Movement disorders : official journal of the Movement Disorder Society
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In the mid-1980s, the treatment of Parkinson's disease was quite exclusively centered on dopatherapy and was focusing on dopamine systems and motor symptoms. A few dopamine agonists and a monoamine oxidase B inhibitor (selegiline) were used as adjuncts in advanced Parkinson's disease. In the early 2010s, levodopa remains the gold standard. ⋯ Despite therapeutic advances, Parkinson's disease continues to be a relentlessly progressive disorder leading to severe disability. Neuroprotective interventions able to modify the progression of Parkinson's disease have stood out as a failed therapeutic goal over the last 2 decades, despite potentially encouraging results with compounds like rasagiline. Newer molecular targets, new animal models, novel clinical trial designs, and biomarkers to assess disease modification have created hope for future therapeutic interventions.
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There have been extraordinary advances in our knowledge of the underlying gene, the protein it encodes, various models of disease, and potential targets for effective therapies for Huntington disease. Huntington disease research has increased exponentially in the past 25 years, and we now understand many of the molecular mechanisms underlying the disease. ⋯ Clinical research on biomarkers and clinical trials on potential neuroprotective agents are underway. Here we review our progress in these areas over the last 25 years and speculate on what the next 25 years may hold.
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Comparative Study
Comparison of subthalamic nucleus deep brain stimulation and Duodopa in the treatment of advanced Parkinson's disease.
Subthalamic nucleus deep brain stimulation (STN-DBS) and levodopa/carbidopa enteral (Duodopa) infusion are two effective therapeutic options for the treatment of advanced Parkinson's disease (PD). ⋯ STN-DBS and Duodopa showed a significant efficacy on motor symptoms, activities of daily living, and motor complications. The group of Duodopa-treated patients developed more procedure-related complications.
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Comparative Study
Instability of syllable repetition in Parkinson's disease--influence of levodopa and deep brain stimulation.
The aim of this study was to test the hypothesis of a fundamental impairment of vocal pace performance in Parkinson's disease (PD) based on a syllable repetition paradigm and the influence of levodopa and deep brain stimulation of the subthalamic nucleus (STN-DBS). Twenty-two PD patients under stable dopaminergic medication, 14 patients with STN-DBS, and 30 controls were tested. Participants had to repeat the syllable /pa/ in a steady pace. ⋯ COV was elevated in both PD subgroups. COV was not influenced by levodopa administration but showed a further deterioration under STN-DBS. The impaired syllable repetition capacity shows similarities to the patterns of more complex speech rhythm abnormalities in PD and therefore might share the same pathophysiology.
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Anxiety is a prevalent and disabling condition in Parkinson's disease (PD). The lack of anxiety rating scales validated for this population hampers research into anxiety in PD. The aim of this study is to assess the clinimetric properties of the Hamilton anxiety rating scale (HARS), the Beck anxiety inventory (BAI), and the hospital anxiety and depression scale (HADS) in PD patients. ⋯ Given the adequate known groups validity of all three rating scales, each of these scales is likely to be useful in clinical practice or research for evaluation of symptom severity. Limitations in the construct validity of the anxiety scales in this study raise questions regarding suitability for their use in PD.