Parkinsonism & related disorders
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In the field of neurology, Parkinson's disease (PD) is commonly perceived to be a disorder affecting only the (extrapyramidal) motor system, characteristically manifesting as bradykinesia, rigidity, tremor and postural instability. Although non-motor symptoms such as behavioural abnormalities, dysautonomia, sleep disturbances and sensory dysfunctions are also common and quite disabling manifestations of the disease, they are often not formally assessed and thus are frequently misdiagnosed and/or under diagnosed. For this reason, in this review we have concentrated on the pathophysiological and clinical basis of non-motor involvement such as olfactory dysfunction, depression, dementia, dysautonomia and sleep disorders in PD. The early recognition of these symptoms may well perhaps lead to an earlier diagnosis of PD, but in any case should lead to more prompt and effective treatment of the relatively unrecognized non-motor problems associated with PD.
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Parkinsonism Relat. Disord. · Aug 2007
Case ReportsUsing STN DBS and medication reduction as a strategy to treat pathological gambling in Parkinson's disease.
We describe two patients with Parkinson's disease (PD) who developed clinical criteria of pathological gambling addiction in the setting of increased dopamine replacement therapy (levodopa and dopamine agonist medications). The second patient showed also signs of dopamine dysregulation syndrome, with an addiction to dopaminergic medication. Neither patients responded to the standard therapy for gambling behavior, but dramatically improved after bilateral subthalamic nucleus (STN) deep brain stimulation (DBS) and early postoperative withdrawal of dopaminergic therapy. The possible therapeutic role of subthalamic nucleus deep brain stimulation (STN-DBS) on such a disabling behavior needs to be investigated prospectively.
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Parkinsonism Relat. Disord. · Jul 2007
ReviewDeep brain stimulation of globus pallidus internus for dystonia.
Neuromodulation is the functional modification of neural structures through the use of electrical stimulation. Its most clinically applicable use is deep brain stimulation (DBS) of basal ganglia structures in Parkinson's disease (PD) and essential tremor (ET). ⋯ In comparison to the effects seen in PD, the improvement in dystonic postures appear to differ in several ways--delay of clinical benefit, higher voltage requirements, and varied stimulator settings. In this review, the authors discuss the clinical characteristics, pathophysiology, microelectrode recording (MER) signatures, optimal surgical targets, programming parameters and outcomes in dystonia.
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Parkinsonism Relat. Disord. · Jul 2007
Electronic motor function diary for patients with Parkinson's disease: a feasibility study.
Parkinson's disease (PD) studies often measure daily motor function with paper diaries resulting in issues of compliance and reliability. The feasibility and compliance of PD patients using electronic diaries were examined. ⋯ Entry compliance was 99.98% within 24h and average response time during awake hours was 63 min. Electronic diaries could be operated by PD patients, provided valuable information about response patterns and resulted in average response compliance of approximately 1h.
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Parkinsonism Relat. Disord. · May 2007
Predictors of battery life for the Activa Soletra 7426 Neurostimulator.
DBS is increasingly used for Parkinson's disease, essential tremor and other movement disorders. The advertised battery life for Medtronic implantable pulse generators is 4-5 years, but can vary markedly. Theoretical formulas exist to predict battery life as a function of parameter setting, but almost no empiric confirmation of these predictions has been reported. ⋯ In this group, the main predictors of a shorter battery life were greater amplitude (p=0.002), pulse width (p=0.026), and not using exclusive bipolar settings (p=0.029). The implant location, underlying disease, and sex did not affect battery life. Battery life varied but was generally consistent with published predictors.