Movement disorders : official journal of the Movement Disorder Society
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We compared postural performances in early stage Parkinson's disease (PD) patients and healthy subjects, and to determine if PD patients have infraclinical postural instability. Nine PD patients and 18 age- and sex-matched control subjects were recorded with open eyes (OE) and closed eyes (CE) using a force platform in static and dynamic conditions with a mobile platform allowing antero posterior and medio lateral oscillations. Oscillations of the mobile platform and balance strategy were quantified using both a force platform and the Vicon system. ⋯ Oscillations of the mobile platform were not different between the two groups. Lastly, all subjects used an ankle strategy, but PD patients had larger head oscillations than the control subjects. Early stage PD patients have an infraclinical postural instability which is compensated when it is more difficult to maintain good balance, suggesting that the neurological mechanisms of balance are partially still operating at this stage of the disease.
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Clinical Trial Controlled Clinical Trial
Differential effects of levodopa and subthalamic nucleus deep brain stimulation on bradykinesia in Parkinson's disease.
Cardinal symptoms of Parkinson's disease (PD) respond well to treatment with levodopa and deep brain stimulation (DBS) of the subthalamic nucleus (STN). However, it has remained unclear whether levodopa and STN-DBS have differential effects on bradykinesia. We investigated 8 PD-patients with STN-electrodes in four conditions: STN-DBS and levodopa (ON(MED)/ON(STIM)), STN-DBS only (OFF(MED)/ON(STIM)), levodopa only (ON(MED)/OFF(STIM)), without STN-DBS/levodopa (OFF(MED)/OFF(STIM)). ⋯ However, maximum frequency remained lower in PD-patients during ON(MED)/ON(STIM) compared with controls. This study demonstrates a better effect of levodopa on distal finger movements and STN-DBS on proximal diadochokinesia. Furthermore, a complementary effect of both therapies on brain areas involved in bradykinesia can be assumed.
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Multicenter Study
Accuracy of DaTSCAN (123I-Ioflupane) SPECT in diagnosis of patients with clinically uncertain parkinsonism: 2-year follow-up of an open-label study.
We previously reported on the role of dopamine transporter (DAT) SPECT in the workup of patients with clinically uncertain parkinsonian syndromes (CUPS). The findings of that study supported the use of SPECT imaging with DaTSCAN ((123)I-Ioflupane) for accurate diagnosis in this population. We report here the 2-year follow-up of the CUPS study, which aimed to validate the results of DaTSCAN imaging and to ascertain whether a second scan could minimize any residual diagnostic uncertainty among those with an inconclusive diagnosis. ⋯ Follow-up DaTSCAN SPECT helped to establish a diagnosis in 7 of 8 patients (87.5%) with a previously inconclusive diagnosis. DaTSCAN imaging shows a high rate of agreement with clinical diagnosis after 2-years follow-up. A second scan at 2 years follow-up can reduce remaining diagnostic uncertainty that is present even after a prolonged period of observation.
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Randomized Controlled Trial
Short-term continuous infusion of apomorphine hydrochloride for treatment of Huntington's chorea: A double blind, randomized cross-over trial.
We evaluated tolerability and the efficacy of continuous infusion of apomorphine hydrochloride on involuntary movements and mood disorder in Huntington's disease (HD) patients in a pilot, single center, double-blind, randomized, crossover, and controlled versus placebo study. Nine patients with a molecular diagnosis of HD were screened for response to acute apomorphine injection. Four of them, not ameliorating at the acute test, were discontinued. ⋯ The HAD score did not change after infusion of either treatment. No serious adverse events were reported by either group during the study. Our results suggest that continuous infusion of apomorphine might be considered for the treatment of involuntary movements in some HD patients.