Parkinsonism & related disorders
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Parkinsonism Relat. Disord. · Mar 2012
Randomized Controlled TrialDeep brain stimulation in early Parkinson's disease: enrollment experience from a pilot trial.
Deep brain stimulation (DBS) of the subthalamic nucleus is an accepted therapy for advanced Parkinson's disease (PD). In animal models, pharmacologic ablation and stimulation of the subthalamic nucleus have resulted in clinical improvement and, in some cases, improved survival of dopaminergic neurons. DBS has not been studied in the early stages of PD, but early application should be explored to evaluate safety, efficacy, and the potential to alter disease progression. ⋯ This report demonstrates that subjects with early stage PD can be successfully recruited, consented and retained in a long-term clinical trial of DBS. Our ongoing pilot investigation will provide important preliminary safety and tolerability data concerning the application of DBS in early stage PD.
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Parkinsonism Relat. Disord. · Feb 2012
ReviewRelationships between motor aspects of gait impairments and activity limitations in people with Parkinson's disease: a systematic review.
Gait disorders are common in people with Parkinson's disease (PD) yet their associations with activity limitations remain poorly understood. The objective of this review is to investigate the relationships between gait impairments and activity limitations in people with idiopathic PD. Six electronic databases (MEDLINE ISI, CINAHL, Web of Science ISI, EMBASE, PsycINFO and Scopus) were systematically searched using relevant terms to source for English-language studies published between 1900 and January 2011. ⋯ Gait hypokinesia measured by gait speed was significantly correlated with UPDRS ADL (-0.41; 95% CI, -0.56 to -0.26; p < 0.001). Gait freezing measured by the Freezing of Gait Questionnaire was associated with reduction in ADL (0.45; 95% CI, 0.36 to 0.54; p < 0.001). Knowledge of gait disturbances and their associations with disability may help to guide clinicians in assessing patients to optimize functional outcomes.
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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.