RESUMO
BACKGROUND: Whether there may be any relationship between stressful or traumatic life events (LE) and the subsequent motor symptoms onset in Parkinson's disease (PD) is still controversial. OBJECTIVES: To explore whether a subjectively perceived as stressful or traumatic LE were more frequently present in a group of recent motor onset parkinsonian patients (Recent Onset Parkinsonism - ROP) compared with healthy controls (HC) and a group of patients already diagnosed as PD. METHODS: A consecutive series of 139 ROP patients, 138 matched PD patients and 138 HC were pooled through a validated LE exposure questionnaire evaluating the number of patients affected by LE and the amount of LE per group occurred in the last year, segregating by subjective severity in total and severe LE. RESULTS: There was no significant difference in the percentage of patients affected by total (p = 0.134) nor by severe (p = 0.133) LE within the 3 groups. No significant difference was observed in the number of total LE between ROP and HC (p = 0.063), ROP and PD (p = 0.688), nor in severe LE (ROP vs. HC, p = 0.637. ROP vs. PD, p = 0.500). CONCLUSIONS: During the year of parkinsonian motor symptoms onset, the number of ROP patients exposed to total or severe LE or the amount of total or severe LE suffered by ROP were not significantly different to the group of PD patients or HC. A casual relationship between LE and the onset of motor symptoms in parkinsonian patients may be suggested.
Assuntos
Doença de Parkinson , Transtornos Parkinsonianos , Humanos , Doença de Parkinson/complicações , Inquéritos e QuestionáriosRESUMO
Most of the validated 'events exposure' questionnaires are focused on lifetime burden and are hardly applicable to Argentina owing to its sociocultural and natural conditions, where corruption and economic crises have been hitting middle-class people's lives in a cyclic manner. This prompted us to develop a new questionnaire, validated in Argentina, to assess the occurrence of exposure to events and their severity over a limited period. Deductive (bibliographic search) and inductive (by a Delphi group) selection was used to create an initial group of 24 questions, which were condensed into a final 14-item questionnaire. After administration to 512 inhabitants of the metropolitan area of Buenos Aires and other major cities in Argentina, the questionnaire was shown to have an intraclass correlation coefficient of 0.996 and an internal consistency, measured by the omega coefficient, of 0.86. Because this study was conducted during the coronavirus disease 2019 (COVID-19) pandemic, an additional question on how this situation affected individuals was included. The time span used to measure event exposure was 1 year prior to the study. In the case of an affirmative event exposure, the responder selected the severity of the stress perception generated on a Likert-like scale, ranging from 0 (nothing) to 5 (severe). Fifty-eight per cent of the responders were women, and the mean age was 47.14 years (SD: 13.97). The average annual event incidence per person was 2.5 events (SD: 1.88). Thirty-two per cent (164/512) reported at least one 5-point event on the severity scale. Ten per cent (51/512) responded that the COVID-19 pandemic affected them in a different manner than events related to personal or family disease, or the death of a close family member or friend.
La mayoría de los cuestionarios validados de 'exposición a eventos' se centran en la carga durante la vida y son difícilmente aplicables a la Argentina debido a las diferentes condiciones socioculturales y naturales, donde la corrupción y la crisis económica han estado golpeando la vida de las personas de clase media de una manera cíclica. Esto nos impulsó a desarrollar un nuevo cuestionario, validado en Argentina para evaluar la ocurrencia de exposición a eventos y su severidad en un período de tiempo determinado. Se utilizó selección deductiva (búsqueda bibliográfica) e inductiva (por un grupo Delphi) para crear un grupo inicial de 24 preguntas, que se condensaron en un cuestionario final de 14 ítemes con un coeficiente de correlación intraclase de 0.996 y una consistencia interna medida por el coeficiente Omega de 0.86, luego de la administración a 512 habitantes del área metropolitana de Buenos Aires y otras ciudades importantes de Argentina. Teniendo en cuenta que este estudio se realizó durante la situación de pandemia de COVID-19, se incluyó una pregunta adicional sobre cómo esta situación afectó a las personas. El intervalo de tiempo utilizado para medir la exposición a eventos fue el último año. En caso de una exposición de evento afirmativa, el respondedor tenía que seleccionar la severidad de la percepción del estrés generado en una escala tipo Likert, que va de 0 (nada) a 5 (grave). Cincuenta y ocho por ciento de los que respondieron eran mujeres, y la edad promedio fue de 47,14 años (DE = 13,97). La incidencia anual promedio de 'eventos' por persona fue de 2.5 eventos (DE = 1.88). Treinta y dos por ciento (164/512) informaron al menos un evento de 5 puntos en la escala de severidad. Diez por ciento (51/512) respondió que la pandemia de COVID-19 los afectó de manera diferente que la relacionada con la enfermedad personal o familiar o la muerte de un familiar cercano o amigo.
Assuntos
Estresse Psicológico/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Argentina/epidemiologia , COVID-19/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Estresse Psicológico/diagnóstico , Estresse Psicológico/etiologia , Inquéritos e Questionários , Adulto JovemRESUMO
OBJECTIVE: To determine whether brain white matter hyperintensities (WMH) influence l-dopa response in Parkinson's disease (PD) patients. METHODS: We prospectively evaluated 60 PD patients with an acute l-dopa challenge test, and assessed motor performance with the Movement Disorders Society revised Unified Parkinson's Disease Rating Scale (MDS-UPDRS) during "ON" and "OFF" medication states. Magnetic resonance images were examined using a visual semi-quantitative rating scale for quantification and distribution analysis of WMH. l-dopa challenge test response was correlated to extent and location of WMH, to determine a potential association between them. RESULTS: Subjects with greater deep WMH burden, showed less response to l-dopa on axial motor symptoms (R = -0.35; p < 0.027), when tested with Part III of the MDS-UPDRS before and after acute levodopa challenge. CONCLUSIONS: Results suggest WMH may affect response to l-dopa on axial function of PD patients, which could be due to either non-dopaminergic (cortico-basal ganglia) motor pathway disruption, or postsynaptic nigrostriatal pathway involvement.
Assuntos
Antiparkinsonianos/uso terapêutico , Levodopa/uso terapêutico , Imageamento por Ressonância Magnética , Doença de Parkinson/tratamento farmacológico , Substância Branca/efeitos dos fármacos , Substância Branca/diagnóstico por imagem , Idoso , Feminino , Transtornos Neurológicos da Marcha/diagnóstico por imagem , Transtornos Neurológicos da Marcha/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Doença de Parkinson/complicações , Estudos Retrospectivos , Estatísticas não Paramétricas , Resultado do TratamentoRESUMO
BACKGROUND AND PURPOSE: Pathological gambling (PG) in Parkinson's disease (PD) is a frequent impulse control disorder associated mainly with dopamine replacement therapy. As impairments in decision-making were described independently in PG and PD, the objective of this study was to assess decision-making processes in PD patients with and without PG. METHODS: Seven PD patients with PG and 13 age, sex, education and disease severity matched PD patients without gambling behavior were enrolled in the study. All patients were assessed with a comprehensive neuropsychiatric and cognitive evaluation, including tasks used to assess decision-making abilities under ambiguous or risky situations, like the Iowa Gambling Task (IGT), the Game of Dice Task and the Investment Task. RESULTS: Compared to PD patients without gambling behavior, those with PG obtained poorer scores in the IGT and in a rating scale of social behavior, but not in other decision-making and cognitive tasks. CONCLUSIONS: Low performance in decision-making under ambiguity and abnormal social behavior distinguished PD patients with PG from those without this disorder. Dopamine replacement therapy may induce dysfunction of the ventromedial prefrontal cortex and amygdala-ventral striatum system, thus increasing the risk for developing PG.
Assuntos
Transtornos Cognitivos/psicologia , Transtornos Disruptivos, de Controle do Impulso e da Conduta/psicologia , Dopaminérgicos/efeitos adversos , Jogo de Azar/psicologia , Doença de Parkinson/tratamento farmacológico , Idoso , Tonsila do Cerebelo/efeitos dos fármacos , Tonsila do Cerebelo/fisiopatologia , Gânglios da Base/efeitos dos fármacos , Gânglios da Base/fisiopatologia , Transtornos Cognitivos/induzido quimicamente , Transtornos Cognitivos/diagnóstico , Tomada de Decisões/efeitos dos fármacos , Tomada de Decisões/fisiologia , Avaliação da Deficiência , Transtornos Disruptivos, de Controle do Impulso e da Conduta/induzido quimicamente , Transtornos Disruptivos, de Controle do Impulso e da Conduta/diagnóstico , Dopamina/metabolismo , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Testes Neuropsicológicos , Córtex Pré-Frontal/efeitos dos fármacos , Córtex Pré-Frontal/fisiopatologia , Transtornos do Comportamento Social/induzido quimicamente , Transtornos do Comportamento Social/diagnóstico , Transtornos do Comportamento Social/psicologia , Análise e Desempenho de TarefasRESUMO
BACKGROUND: There is a clear need for brief, sensitive and specific cognitive screening instruments in Parkinson's disease (PD). OBJECTIVES: To study Addenbrooke's Cognitive Examination (ACE) validity for cognitive assessment of PD patient's using the Mattis Dementia Rating Scale (MDRS) as reference method. A specific scale for cognitive evaluation in PD, in this instance the Scales for Outcomes of Parkinson's disease-Cognition (SCOPA-COG), as well as a general use scale the Mini-mental state examination (MMSE) were also studied for further correlation. METHODS: Forty-four PD patients were studied, of these 27 were males (61%), with a mean (SD) age of 69.5 (11.8) years, mean (SD) disease duration of 7.6 (6.4) years (range 1-25), mean (SD) total Unified Parkinson's Disease Rating Scale (UPDRS) score 37 (24) points, UPDRS III 16.5 (11.3) points. MDRS, ACE and SCOPA-COG scales were administered in random order. All patients remained in on-state during the study. RESULTS: Addenbrooke's Cognitive Examination correlated with SCOPA-COG (r = 0.93, P < 0.0001), and MDRS (r = 0.91 P < 0.0001) and also with MMSE (r = 0.84, P < 0.001). Area under the receiver-operating curve, taking MDRS as the reference test, was 0.97 [95% confidence interval (CI): 0.92-1.00] for ACE, 0.92 (95% CI: 0.83-1.00) for SCOPA-COG and 0.91 (95% CI: 0.83-1.00) for MMSE. Best cut-off value for ACE was 83 points [Sensitivity (Se) = 92%; Specificity (Sp) = 91%; Kappa concordance (K) = 0.79], 20 points for the SCOPA-COG (Se = 92%; Sp = 87%; K = 0.74) and 26 points for MMSE (Se = 61%; Sp = 100%; K = 0.69). CONCLUSION: Addenbrooke's Cognitive Examination appears to be a valid tool for dementia evaluation in PD, with a cut-off point which should probably be set at 83 points, displaying good correlation with both the scale specifically designed for cognitive deficits in PD namely SCOPA-COG, as well as with less specific tests such as MMSE.
Assuntos
Transtornos Cognitivos/diagnóstico , Doença por Corpos de Lewy/diagnóstico , Exame Neurológico/métodos , Testes Neuropsicológicos/normas , Doença de Parkinson/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Transtornos Cognitivos/etiologia , Transtornos Cognitivos/fisiopatologia , Estudos de Coortes , Diagnóstico Diferencial , Feminino , Humanos , Doença por Corpos de Lewy/fisiopatologia , Masculino , Pessoa de Meia-Idade , Doença de Parkinson/complicaçõesRESUMO
INTRODUCTION: Parkinson's disease (PD) is a progressive disorder that is strongly linked to non-motor symptoms (NMS). Unfortunately, these symptoms have been almost neglected for many years and only recently have researchers begun to assess how they affect the quality of life in patients with PD. AIMS: To review our current understanding of the subject and to highlight the importance of NMS in PD. DEVELOPMENT: Recent studies have emphasised the fact that the basal ganglia play an important role in a number of non-motor functions. At the same time, the exclusive involvement of the substantia nigra in PD is being reviewed and the development of PD has been defined as a continuum that covers a range of different stages, including non-dopaminergic systems and nuclei. This would account for the constellation of non-motor symptoms that do not respond to dopamine replacement therapy and which affect patients with PD, such as depression, apathy, sialorrhea and urinary incontinence, among others. CONCLUSIONS: NMS make a significant contribution to the morbidity and mortality rates of PD and are often the main cause of hospitalisation of patients with PD. Current evidence suggests that some NMS, such as constipation, hyposmia and REM sleep disorders, could even be preclinical markers of PD. Both of these reasons stress the importance of reaching a diagnosis faster and earlier.
Assuntos
Gânglios da Base/fisiologia , Sintomas Comportamentais/diagnóstico , Sintomas Comportamentais/fisiopatologia , Doença de Parkinson/diagnóstico , Doença de Parkinson/fisiopatologia , Doenças do Sistema Nervoso Autônomo/diagnóstico , Doenças do Sistema Nervoso Autônomo/etiologia , Doenças do Sistema Nervoso Autônomo/fisiopatologia , Gânglios da Base/patologia , Sintomas Comportamentais/etiologia , Dopamina/metabolismo , Gastroenteropatias/diagnóstico , Gastroenteropatias/etiologia , Gastroenteropatias/fisiopatologia , Humanos , Transtornos Mentais/diagnóstico , Transtornos Mentais/etiologia , Transtornos Mentais/fisiopatologia , Doença de Parkinson/complicações , Doença de Parkinson/epidemiologia , Qualidade de Vida , Transtornos do Sono-Vigília/diagnóstico , Transtornos do Sono-Vigília/etiologia , Transtornos do Sono-Vigília/fisiopatologiaRESUMO
It has been suggested that potential risk of hemiballismus after subthalamotomy makes DBS preferable to ablation for IPD treatment; however, cost and the need for regular electrode control have also been observed as disadvantages to stimulation. The objective was to compare efficacy and safety of different surgical approaches to STN, in a prospective randomized pilot study. Sixteen consecutive IPD patients randomized to receive either: bilateral STN-DBS, bilateral subthalamotomy or unilateral subthalamotomy plus contralateral STN-DBS implantation, and followed for 12 months after surgery. One patient died and was excluded from the analysis. Total and motor UPDRS scores, as well as drug-induced dyskinesias improved significantly at 1 year follow-up, regardless of the procedure administered and without statistically significant differences between treatment modalities. Discrete changes were observed on ACE and MMSE scores. Psychiatric examination of patients subjected to bilateral stimulation and lesion, revealed slight increment in apathy and irritability scores, coinciding with significant deterioration of mentation, behaviour and mood as measured using the UPDRS. One patient presented persistent hemiballismus and required ulterior posteroventral pallidotomy. In this small group of patients, overall motor performance significantly improved after all three procedures, without major differences in outcome. Adverse events were, nevertheless, observed after both ablation and stimulation. The role of bilateral subthalamotomy in patients unable to receive a DBS electrode-implant merits further exploration in a larger series of patients with longer follow-up.
Assuntos
Antiparkinsonianos/uso terapêutico , Terapia por Estimulação Elétrica/métodos , Doença de Parkinson/terapia , Subtálamo/cirurgia , Idoso , Métodos Epidemiológicos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Destreza Motora , Testes Neuropsicológicos , Doença de Parkinson/cirurgia , Resultado do TratamentoRESUMO
Two patients with severe Parkinson's disease undergoing partial or complete ablative interruption of basal ganglia (BG) output are presented. One patient who underwent bilateral subthalamotomy, and a second who underwent unilateral posteroventral pallidotomy, followed 7 years later by a bilateral subthalamotomy because of contralateral disease progression, were studied. In addition to the usual clinical evaluation, changes in joint kinematics observed during unconstrained, skilled multi-joint movement and repetitive single joint (RSJ) movement of the wrist were studied. Clinical UPDRS items referred to hand movements contralateral to the procedure, and instrumental measurement of RSJ improved in both patients after either pallidotomy or subthalamotomy. When both BG outflow paths were interrupted as was the case in the second patient (bilateral subthalamotomy after the initial pallidotomy), no added clinical improvement was observed, RSJ even deteriorated slightly. Instrument-based studies for movement alteration detection after simultaneous ablation of the globus pallidus and the subthalamic nucleus of these two patients showed greater sensitivity than clinical evaluation alone. Complex gestural movement performance remained unaffected after partial (subthalamotomy or pallidotomy) or complete interruption of BG outflow (case 2), indicating BG compensatory capacity after total outflow interruption remained intact.
Assuntos
Movimento/fisiologia , Palidotomia/métodos , Doença de Parkinson/fisiopatologia , Doença de Parkinson/cirurgia , Idoso , Feminino , Humanos , Articulações/inervação , Estudos Longitudinais , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Doença de Parkinson/patologia , Núcleo Subtalâmico/fisiopatologia , Punho/inervaçãoRESUMO
Our aim was to investigate whether patients with epileptiform foci in the frontal lobe, as revealed by video EEG (VEEG) analysis, exhibit non-forced grasping behaviour and manipulatory movements during seizures. We retrospectively reviewed ictal videotapes of 30 consecutive patients with frontal and 30 with temporal lobe epilepsy undergoing VEEG for the presence and type of grasping and manipulatory movements. Four of the 30 patients with frontal lobe epilepsy (13%) showed unilateral grasping behaviour, three of whom had whole hand prehension (one with manipulation movements as well) and one pinching movements. In all patients, arm abduction and elevation resembling reaching invariably preceded grasping hand movements. The epileptogenic focus was located in the contralateral and ipsilateral frontocentral region in two and one patient, respectively, and in the ipsilateral orbitofrontal region in another. However, none of the patients with temporal lobe epilepsy showed grasping behaviour. Patients with frontal lobe epilepsy may show non-forced grasping with or without manipulatory finger movements as part of ictal phenomena.
Assuntos
Epilepsia do Lobo Frontal/fisiopatologia , Força da Mão , Mãos/fisiopatologia , Atividade Motora , Adolescente , Adulto , Eletroencefalografia , Epilepsia do Lobo Frontal/diagnóstico , Epilepsia do Lobo Temporal/diagnóstico , Epilepsia do Lobo Temporal/fisiopatologia , Feminino , Humanos , Masculino , Tempo de Reação , Estudos Retrospectivos , Gravação de VideoteipeRESUMO
BACKGROUND: Dyskinesias are a transient but severe complication of subthalamotomy in some patients. PATIENTS AND METHODS: Three patients with Parkinson's disease undergoing bilateral micro-recording guided surgery of the subthalamic nucleus (STN) are described; deep brain stimulation (DBS) was used in one case, and subthalamotomy in the other two. Prior to surgery, levodopa induced dyskinesia had improved (< or = 50%) under treatment with amantadine (400 mg/day, po) in all three patients. The patient treated with DBS developed severe dyskinesia a few days after discharge and began self medication with amantadine but showed no improvement. This suggested a possible lack of response to amantadine for treatment of dyskinesias induced by surgery of the STN. RESULTS: Both patients treated with bilateral subthalamotomy developed unilateral choreoballistic movements immediately after surgery, despite not taking levodopa (L-dopa). Patients were scored using the dyskinesia scale and started treatment with 400 mg amantadine (po) for 4 days within the first postoperative week with no effect on dyskinesia score or its phenomenology. Amantadine was therefore discontinued. One month after surgery both patients were free of involuntary movements with an improvement of about 60% in the "off" state UPDRS motor score. Six month follow up showed maintained antiparkinsonian benefit, without need for levodopa treatment and complete absence of dyskinesia. CONCLUSION: The present findings suggest that: (i) amantadine probably exerts its anti-dyskinetic effect by acting on the "indirect" pathway; (ii) the pathophysiological mechanisms of subthalamotomy induced dyskinesias may differ from those involved in L-dopa induced dyskinesias; (iii) dyskinesias induced by STN surgery resolve spontaneously as compensatory mechanisms develop.