Movement disorders : official journal of the Movement Disorder Society
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Comparative Study
Health-related quality of life in patients with advanced Parkinson's disease treated with deep brain stimulation of the subthalamic nuclei.
Parkinson's disease (PD) is a progressive neurodegenerative disorder for which there is as yet no cure. It affects many aspects of patients' lives, only some of which can be monitored by available clinical rating scales. In the past decade, there has been a new emphasis on the use of health-related quality of life (HRQOL) measures to describe patient response to treatment. ⋯ HRQOL, UPDRS part II and III, duration of off periods, and dyskinesias improved significantly from T(0) to T(3) and from T(0) to T(6) for the surgery group but not for the nonsurgery group. Ten of the 11 patients treated with DBS of the STN reported a lower summary score (indicating better HRQOL) 6 months after surgery. The results of this prospective controlled study suggest that patients with advanced idiopathic PD treated with DBS of the STN obtain significant improvements in patient reported HRQOL and in clinical outcomes 3 and 6 months after surgery.
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Case Reports
Corticobasal degeneration syndrome with basal ganglia calcification: Fahr's disease as a corticobasal look-alike?
A 57-year-old man with a 5-year history of progressive left-sided rigidity and apraxia had extensive bilateral calcification of basal ganglia, centrum semiovale, dentate nuclei, and cerebellar white matter on brain imaging. The case is an example of radiological Fahr's disease accompanying a clinical syndrome of corticobasal degeneration. Possible pathogenetic and nosological implications of this association are discussed.
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Comparative Study
[123I]beta-CIT SPECT distinguishes vascular parkinsonism from Parkinson's disease.
We investigated whether [(123)I]-beta-CIT and single-photon emission computed tomography (SPECT) imaging distinguishes patients with clinically suspected vascular parkinsonism (VP) from patients with idiopathic Parkinson's disease (PD). [(123)I]beta-CIT SPECT is a sensitive marker of dopaminergic degeneration, and the degree of striatal binding reduction in PD correlates with disease severity. Thirteen patients who fulfilled rigid clinical criteria for VP (mean +/- S. D.: age, 76.5 +/- 5.3 years; disease duration, 3.6 +/- 2.8 years), 20 PD patients (age, 66.2 +/- 9.5 years; disease duration, 4.3 +/- 2.7 years), and 30 healthy persons (age, 44.6 +/- 19.2 years) underwent [(123)I]beta-CIT SPECT imaging. ⋯ Moreover, putamen-caudate nucleus ratios were significantly reduced in PD compared with both VP patients and healthy controls (F(2) = 65.5, P < 0.001). Whole striatal beta-CIT binding was more than one standard deviation above the mean PD values in all but one of the individual VP patients. Our findings suggest that the presynaptic dopaminergic deficits seen in PD are absent in most patients with VP. [(123)I]beta-CIT SPECT imaging may be useful to help distinguish between PD and VP patients during life.
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Comment Letter Case Reports
Subthalamotomy for end-stage severe Parkinson's disease.