Funct Neurol
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Long-term oral therapy with levodopa is associated with the development of motor fluctuations and dyskinesia in a large percentage of patients with Parkinson's disease (PD). Motor complications are associated with a number of non-motor symptoms and have a negative impact on disability and quality of life. There are three therapeutic options available for the management of patients at this advanced stage: high frequency deep brain stimulation, continuous subcutaneous infusion of apomorphine, and continuous intestinal infusion of levodopa/carbidopa. On the basis of published data and in consideration of the risk-benefit profile of current therapeutic strategies, we here propose an algorithm to help clinicians select the most suitable treatment option for patients with advanced PD.
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The Italian region of Lombardy, with its existing stroke centers and high-technology laboratories, provides a favorable context for studying monogenic diseases associated with stroke. The Lombardia GENS project was set up to create a regional network for the diagnosis of six monogenic diseases associated with stroke: CADASIL, Fabry disease, MELAS, familial and sporadic hemiplegic migraine, hereditary cerebral amyloid angiopathy and Marfan syndrome. The network comprises 36 stroke centers and seven high-technology laboratories, performing molecular analysis. ⋯ Demographic, clinical and family data and diagnostic criteria are collected using standardized forms. On the basis of stroke incidence in Lombardy and the reported prevalence of the diseases considered, we expect, during the course of the study, to collect datasets and DNA samples from more than 200 stroke patients suspected of having monogenic diseases. This will allow evaluation of the regional burden and better phenotype characterization of monogenic diseases associated with stroke.
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Multicenter Study
Depressive symptoms among surrogate decision makers in Lebanese ICUs.
Surrogate decision making is advocated to protect the vulnerable patient. Family members of patients in intensive care units (ICUs) are prone to develop depressive symptoms which may undermine their decisional capacity. Lebanon is a multicultural country where paternalism still dominates the physician-patient relationship and ethics are far from being the subject of research and studies. ⋯ Severity of depression and suicidal ideation were not related to any of the studied factors. Depressive symptoms are prevalent among family members deciding on behalf of ICU patients, rendering them vulnerable. Appropriate measures should be taken to identify and treat them.
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Tourette syndrome (TS) is a childhood-onset neuropsychiatric condition characterised by multiple motor and phonic tics. Comorbid behavioural problems are common, especially attention deficit hyperactivity disorder (ADHD) and obsessive-compulsive disorder (OCD). Little is known about the long-term prognosis of TS, despite the need to inform patients about their possible clinical course and advise health care providers on clinical resource allocation strategies. ⋯ Predictors of increased tic severity in adulthood include higher childhood tic severity, smaller caudate volumes and poorer fine motor control. Furthermore, the presence of untreated comorbid psychopathology, such as ADHD and OCD, can adversely affect the long-term outcome of patients with TS. Future studies on the prognosis of TS should be conducted on larger samples, both in community and clinical settings.
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The aim of this study was to assess the prevalence of chronic cerebrospinal venous insufficiency in an unselected cohort of multiple sclerosis (MS) patients. A total of 586 patients with clinically defined MS underwent catheter venography of the internal jugular veins, brachiocephalic veins and azygos vein. The following findings were regarded as pathologic: no outflow, slowed outflow, reversal of flow direction, prestenotic dilation accompanied by impaired outflow, outflow through collaterals, intraluminal structures obstructing the vein, hypoplasia, agenesia or significant narrowing of the vein. ⋯ Lesions in one vein were found in 43.5%, in two veins in 49.5%, and in three veins in 3.1% of patients. Venous pathologies in the right internal jugular vein were found in 64.0% of patients, in the left internal jugular vein in 81.7%, in the left brachiocephalic vein in 1.0%, and in the azygos vein in 4.9%. Venous pathologies were found to be highly associated with MS, yet the clinical relevance of this phenomenon remains to be established.