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Kruse C, Lipinski A, Verheyen M, Balzer-Geldsetzer M, Wittenberg M, Lorenzl S, Richinger C, Schmotz C, Tönges L, Woitalla D, Klebe S, Bloem BR, Hommel A, Meissner WG, Laurens B, Boraud T, Foubert-Samier A, Vergnet S, Tison F, Costa N, Odin P, Rosqvist K, Norlin JM, Hjalte F, Schrag A, Dodel R. Care of Late-Stage Parkinsonism: Resource Utilization of the Disease in Five European Countries. Mov Disord 2024; 39:571-584. [PMID: 38425158 DOI: 10.1002/mds.29718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 12/29/2023] [Accepted: 01/02/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Parkinson's disease (PD) is a neurodegenerative disease that leads to progressive disability. Cost studies have mainly explored the early stages of the disease, whereas late-stage patients are underrepresented. OBJECTIVE The aim is to evaluate the resource utilization and costs of PD management in people with late-stage disease. METHODS The Care of Late-Stage Parkinsonism (CLaSP) study collected economic data from patients with late-stage PD and their caregivers in five European countries (France, Germany, the Netherlands, UK, Sweden) in a range of different settings. Patients were eligible to be included if they were in Hoehn and Yahr stage >3 in the on state or Schwab and England stage at 50% or less. In total, 592 patients met the inclusion criteria and provided information on their resource utilization. Costs were calculated from a societal perspective for a 3-month period. A least absolute shrinkage and selection operator approach was utilized to identify the most influential independent variables for explaining and predicting costs. RESULTS During the 3-month period, the costs were €20,573 (France), €19,959 (Germany), €18,319 (the Netherlands), €25,649 (Sweden), and €12,156 (UK). The main contributors across sites were formal care, hospitalization, and informal care. Gender, age, duration of the disease, Unified Parkinson's Disease Rating Scale 2, the EQ-5D-3L, and the Schwab and England Scale were identified as predictors of costs. CONCLUSION Costs in this cohort of individuals with late-stage PD were substantially higher compared to previously published data on individuals living in earlier stages of the disease. Resource utilization in the individual sites differed in part considerably among these three parameters mentioned. © 2024 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Christopher Kruse
- Department of Geriatric Medicine, Center for Translational Neuro- and Behavioral Sciences, University of Duisburg-Essen, Essen, Germany
| | - Anna Lipinski
- Department of Geriatric Medicine, Center for Translational Neuro- and Behavioral Sciences, University of Duisburg-Essen, Essen, Germany
- Department of Neurology, Philipps-University Marburg, Marburg, Germany
| | - Malte Verheyen
- Department of Geriatric Medicine, Center for Translational Neuro- and Behavioral Sciences, University of Duisburg-Essen, Essen, Germany
| | - Monika Balzer-Geldsetzer
- Department of Geriatric Medicine, Center for Translational Neuro- and Behavioral Sciences, University of Duisburg-Essen, Essen, Germany
- Department of Neurology, Philipps-University Marburg, Marburg, Germany
| | - Michael Wittenberg
- Coordination Center for Clinical Trials of the Philipps-University Marburg, Marburg, Germany
| | - Stefan Lorenzl
- Department of Palliative Medicine, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
- Institute of Palliative Care, Paracelsus Medical University, Salzburg, Austria
| | - Carmen Richinger
- Institute of Palliative Care, Paracelsus Medical University, Salzburg, Austria
| | - Christian Schmotz
- Institute of Palliative Care, Paracelsus Medical University, Salzburg, Austria
| | - Lars Tönges
- Department of Neurology, St. Josef-Hospital, Ruhr-University, Bochum, Germany
- Neurodegeneration Research, Centre for Protein Diagnostics (ProDi), Ruhr-University, Bochum, Germany
| | - Dirk Woitalla
- Department of Neurology, St. Josef-Krankenhaus Kupferdreh, Essen, Germany
| | - Stephan Klebe
- Department of Neurology, Essen University Hospital, Essen, Germany
| | - Bastiaan R Bloem
- Department of Neurology, Radboud University Nijmegen Medical Center, Donders Institute for Brain, Cognition and Behavior, Nijmegen, The Netherlands
| | - Adrianus Hommel
- Department of Neurology, Radboud University Nijmegen Medical Center, Donders Institute for Brain, Cognition and Behavior, Nijmegen, The Netherlands
| | - Wassilios G Meissner
- Service de Neurologie des Maladies Neurodégénératives, Bordeaux, France and University of Bordeaux, CNRS, IMN, UMR, Bordeaux, France
| | - Brice Laurens
- Service de Neurologie des Maladies Neurodégénératives, Bordeaux, France and University of Bordeaux, CNRS, IMN, UMR, Bordeaux, France
| | - Thomas Boraud
- Service de Neurologie des Maladies Neurodégénératives, Bordeaux, France and University of Bordeaux, CNRS, IMN, UMR, Bordeaux, France
| | - Alexandra Foubert-Samier
- Service de Neurologie des Maladies Neurodégénératives, Bordeaux, France and University of Bordeaux, CNRS, IMN, UMR, Bordeaux, France
| | - Sylvain Vergnet
- Service de Neurologie des Maladies Neurodégénératives, Bordeaux, France and University of Bordeaux, CNRS, IMN, UMR, Bordeaux, France
| | - François Tison
- Service de Neurologie des Maladies Neurodégénératives, Bordeaux, France and University of Bordeaux, CNRS, IMN, UMR, Bordeaux, France
| | - Nadège Costa
- Health Economic Unit, Medical Information Department, University Hospital, Toulouse, France
| | - Per Odin
- Division of Neurology, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Kristina Rosqvist
- Division of Neurology, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Jenny M Norlin
- The Swedish Institute for Health Economics, Lund, Sweden
| | - Frida Hjalte
- The Swedish Institute for Health Economics, Lund, Sweden
| | - Anette Schrag
- Department of Clinical Neurosciences, UCL Institute of Neurology, University College London, London, UK
| | - Richard Dodel
- Department of Geriatric Medicine, Center for Translational Neuro- and Behavioral Sciences, University of Duisburg-Essen, Essen, Germany
- Department of Neurology, Philipps-University Marburg, Marburg, Germany
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Gunzler DD, Gunzler SA, Briggs FB. Heterogeneous pain trajectories in persons with Parkinson's disease. Parkinsonism Relat Disord 2022; 102:42-50. [DOI: 10.1016/j.parkreldis.2022.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 06/22/2022] [Accepted: 07/10/2022] [Indexed: 11/28/2022]
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Mitsui T, Arii Y, Taniguchi K, Tsutsumi S, Takahara M, Mabuchi M, Sumitomo N, Matsuura M, Kuroda Y. Efficacy of Repetitive Trans-spinal Magnetic Stimulation for Patients with Parkinson's Disease: a Randomised Controlled Trial. Neurotherapeutics 2022; 19:1273-1282. [PMID: 35759108 PMCID: PMC9587186 DOI: 10.1007/s13311-022-01213-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/25/2022] [Indexed: 12/18/2022] Open
Abstract
We evaluated the effect of repetitive trans-spinal magnetic stimulation (rTSMS) in patients with Parkinson's disease (PD) in a randomised, single-blind study. Participants were hospitalised and administered a single trial of rTSMS or sham treatment 2 days a week for 4 weeks. In addition, all participants underwent rehabilitation 5 days a week for 4 weeks. The primary outcome was the difference between the two groups in the mean change from baseline to post-training in the total score on the Unified Parkinson's Disease Rating Scale (UPDRS). Secondary endpoints included the differences between the two groups in the mean change on the UPDRS part III (motor) score and the Timed Up and Go (TUG) score. Eligible participants were randomly assigned to either the rTSMS group (n = 50) or sham group (n = 50). The between-group difference in mean change in the total UPDRS score was 10.28 (95% confidence interval (CI), 4.42 to 16.13; P = 0.014) immediately after intervention from baseline, 5.04 (95% CI, - 5.41 to 15.50; P = 0.024) 3 months after intervention from baseline and 2.38 (95% CI, 7.18 to 11.85; P = 0.045) 6 months after intervention from baseline. Significant differences between groups in UPDRS part III and TUG scores were maintained more strictly than those in the UPDRS total score. These results strongly indicate that rTSMS promotes the effect of rehabilitation on motor function in patients with PD.
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Affiliation(s)
- Takao Mitsui
- Department of Neurology, Tokushima National Hospital National Hospital Organization, 1354 Shikiji, Kamojima, Yoshinogawa, Tokushima, 776-0031, Japan.
- Department of Clinical Research, Tokushima National Hospital National Hospital Organization, 1354 Shikiji, Kamojima, Yoshinogawa, Tokushima, 776-0031, Japan.
| | - Yoshiharu Arii
- Department of Neurology, Tokushima National Hospital National Hospital Organization, 1354 Shikiji, Kamojima, Yoshinogawa, Tokushima, 776-0031, Japan
| | - Koichiro Taniguchi
- Department of Neurology, Tokushima National Hospital National Hospital Organization, 1354 Shikiji, Kamojima, Yoshinogawa, Tokushima, 776-0031, Japan
| | - Satoshi Tsutsumi
- Department of Neurology, Tokushima National Hospital National Hospital Organization, 1354 Shikiji, Kamojima, Yoshinogawa, Tokushima, 776-0031, Japan
| | - Mika Takahara
- Department of Neurology, Tokushima National Hospital National Hospital Organization, 1354 Shikiji, Kamojima, Yoshinogawa, Tokushima, 776-0031, Japan
| | - Masaru Mabuchi
- Department of Rehabilitation, Tokushima National Hospital National Hospital Organization, 1354 Shikiji, Kamojima, Yoshinogawa, Tokushima, 776-0031, Japan
| | - Nichika Sumitomo
- Department of Clinical Research, Tokushima National Hospital National Hospital Organization, 1354 Shikiji, Kamojima, Yoshinogawa, Tokushima, 776-0031, Japan
| | - Mieko Matsuura
- Department of Clinical Research, Tokushima National Hospital National Hospital Organization, 1354 Shikiji, Kamojima, Yoshinogawa, Tokushima, 776-0031, Japan
| | - Yukiko Kuroda
- Department of Clinical Research, Tokushima National Hospital National Hospital Organization, 1354 Shikiji, Kamojima, Yoshinogawa, Tokushima, 776-0031, Japan
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Behl T, Madaan P, Sehgal A, Singh S, Makeen HA, Albratty M, Alhazmi HA, Meraya AM, Bungau S. Demystifying the Neuroprotective Role of Neuropeptides in Parkinson's Disease: A Newfangled and Eloquent Therapeutic Perspective. Int J Mol Sci 2022; 23:ijms23094565. [PMID: 35562956 PMCID: PMC9099669 DOI: 10.3390/ijms23094565] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 04/17/2022] [Accepted: 04/18/2022] [Indexed: 02/07/2023] Open
Abstract
Parkinson's disease (PD) refers to one of the eminently grievous, preponderant, tortuous nerve-cell-devastating ailments that markedly impacts the dopaminergic (DArgic) nerve cells of the midbrain region, namely the substantia nigra pars compacta (SN-PC). Even though the exact etiopathology of the ailment is yet indefinite, the existing corroborations have suggested that aging, genetic predisposition, and environmental toxins tremendously influence the PD advancement. Additionally, pathophysiological mechanisms entailed in PD advancement encompass the clumping of α-synuclein inside the lewy bodies (LBs) and lewy neurites, oxidative stress, apoptosis, neuronal-inflammation, and abnormalities in the operation of mitochondria, autophagy lysosomal pathway (ALP), and ubiquitin-proteasome system (UPS). The ongoing therapeutic approaches can merely mitigate the PD-associated manifestations, but until now, no therapeutic candidate has been depicted to fully arrest the disease advancement. Neuropeptides (NPs) are little, protein-comprehending additional messenger substances that are typically produced and liberated by nerve cells within the entire nervous system. Numerous NPs, for instance, substance P (SP), ghrelin, neuropeptide Y (NPY), neurotensin, pituitary adenylate cyclase-activating polypeptide (PACAP), nesfatin-1, and somatostatin, have been displayed to exhibit consequential neuroprotection in both in vivo and in vitro PD models via suppressing apoptosis, cytotoxicity, oxidative stress, inflammation, autophagy, neuronal toxicity, microglia stimulation, attenuating disease-associated manifestations, and stimulating chondriosomal bioenergetics. The current scrutiny is an effort to illuminate the neuroprotective action of NPs in various PD-experiencing models. The authors carried out a methodical inspection of the published work procured through reputable online portals like PubMed, MEDLINE, EMBASE, and Frontier, by employing specific keywords in the subject of our article. Additionally, the manuscript concentrates on representing the pathways concerned in bringing neuroprotective action of NPs in PD. In sum, NPs exert substantial neuroprotection through regulating paramount pathways indulged in PD advancement, and consequently, might be a newfangled and eloquent perspective in PD therapy.
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Affiliation(s)
- Tapan Behl
- Chitkara College of Pharmacy, Chitkara University, Rajpura 140401, India; (P.M.); (A.S.); (S.S.)
- Correspondence: (T.B.); (S.B.)
| | - Piyush Madaan
- Chitkara College of Pharmacy, Chitkara University, Rajpura 140401, India; (P.M.); (A.S.); (S.S.)
| | - Aayush Sehgal
- Chitkara College of Pharmacy, Chitkara University, Rajpura 140401, India; (P.M.); (A.S.); (S.S.)
| | - Sukhbir Singh
- Chitkara College of Pharmacy, Chitkara University, Rajpura 140401, India; (P.M.); (A.S.); (S.S.)
| | - Hafiz A. Makeen
- Pharmacy Practice Research Unit, Department of Clinical Pharmacy, College of Pharmacy, Jazan University, Jazan 45142, Saudi Arabia; (H.A.M.); (A.M.M.)
| | - Mohammed Albratty
- Department of Pharmaceutical Chemistry, College of Pharmacy, Jazan University, Jazan 45142, Saudi Arabia; (M.A.); (H.A.A.)
| | - Hassan A. Alhazmi
- Department of Pharmaceutical Chemistry, College of Pharmacy, Jazan University, Jazan 45142, Saudi Arabia; (M.A.); (H.A.A.)
- Substance Abuse and Toxicology Research Center, Jazan University, Jazan 45142, Saudi Arabia
| | - Abdulkarim M. Meraya
- Pharmacy Practice Research Unit, Department of Clinical Pharmacy, College of Pharmacy, Jazan University, Jazan 45142, Saudi Arabia; (H.A.M.); (A.M.M.)
| | - Simona Bungau
- Department of Pharmacy, Faculty of Medicine and Pharmacy, University of Oradea, 410028 Oradea, Romania
- Doctoral School of Biomedical Sciences, University of Oradea, 410028 Oradea, Romania
- Correspondence: (T.B.); (S.B.)
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Açai Berry Mitigates Parkinson's Disease Progression Showing Dopaminergic Neuroprotection via Nrf2-HO1 Pathways. Mol Neurobiol 2022; 59:6519-6533. [PMID: 35970975 PMCID: PMC9463222 DOI: 10.1007/s12035-022-02982-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 07/27/2022] [Indexed: 02/08/2023]
Abstract
The current pharmacological treatment for Parkinson's disease (PD) is focused on symptom alleviation rather than disease prevention. In this study, we look at a new strategy to neuroprotection that focuses on nutrition, by a supplementation with Açai berry in an experimental models of PD. Daily orally supplementation with Açai berry dissolved in saline at the dose of 500 mg/kg considerably reduced motor and non-motor symptom and neuronal cell death of the dopaminergic tract induced by 4 injections of 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP). Furthermore, Açai berry administration reduced α-synuclein aggregation in neurons, enhanced tyrosine hydroxylase and dopamine transporter activities, and avoided dopamine depletion. Moreover, Açai berry administration was able to reduce astrogliosis and microgliosis as well as neuronal death. Its beneficial effects could be due to its bioactive phytochemical components that are able to stimulate nuclear factor erythroid 2-related factor 2 (Nrf2) by counteracting the oxidative stress and neuroinflammation that are the basis of this neurodegenerative disease.
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Vaughan CL, Bruno V. What neurologists wish palliative care physicians knew. HANDBOOK OF CLINICAL NEUROLOGY 2022; 190:93-104. [PMID: 36055723 DOI: 10.1016/b978-0-323-85029-2.00005-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
As the incidence of neurologic (particularly neurodegenerative) diseases continues to rise, so too will the palliative needs in this patient population. To appropriately care for these patients and families, neurologists and palliative care providers will need to strengthen collaboration. Palliative care providers not formally trained in neurology may feel ill-equipped to manage some of the distinct neuropalliative care needs of these patients. Here, we provide insights into the unique characteristics of patients with neurologic disease and emphasize the relevance of the palliative care skillset in this population to aid the collaboration between palliative care providers and neurologists.
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Affiliation(s)
- Christina L Vaughan
- Department of Neurology and Medicine, Anschutz Medical Center, University of Colorado, Aurora, CO, United States; Department of Neurology, VA Eastern Colorado Health System, Aurora, CO, United States.
| | - Veronica Bruno
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
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7
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Kruse C, Kretschmer S, Lipinski A, Verheyen M, Mengel D, Balzer-Geldsetzer M, Lorenzl S, Richinger C, Schmotz C, Tönges L, Woitalla D, Klebe S, Schrag A, Dodel R. Resource Utilization of Patients with Parkinson's Disease in the Late Stages of the Disease in Germany: Data from the CLaSP Study. PHARMACOECONOMICS 2021; 39:601-615. [PMID: 33738776 PMCID: PMC8079299 DOI: 10.1007/s40273-021-01011-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 02/18/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE The Care of Late-Stage Parkinsonism (CLaSP) study aimed to collect qualitative and standardized patient data in six European countries (France, Germany, Netherlands, Portugal, UK, Sweden) to enable a detailed evaluation of the underexplored late stages of the disease (Hoehn and Yahr stage > 3) using clinical, neuropsychological, behavioral, and health economic data. The aim of this substudy was to provide a health economic evaluation for the German healthcare system. METHODS In Germany, 228 patients were included in the study. Costs were calculated from a societal perspective for a 3-month period. Univariate analyses were performed to identify cost-driving predictors. Total and direct costs were analyzed using a generalized linear model with a γ-distributed dependent variable and log link function. Indirect costs were analyzed using a binomial generalized linear model with probit link function. RESULTS The mean costs for the 3-month period were approximately €20,000. Informal care costs and hospitalization are approximately €11,000 and €5000. Direct costs amounted to 89% of the total costs, and the share of indirect costs was 11%. Independent predictors of total costs were the duration of the disease and age. The duration of the disease was the main independent predictor of direct costs, whereas age was an independent predictor of indirect costs. DISCUSSION Costs in the late stage of the disease are considerably higher than those found in earlier stages. Compared to the latter, the mean number of days in hospital and the need for care is increasing. Informal caregivers provide most of the care. CLINICAL TRIAL REGISTRATION The protocol was registered at ClinicalTrials.gov as NCT02333175 on 7 January, 2015.
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Affiliation(s)
- Christopher Kruse
- Department of Geriatric Medicine, University of Duisburg-Essen, Germaniastrasse 1-3, 45356, Essen, Germany
| | - Sabrina Kretschmer
- Department of Geriatric Medicine, University of Duisburg-Essen, Germaniastrasse 1-3, 45356, Essen, Germany
- Department of Neurology, Philipps-University Marburg, Marburg, Germany
| | - Anna Lipinski
- Department of Geriatric Medicine, University of Duisburg-Essen, Germaniastrasse 1-3, 45356, Essen, Germany
- Department of Neurology, Philipps-University Marburg, Marburg, Germany
| | - Malte Verheyen
- Department of Geriatric Medicine, University of Duisburg-Essen, Germaniastrasse 1-3, 45356, Essen, Germany
| | - David Mengel
- Department of Neurodegenerative Diseases, Center for Neurology and Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Monika Balzer-Geldsetzer
- Department of Geriatric Medicine, University of Duisburg-Essen, Germaniastrasse 1-3, 45356, Essen, Germany
- Department of Neurology, Philipps-University Marburg, Marburg, Germany
| | - Stefan Lorenzl
- Department of Neurology, Ludwig-Maximilians University, Munich, Germany
- Krankenhaus Agatharied GmbH, Institute of Nursing Science and Practice, Paracelsus Medical University, Salzburg, Austria
| | - Carmen Richinger
- Krankenhaus Agatharied GmbH, Institute of Nursing Science and Practice, Paracelsus Medical University, Salzburg, Austria
| | - Christian Schmotz
- Krankenhaus Agatharied GmbH, Institute of Nursing Science and Practice, Paracelsus Medical University, Salzburg, Austria
| | - Lars Tönges
- Department of Neurology, St. Josef-Hospital, Ruhr-University, Bochum, Germany
- Neurodegeneration Research, Centre for Protein Diagnostics (ProDi), Ruhr-University, Bochum, Germany
| | - Dirk Woitalla
- Department of Neurology, St. Josef-Krankenhaus Kupferdreh, Essen, Germany
| | - Stephan Klebe
- Department of Neurology, Essen University Hospital, Essen, Germany
| | | | - Richard Dodel
- Department of Geriatric Medicine, University of Duisburg-Essen, Germaniastrasse 1-3, 45356, Essen, Germany.
- Department of Neurology, Philipps-University Marburg, Marburg, Germany.
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Effects of multimodal balance training supported by rhythmical auditory stimuli in people with advanced stages of Parkinson's disease: a pilot randomized clinical trial. J Neurol Sci 2020; 418:117086. [DOI: 10.1016/j.jns.2020.117086] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 07/07/2020] [Accepted: 08/05/2020] [Indexed: 11/24/2022]
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Tai YC, Lin CH. An overview of pain in Parkinson's disease. Clin Park Relat Disord 2019; 2:1-8. [PMID: 34316612 PMCID: PMC8302194 DOI: 10.1016/j.prdoa.2019.11.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Revised: 10/20/2019] [Accepted: 11/25/2019] [Indexed: 12/13/2022] Open
Abstract
Pain is a common non-motor symptom of Parkinson's disease (PD) and the prevalence of pain among PD patients varies because of the disease stage, co-morbidities, and evaluating tools. Risk factors for pain in PD include an early age of onset, long disease duration, motor complications, concomitant depressive symptoms, female gender, and associated medical conditions. In patients with PD, pain can be classified as musculoskeletal pain, chronic body pain (central or visceral), fluctuation-related pain, nocturnal pain, orofacial pain, pain with discolouration/oedema/swelling, and radicular/neuropathic pain; musculoskeletal pain as the most common type. Potential underlying mechanisms include a disruption of peripheral nociception and alterations in central pain threshold/processing. Genetic polymorphisms in genes that confer pain susceptibility might also play a role in the occurrence of pain in PD. In advanced stage of patients with PD, polyneuropathy could occur in patients using high dosage of levodopa. Pain often correlates to other non-motor symptoms of PD, including depression, sleep, and autonomic symptoms. Dopaminergic drugs, non-dopaminergic medications, botulinum toxin, deep brain stimulation, and physiotherapy have shown some benefits for certain types of PD-related pain. An increased awareness of pain as a common non-motor symptom of PD provides further insights into sensory system dysregulation in this disease. In this review, we aim to summarizes the clinical features of pain in patients with PD and emphasize the latest evidence of pain related to levodopa treatment.
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Affiliation(s)
- Yi-Cheng Tai
- Department of Neurology, E-DA Hospital, Kaohsiung, Taiwan
| | - Chin-Hsien Lin
- Department of Neurology, National Taiwan University, College of Medicine, Taipei, Taiwan
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Rana AQ, Qureshi D, Sabeh W, Mosabbir A, Rahman E, Sarfraz Z, Rana R. Pharmacological therapies for pain in Parkinson's disease - a review paper. Expert Rev Neurother 2017; 17:1209-1219. [PMID: 28949252 DOI: 10.1080/14737175.2017.1385393] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Parkinson's disease (PD) is a neurodegenerative movement disorder characterized by the loss of dopamine containing cells in the substantia nigra, with pain being one of the most common, yet frequently misunderstood symptoms. The prevalence of pain in PD populations ranges from 40-85% and is usually categorized under the following types: i) musculoskeletal pain ii) radicular and neuropathic pain iii) dystonia-related pain iv) akathitic pain and iv) central parkinsonian pain. Areas covered: The aim of this literature review was to document and present the common and uncommon pharmaceutical therapies that treat and/or alleviate these types of pain in PD. The PubMed database was searched with keywords: "Parkinson's disease", "Pain", and "Pharmacological Therapies". Research articles involving randomized, controlled trials were included as well as case studies and qualitative studies. Expert commentary: Given the increased prevalence of pain in PD populations, there is a need for a clear understanding of the types of pain treatments available and how they can be best combined to fit the specific needs of each patient.
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Affiliation(s)
- Abdul Qayyum Rana
- a Parkinson's Clinic of Eastern Toronto and Movement Disorders Center , Toronto , Canada
| | | | | | | | | | | | - Ruqqiyah Rana
- f University of Ontario Institute of Technology , Oshawa , Canada
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11
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Fabbri M, Coelho M, Guedes LC, Chendo I, Sousa C, Rosa MM, Abreu D, Costa N, Godinho C, Antonini A, Ferreira JJ. Response of non-motor symptoms to levodopa in late-stage Parkinson's disease: Results of a levodopa challenge test. Parkinsonism Relat Disord 2017; 39:37-43. [PMID: 28389156 DOI: 10.1016/j.parkreldis.2017.02.007] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 01/26/2017] [Accepted: 02/05/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND Non-motor symptoms (NMS) are extremely common among late-stage Parkinson's disease (LSPD) patients. Levodopa (L-dopa) responsiveness seems to decrease with disease progression but its effect on NMS in LSPD still needs to be investigated. OBJECTIVE To assess the response of blood pressure (BP), pain, fatigue and anxiety to L-dopa in LSPD patients. METHODS 20 LSPD patients, defined as Schwab and England ADL Scale <50 or Hoehn Yahr Stage >3 (MED ON) and 22 PD patients treated with subthalamic deep brain stimulation (advanced PD group) underwent an L-dopa challenge. BP and orthostatic hypotension (OH) assessment, a visual analogue scale (VAS) for pain and fatigue and the Strait Trait Anxiety (STAI) were evaluated before and after the L-dopa challenge. RESULTS Systolic BP dropped significantly after L-dopa intake (p < 0.05) in LSPD patients, while there was no change in pain, fatigue or anxiety. L-dopa significantly improved (p < 0.05) pain and anxiety in the advanced PD group, whereas it had no effect on BP or fatigue. L-dopa-related adverse effects (AEs), namely OH and sleepiness, were more common among LSPD patients. 40% and 65% of LSPD patients were not able to fill out the VAS and the STAI, respectively, while measurement of orthostatic BP was not possible in four LSPD patients. CONCLUSIONS This exploratory study concludes that some non-motor variables in LSPD do not benefit from the acute action of L-dopa while it can still induce disabling AEs. There is a need for assessment tools of NMS adapted to these disabled LSPD patients.
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Affiliation(s)
- Margherita Fabbri
- Instituto de Medicina Molecular, Faculty of Medicine, University of Lisbon, Portugal
| | - Miguel Coelho
- Instituto de Medicina Molecular, Faculty of Medicine, University of Lisbon, Portugal; Department of Neurosciences, Hospital Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon, Portugal
| | - Leonor Correia Guedes
- Instituto de Medicina Molecular, Faculty of Medicine, University of Lisbon, Portugal; Department of Neurosciences, Hospital Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon, Portugal
| | - Ines Chendo
- Department of Neurosciences, Hospital Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon, Portugal
| | - Catarina Sousa
- Laboratory of Clinical Pharmacology and Therapeutics, Faculty of Medicine, University of Lisbon, Portugal
| | - Mario M Rosa
- Instituto de Medicina Molecular, Faculty of Medicine, University of Lisbon, Portugal; Department of Neurosciences, Hospital Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon, Portugal; Laboratory of Clinical Pharmacology and Therapeutics, Faculty of Medicine, University of Lisbon, Portugal
| | - Daisy Abreu
- Instituto de Medicina Molecular, Faculty of Medicine, University of Lisbon, Portugal
| | - Nilza Costa
- Instituto de Medicina Molecular, Faculty of Medicine, University of Lisbon, Portugal
| | - Catarina Godinho
- Laboratory of Clinical Pharmacology and Therapeutics, Faculty of Medicine, University of Lisbon, Portugal; Center for Interdisciplinary Research Egas Moniz (CiiEM), Instituto Superior de Ciências da Saúde Egas Moniz, Monte de Caparica, Portugal
| | - Angelo Antonini
- Fondazione Ospedale San Camillo-I.R.C.C.S., Parkinson and Movement Disorders Unit, Venice, Italy; Department of Neurosciences (DNS), Padova University, Padova, Italy
| | - Joaquim J Ferreira
- Instituto de Medicina Molecular, Faculty of Medicine, University of Lisbon, Portugal; Department of Neurosciences, Hospital Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon, Portugal; Laboratory of Clinical Pharmacology and Therapeutics, Faculty of Medicine, University of Lisbon, Portugal.
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Mundt-Petersen U, Odin P. Infusional Therapies, Continuous Dopaminergic Stimulation, and Nonmotor Symptoms. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2017; 134:1019-1044. [DOI: 10.1016/bs.irn.2017.05.036] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/17/2023]
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13
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The efficacy of apomorphine – A non-motor perspective. Parkinsonism Relat Disord 2016; 33 Suppl 1:S28-S35. [DOI: 10.1016/j.parkreldis.2016.11.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 11/25/2016] [Accepted: 11/30/2016] [Indexed: 01/09/2023]
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14
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Todorova A, Ray Chaudhuri K. Subcutaneous apomorphine and non-motor symptoms in Parkinson's disease. Parkinsonism Relat Disord 2013; 19:1073-8. [PMID: 24051336 DOI: 10.1016/j.parkreldis.2013.08.012] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Revised: 08/01/2013] [Accepted: 08/19/2013] [Indexed: 10/26/2022]
Abstract
Non-motor symptoms (NMS) are now recognized to occur across all stages of Parkinson's disease (PD) and as a result there has been an increasing focus on their diagnosis, quantification and effective management. While in some subjects, NMS may be present before diagnosis, in advanced PD, NMS can contribute to hospitalization, severe disability and a shortened life expectancy. Strategies for continuous drug delivery have been reported to have a beneficial effect on NMS in PD and while the efficacy of apomorphine on motor function in PD has been confirmed in a number of studies, in addition to its possible anti-dyskinetic effect, a number of reports have also outlined the possible beneficial effect of apomorphine on NMS. This review sets out to examine the efficacy of apomorphine in non-motor aspects of PD, including its effect on neuropsychiatric and gastrointestinal symptoms, sleep (including restless legs syndrome), urinary dysfunction, pain and impulse control disorders. The analysis takes into consideration case reports, and open-label and comparative case-control studies published to date. Results of this review suggest that although data on the effect of apomorphine on NMS in PD patients are limited there is a strong suggestion of a beneficial effect that warrants further investigation in double-blind studies.
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Affiliation(s)
- Antoniya Todorova
- National Parkinson Foundation Centre of Excellence, Department of Neurology, King's College Hospital, and King's Health Partners, London, UK.
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Abstract
Despite three decades of huge progress in molecular genetics, in cloning of disease causative gene as well as technology breakthroughs in viral biotechnology, out of thousands of gene therapy clinical trials that have been initiated, only very few are now reaching regulatory approval. We shall review some of the major hurdles, and based on the current either positive or negative examples, we try to initiate drawing a learning curve from experience and possibly identify the major drivers for future successful achievement of human gene therapy trials.
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Affiliation(s)
- Patrice P Denèfle
- Translational Sciences, IPSEN, and Biotherapies, ParisTech Institute, Paris-Descartes University, Paris, France.
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16
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Abstract
Juvenile parkinsonism, with onset prior to age 21 years, is a relatively rare syndrome. It is caused by a group of heterogeneous entities that can present with a clinical picture similar to idiopathic Parkinson's disease or manifest parkinsonism as part of a spectrum of other signs. Diagnostic testing is guided by the presenting symptoms and aimed at uncovering potentially reversible and/or treatable causes. If an underlying condition is found, treatment is tailored accordingly. Otherwise, treatment is symptomatic and relies on medications commonly employed to treat idiopathic Parkinson's disease. Juvenile parkinsonism patients tend to be plagued by treatment-induced complications, so caution must be employed.
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Affiliation(s)
- Teri R Thomsen
- Department of Neurology, Carver College of Medicine, University of Iowa, Iowa City, Iowa 52242, USA
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