Parkinson's Disease
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Parkinson's Disease
NIH - Medical Encyclopedia Parkinson's disease
"Parkinson's disease is a disorder of the brain characterized by shaking (tremor) and difficulty with walking, movement, and coordination. The disease is associated with damage to a part of the brain that is involved with movement. … Some people with Parkinson's disease become severely depressed. This may be due to loss of dopamine in certain brain areas involved with pleasure and mood. Lack of dopamine can also affect motivation and the ability to make voluntary movements. Early loss of mental capacities is uncommon. However, persons with severe Parkinson's may have overall mental deterioration (including dementia and hallucinations). Dementia can also be a side effect of some of the medications used to treat the disorder. ...
Symptoms:
• Muscle rigidity • Unstable, stooped, or slumped-over posture • Loss of balance • Gait (walking pattern) changes • Shuffling walk • Slow movements • Difficulty initiating any voluntary movement • Small steps followed by the need to run to maintain balance • Freezing of movement when the movement is stopped, inability to resume movement • Muscle aches and pains (myalgia) • Shaking, tremors (varying degrees, may not be present) • Changes in facial expression • Reduced ability to show facial expressions • Voice or speech changes • Loss of fine motor skills • Frequent falls • Decline in intellectual function (may occur, can be severe) • A variety of gastrointestinal symptoms, mainly constipation.… symptoms may be difficult to assess, particularly in the elderly. For example, the tremor may not appear when the person is sitting quietly with arms in the lap. The posture changes may be similar to osteoporosis or other changes associated with aging. Lack of facial expression may be a sign of depression. An examination may show "cogwheel" rigidity (jerky, stiff movements), tremors of the Parkinson's type, and difficulty initiating or completing voluntary movements. Reflexes are essentially normal. Tests are not usually specific for Parkinson's, but they may be required to rule out other disorders that cause similar symptoms. See also essential tremor."
Highlighted Article
[Clinical criteria of Parkinson's disease.] (Ther Umsch. 2007)
"The clinical criteria of Parkinson's disease are akinesia in combination with at least one of the following three symptoms: tremor (asymmetrical resting tremor), rigidity, impairment of posture, gait and balance. Symptomatic and atypical parkinsonian syndromes are ruled out by history, clinical examination, cranial CT, MRI, SPECT or PET. Patients with Parkinson's disease respond to levodopa or dopaminagonists throughout the course of the disease."
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Notes
The 2007 Treatment Guidelines section will contain the 2007 published guidelines. To view Guidelines from previous years, view year 2006 Treatment Guidelines and 2005 InfoMedlinks (Articles section) or our Monthly Online Newsletter (under the Guidelines section).
Parkinson's Disease
Daily Treatment Report
Cognitive Therapy-CBT-Psychotherapy
Device Therapy
Drug Side-Effects and Interactions
Parkinson's treatment tied to impulsiveness "Scientists have long known that anti-Parkinson medications occasionally spark compulsions like pathological gambling. Research published Thursday found another treatment, a pacemaker-like brain implant, can trigger a completely different kind of impulsiveness. … Doctors have long noticed varying degrees of impulsiveness in Parkinson's patients, from making uncensored remarks to rare cases of extreme behavior such as compulsive gambling, shopping, eating or sex. Changing medications or doses often solves extreme symptoms — if patients or their families report the worrisome behavior."
Levodopa-induced dyskinesia in Parkinson's disease: clinical features, pathogenesis, prevention and treatment. (Postgrad Med J. 2007)
Acute vs chronic effects of l-dopa on bladder function in patients with mild Parkinson disease (NEUROLOGY 2007)
Permax (pergolide) and generic equivalents "FDA notified healthcare professionals and patients that companies that manufacture and distribute pergolide have agreed to withdraw the drug from the market. Pergolide is a dopamine agonist (DA) used with levodopa and carbidopa to manage the signs and symptoms of Parkinson's disease. Results of two new studies showed that some patients with Parkinson's disease treated with pergolide had serious damage to their heart valves when compared to patients who did not receive the drug."
Parkinson's Drug Raises Risk of Cardiac Valve Regurgitation "Findings from a new study add to the growing body of literature suggesting that the long-term use of pergolide for Parkinson's disease increases the risk of cardiac valve regurgitation. By contrast, non-ergot-derived dopamine agonists seem to have little effect on this risk."
Treatment of drug-induced psychosis in Parkinson's disease with ziprasidone can induce severe dose-dependent off-periods and pathological laughing (Clinical Neurology and Neurosurgery 2007)
Parkinson's Drugs Can Damage Heart Valves "Two drugs commonly used to treat Parkinson's disease can cause harm to heart valves, according to two studies in the Jan. 4 New England Journal of Medicine. The drugs, pergolide and cabergoline, are both from a class of medications called "ergot-derived dopamine receptor agonists." Ergot is a fungus, and ergot-derived drugs are used not only in the treatment of Parkinson's but also for restless leg syndrome and migraine headaches. Ergot-derived dopamine receptor agonists were also in the now banned diet drug Fen-phen -- also associated with heart valve disease."
Drugs
Comprehensive review of rasagiline, a second-generation monoamine oxidase inhibitor, for the treatment of Parkinson's Disease. (Clin Ther. 2007)
Patterns of levodopa response in Parkinson's disease: a clinico-pathological study. (Brain. 2007)
Safety and efficacy of newly formulated selegiline orally disintegrating tablets as an adjunct to levodopa in the management of 'off' episodes in patients with Parkinson's disease. (Curr Med Res Opin. 2007)
Dopaminergic therapy promotes lateralized motor activity in the subthalamic area in Parkinson's disease. (Brain. 2007) "These findings suggest that dopaminergic therapy restores a more physiological pattern of reactivity in the STN of patients with Parkinson's disease."
Zonisamide improves motor function in Parkinson disease (NEUROLOGY 2007)
Exercise
Parkinson's disease and resistive exercise: Rationale, review, and recommendations. (Mov Disord. 2007)
Rotating treadmill training reduces freezing in Parkinson disease: Preliminary observations. (Parkinsonism Relat Disord. 2007)
The Impact of Exercise Rehabilitation and Physical Activity on the Management of Parkinson's Disease (Geriatrics Aging. 2007)
Exercise improves efficacy of levodopa in patients with Parkinson's disease. (ov Disord. 2007) "Moderate exercise increases clinical efficacy of LD."
General Information
[Initial management of Parkinson disease.] (Presse Med. 2007)
Guidelines
Immunotherapy
Internet Sites
Treatment Information
Drug-Food-Supplement Information
DrugDigest (drug interactions)
FDA - Drug Interactions: What You Should Know
NIH - Botanical Dietary Supplements: Background Information
NIH - Drug, Supplements, and Herbal Information
NIH - Herbal Supplements: Consider Safety, Too
NIH - Vitamin and Mineral Supplement Fact Sheets
Nutrition
Nutritional therapies in Parkinson's disease. (Curr Treat Options Neurol. 2007)
Other
Other Treatments
Primary and secondary features of Parkinson's disease improve with strategic exposure to bright light: a case series study. (Chronobiol Int. 2007)
Botulinum toxin in the treatment of tremors, dystonias, sialorrhea and other symptoms associated with Parkinson's disease. (Expert Rev Neurother. 2007) "RESULTS: Regardless of LVEF, patients showed significant improvements (all p<.05) in lifestyle behaviours, body weight, body fat, blood pressure, resting heart rate, total and LDL-cholesterol, exercise capacity, and quality of life by 3 months; most improvements were maintained over 12 months. CONCLUSION: CHD patients at risk for heart failure with an LVEF40%."
Effects of Bilateral Subthalamic Nucleus Stimulation and Medication on Parkinsonian Speech Impairment. (J Voice. 2007) "The improvement of acoustic parameters related to glottal vibration and voice tremor was not accompanied by a substantial effect on speech intelligibility. STN stimulation was more effective on global motor limb dysfunctions than on dysarthria, but we did not report negative consequences on speech."
Subthalamic nucleus deep brain stimulation in elderly patients - analysis of outcome and complications. (BMC Neurol. 2007) "Conclusions: DBS of the STN is clinically as effective in elderly patients as it is in younger ones. However, a more careful selection and follow-up of the elderly patients are required because elderly patients have a higher risk of surgery-related complications and a higher morbidity rate."
Tremor reduction by subthalamic nucleus stimulation and medication in advanced Parkinson's disease. (J Neurol. 2007)
Experimental
Beneficial effects of dietary omega-3 polyunsaturated fatty acid on toxin-induced neuronal degeneration in an animal model of Parkinson's disease. (FASEB J. 2007) “Taken together, these data suggest that a high n-3 PUFA dietary intake exerts neuroprotective actions in an animal model of Parkinsonism.“
Protective Effects of Green Tea Polyphenols in the 6-OHDA Rat Model of Parkinson's Disease Through Inhibition of ROS-NO Pathway. (Biol Psychiatry. 2007)
Radiotherapy
Supplements-Vitamins-CAM
[Coenzyme Q(10) in Parkinson's disease : Symptomatic or neuroprotective effects?] (Nervenarzt. 2007)
Surgery
Safety and efficacy of subthalamic nucleus deep brain stimulation performed with limited intraoperative mapping for treatment of Parkinson's disease. (Neurosurgery. 2007)
Deep brain stimulation for Parkinson's disease. (Acta Neurochir Suppl. 2007)
Update on surgery for Parkinson's disease. (Curr Opin Neurol. 2007)
Does ageing influence deep brain stimulation outcomes in Parkinson's disease? (Mov Disord. 2007)
[Surgery for Parkinson's disease.] (Ther Umsch. 2007)
Neuropsychological Effects of Bilateral Deep Brain Stimulation of the Subthalamic Nucleus in Parkinson's Disease. (Stereotact Funct Neurosurg. 2007) "Conclusions: The pathophysiology of the observed deficit remains ill defined. However, despite a small sample size, the study provides further evidence that bilateral STN-DBS in PD patients can be associated with negative neuropsychological outcome in word fluency, especially in elderly patients."
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