Parkinsonism & related disorders
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Parkinsonism Relat. Disord. · Jan 2012
Comparative StudyEpidemiology and clinical phenomenology for Parkinson's disease with pain and fatigue.
We conducted a cross-sectional analysis with 901 Parkinson's disease (PD) patients in China to understand the epidemiological characteristics of PD pain among Chinese patients. In addition, we searched PubMed and the China Hospital Knowledge Database for epidemiological studies of pain and fatigue among PD patients from 1999 to 2011 to understand the prevalence of these symptoms around the world and associated clinical features. The 901 PD cases were recruited from 42 university affiliated hospitals randomly selected from seven provincial capitals across four economic regions of China. ⋯ Interestingly, Northern-European PD patients reported the highest prevalence of pain, but the lowest prevalence of fatigue. These studies suggest that motor complications and depression are likely key predictors for PD pain, while disease severity, depression and sleep disturbance are associated with PD fatigue. More studies with standardized methods would be needed to better understand the prevalence of PD pain and fatigue across various regions of the world.
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Parkinsonism Relat. Disord. · Jan 2012
ReviewTandem deep brain stimulation--challenging new structural targets for Parkinson's disease.
Deep brain stimulation (DBS) targets for Parkinson's disease have been limited to neuronal regions wherein lesions have produced beneficial effects. Improvements in imaging allow placement in small and novel targets. Additionally, due to the ability of impulse generators to accommodate multiple electrodes, simultaneous stimulation in multiple neuronal regions is possible. ⋯ I hypothesize that tandem DBS, targeting the STN/GPi and fornix/hypothalamus and/or hippocampus may have a positive impact on improving cognitive function and/or reducing risk for subsequent dementia with Lewy bodies/Parkinson dementia. Such targets also pose potential negative ramifications. Nevertheless, given the tremendous disability produced by dementia, new structural targets require systematic study.
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Parkinsonism Relat. Disord. · Jan 2012
ReviewClinical management of pain and fatigue in Parkinson's disease.
Pain and fatigue are part of the phenomenological spectrum of Parkinson's disease (PD). These non-motor symptoms can be as troublesome as motor symptoms, impact activities of daily living, and are often underdiagnosed. ⋯ We review here the clinical manifestations and management of these non-motor symptoms. Their resolution can be challenging, as there is insufficient evidence concerning effective treatment options.
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Parkinsonism Relat. Disord. · Jan 2012
ReviewEpidemiology, diagnosis and differential diagnosis in Parkinson's disease tremor.
The epidemiology of tremor in Parkinson's disease is not well examined. The prevalence of Parkinson's disease is about 100-300 per 100,000, and the majority (70-100%) of these patients may develop tremor during the course of the disorder. The expression of tremor is also influenced by the genetic background of selected patients. ⋯ Misdiagnoses between Parkinson tremor and essential tremor are relatively common. Electrophysiological and functional imaging examinations can be useful in the distinction of the two, but both approaches suffer from some limitations. In general, essential tremor and other tremor forms can be distinguished from Parkinson tremor by their frequency and their expression with different activation.
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The specific effect of DBS at high frequency, discovered during a VIM thalamotomy, was extended to the older targets of ablative neurosurgery such as the pallidum, for tremor in Parkinson's disease (PD), dyskinesias, essential tremor, as well as the internal capsule to treat psychiatric disorders (OCD). A second wave of targets came from basic research, enabled by the low morbidity, reversibility, and adaptability of DBS. ⋯ Serendipity and a scientific approach have provided several instances where targets have produced unexpected effects (such as STN in OCD), as well as limbic effects observed during attempts at VMH stimulation for obesity: this might offer a novel way to treat mild cognitive impairment, or memory deficits reported in Alzheimer's disease. While these might provide solutions for as yet unsolved problems, attention must be paid to ethical considerations.