Parkinsonism & related disorders
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Parkinsonism Relat. Disord. · Dec 2012
Multicenter StudyWhat are the issues facing Parkinson's disease patients at ten years of disease and beyond? Data from the NPF-QII study.
Parkinson's disease (PD) is the second most common neurodegenerative syndrome, classically characterized by levodopa-responsive motor features accompanied by non-motor mood, cognitive, sensory and autonomic issues. Over time, disease burden slowly accumulates resulting in diminished health status. Many clinicians consider the 10 year disease duration mark as significant, however the clinical status and health-related quality of life of patients reaching this milestone have not been well documented. ⋯ Our data on PD patients with at least 10 years disease duration confirmed the younger age of onset of PD, but not the higher proportion of females or rest tremor, or the lower proportion of Caucasians seen in other aged PD cohorts. PD-10 patients had increased disease burden, increased caregiver burden, and impaired health-related quality of life. Although subjects mostly remained independently mobile, balance could be impaired with frequent falls identified. The prevalence of PD-10 patients living at home (93%) was very high in our sample which was drawn from specialty clinics, compared to prior studies reporting up to 27% PD patients institutionalized at 10 years duration. Thus policies to improve in-home support and caregiver support will be crucial in efforts aimed at maintaining patients in a home setting.
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Parkinsonism Relat. Disord. · Dec 2012
ReviewThe conceptual framework of palliative care applied to advanced Parkinson's disease.
With the incidence of Parkinson's disease rising, while imposing a large cost on health care systems around the world, optimizing care has become crucial. The complexity of our patients increases dramatically in the advanced stages. Recently our understanding of advanced Parkinson's disease has led to the question of whether Palliative care approaches would be complementary to the care of these patients. ⋯ Pain has become recognized as a common symptom that can be difficult to treat. Given the success of early Palliative care involvement in cancer populations, it should not be surprising that our specialized Palliative Parkinson's Clinic at the Toronto Western Hospital has become indispensable for our patients. This article will describe the rational for combining the expertise of the Neurology department with that of Palliative care in the care of patients suffering from Parkinson's disease.
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Parkinsonism Relat. Disord. · Dec 2012
Palliative care for advanced Parkinson disease: an interdisciplinary clinic and new scale, the ESAS-PD.
Palliative care provides a holistic approach to symptom relief using a multidisciplinary team approach to enhance quality of life throughout the entire course of a particular illness. The care team consists of movement disorders neurologist, a palliative care physician, a wound care nurse, a spiritual counselor and a care coordinator. Palliative care concepts were applied to a group of advanced Parkinson disease (PD) patients in a dedicated Palliative Care Clinic. ⋯ ESAS-PD is a quick, effective scale for assessment of late stage PD symptoms. Scores are sensitive to intervention, and therefore have potential clinical utility for physicians and other healthcare providers. Advanced PD patients have a similar degree of symptoms as metastatic cancer patients, respond to treatment in a similar way, and therefore should have access to palliative care services.
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Parkinsonism Relat. Disord. · Dec 2012
Clinical TrialUnilateral caudal zona incerta deep brain stimulation for Parkinsonian tremor.
The subthalamic nucleus is currently the target of choice in deep brain stimulation (DBS) for Parkinson's disease (PD), while thalamic DBS is used in some cases of tremor-dominant PD. Recently, a number of studies have presented promising results from DBS in the posterior subthalamic area, including the caudal zona incerta (cZi). The aim of the current study was to evaluate cZi DBS in tremor-dominant Parkinson's disease. ⋯ Unilateral cZi DBS seems to be safe and effective for patients with severe Parkinsonian tremor. The effects on rigidity and bradykinesia were, however, not as profound as in previous reports of DBS in this area.