition to forces under the buttocks and each foot to calculate lower extremity joint angles, joint movements and net body centre of mass displacement (COM). The sit-to-stand (STS) duration was the same for the PD-on and controls, but greater for the PD-off group. The PD groups (on and off) used a hip flexion strategy (greater preparatory hip flexion displacement and forward COM displacement, reduced knee extensor moments) compared to the controls. Contrary to predictions, subjects with PD exaggerated, rather than reduced, the movement preparation of the STS using a hip flexion strategy. Possible underlying causes of this flexion strategy could include compensation for poor lower extremity muscle strength and a need for greater postural stability during the lift-off phase.
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PMID:Postural control during a sit-to-stand task in individuals with mild Parkinson's disease. 1296 Oct 57

We investigated whether preparatory signals, in the form of audiovisual cues, could enhance the performance of sit-to-stand (STS) in Parkinson's disease (PD) patients. Fifteen patients and fifteen control subjects similar in age, gender, weight, and height were examined. All subjects were instructed to carry out STS under self-initiated and cue-initiated conditions. A PEAK Motion Analysis System and two force plates were synchronized to record kinematic and kinetic data. In patients with PD, the addition of audiovisual cues was found to increase hip flexion and knee extension torques and decrease the time-to-peak joint torques, as well as increase peak horizontal and vertical velocities of the body center of mass and decrease the time taken to complete STS. Consequently, the performance of STS in these patients approached that of control subjects. In fact, during cue-initiated STS, no difference was found between the patient and control groups for the time-to-peak of all joint torques, the peak horizontal and vertical velocities, and the time taken to complete STS. Our findings thus demonstrated that audiovisual cues were effective in enhancing STS in patients with PD. These feed-forward signals could have enhanced the defective motor preparatory phase, thus leading to improved performance of the STS task. These findings provide a scientific basis for the use of audiovisual signals to enhance STS performance in patients with PD.
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PMID:Audiovisual cues can enhance sit-to-stand in patients with Parkinson's disease. 1537 90

Akathisia is a neurological side effect of antipsychotic medications, which are used to treat various psychiatric disorders, and is characterized by physical restlessness and a subjective urge to move. Although side effects, such as akathisia, dystonia, and dyskinesia, are common for conventional medications, these effects occur in reduced frequency with the use of new-generation antipsychotics. Despite a lowered incidence profile, akathisia and similar conditions continue to affect patients. Neuroleptic-induced akathisia can present as fidgety movements while seated, rocking in place while standing, pacing, or the inability to sit or stand still for an extended period of time as well as the overwhelming urge to move, which can cause severe distress and an increased risk of suicide for affected patients. First-line treatment of akathisia includes benzodiazepines or beta-blockers for patients who do not have symptoms of Parkinson's disease and anticholinergics for patients with Parkinson's symptoms. Clinicians should ensure that an accurate diagnosis of akathisia is made and target symptoms are decreasing due to treatment, which does not negatively affect the mental health of the patient. This expert roundtable supplement will address the diagnosis, pathophysiology, phenomenology, classification, and history of akathisia as well as provide screening tools and treatment options for the condition.
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PMID:Akathisia: problem of history or concern of today. 1780 18

A new ambulatory method of monitoring physical activities in Parkinson's disease (PD) patients is proposed based on a portable data-logger with three body-fixed inertial sensors. A group of ten PD patients treated with subthalamic nucleus deep brain stimulation (STN-DBS) and ten normal control subjects followed a protocol of typical daily activities and the whole period of the measurement was recorded by video. Walking periods were recognized using two sensors on shanks and lying periods were detected using a sensor on trunk. By calculating kinematics features of the trunk movements during the transitions between sitting and standing postures and using a statistical classifier, sit-to-stand (SiSt) and stand-to-sit (StSi) transitions were detected and separated from other body movements. Finally, a fuzzy classifier used this information to detect periods of sitting and standing. The proposed method showed a high sensitivity and specificity for the detection of basic body postures allocations: sitting, standing, lying, and walking periods, both in PD patients and healthy subjects. We found significant differences in parameters related to SiSt and StSi transitions between PD patients and controls and also between PD patients with and without STN-DBS turned on. We concluded that our method provides a simple, accurate, and effective means to objectively quantify physical activities in both normal and PD patients and may prove useful to assess the level of motor functions in the latter.
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PMID:Ambulatory monitoring of physical activities in patients with Parkinson's disease. 1807 46


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