Parkinsonism & related disorders
-
Parkinsonism Relat. Disord. · Jan 2012
Case ReportsMotor improvement with bilateral subthalamic nucleus deep brain stimulation in a patient with levodopa-responsive secondary parkinsonism.
At many centers, subthalamic nucleus (STN) deep brain stimulation (DBS) is not considered for patients with secondary forms of parkinsonism, due to higher expected rates of treatment failure. We present the case of a woman with secondary parkinsonism that developed following a Measles, Mumps, and Rubella (MMR) vaccination, who experienced sustained improvement in motor function following STN DBS. Despite the diagnosis of a secondary parkinsonism, this patient responded well to dopaminergic therapy, a good predictor of DBS outcome in patients with idiopathic Parkinson's disease. This case suggests that DBS may be considered in the setting of secondary parkinsonism if such patients have levodopa-responsive symptoms.
-
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.
-
Parkinsonism Relat. Disord. · Jan 2012
ReviewTherapeutic strategies for nonmotor symptoms in early Parkinson's disease: the case for a higher priority and stronger evidence.
It is now recognized that the neuropathology of early Parkinson's disease (PD) is not limited to the nigrostriatal dopaminergic system, but also involves various brainstem nuclei, the hypothalamus, the olfactory system, and the peripheral autonomic nervous system. Given the disseminated neuropathology of early PD, the earliest clinical signs include a myriad of non-motor manifestations including sleep-wake cycle regulation, cognition, mood and motivation, olfactory and gustatory functions, autonomic functions, and sensory and pain processing. Despite this realization, there is clearly a paucity of trials that have systematically evaluated the treatment of non-motor symptoms of PD in the early stages. ⋯ There are no reports of randomized controlled trials of therapeutic agents looking at the frequently reported anxiety and fatigue in early PD patients. Based on this lack of evidence, therapy for early non-motor manifestations is often ignored and the focus remains on dopamine replacement strategies with main outcomes being restricted to motor measurements, such as the Unified Parkinson's Disease Rating Scale. This article presents the case for prioritizing well-designed, controlled clinical trials of therapeutic interventions focusing on non-motor symptoms in early PD patients.
-
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.