ABSTRACT
Background: The progression of Parkinson's disease is associated with complications, most of them preventable. Aim: To analyze hospitalizations with a diagnosis of Parkinson's disease in Chile, comparing the different health subsystems. Material and Methods: Analysis of hospital discharge database available at the website of the Chilean Ministry of Health. Discharges that incorporated the diagnosis of Parkinson's disease (ICD 10 code G20), between the years 2001 and 2018 were analyzed. Results: The rate of discharges with the diagnosis of Parkinson's disease was 34.5 per 100,000 hospitalizations. The figures were 55.2 and 29.8 discharges per 100,000 in 2001 and 2018, respectively. Sixty seven percent of hospital admissions for Parkinson's occurred in the public sector and corresponded to beneficiaries of the public health insurance system (FONASA). Beneficiaries of private insurance systems accounted for 12% of hospital admissions. The mean hospital stay was 13.4 days. Conclusions: There is a decrease over time in the rate of hospitalizations with Parkinson's disease. This trend may be related with the incorporation of this disease in a special governmental program that guarantees a timely access to diagnosis and treatment.
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Background: Nonmotor symptoms of Parkinson disease significantly hamper the quality of life of patients and have prognostic significance. Aim: To evaluate the presence of nonmotor symptoms in patients with Parkinson disease. Material and Methods: A structured interview was carried out in 32 patients aged 74 ± 9 years (53% men) with Parkinson disease asking specifically for impulse control disorders and dopaminergic dysregulation. The following scales were also applied: Hoehn & Yahr scale, Montreal Cognitive Assessment, Geriatric depression scale, Nonmotor symptom scale and REM sleep scale. Results: A high frequency of nonmotor symptoms was recorded, specially mood, sleep, urinary and gastrointestinal problems and impulse control disorders. Conclusions: Nonmotor symptoms must be actively sought and managed in patients with Parkinson disease.
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Background: Ataxia can be classified as genetic, sporadic or acquired. Aim: To report the clinical features of a group of patients with ataxia. Material and Methods: Review of medical records of patients consulting in a specialized center in movement disorders. Those records in which the diagnosis of "ataxia" or "ataxic syndrome" appeared, were selected for the review. Results: Of 4,282 records surveyed, the diagnosis of ataxia appeared in 95. After eliminating repeated or incomplete records, 63 were reviewed. Results: Ataxia was sporadic, genetic and acquired in 27, 22 and 14 patients, respectively. The mean age at presentation for genetic, acquired and sporadic ataxia was 24, 46 and 53 years respectively. All autosomal dominant ataxias were type 3 spinocerebellar ataxia (SCA). Friedrich's ataxia was the most common recessive form. Most sporadic forms of ataxia were multiple system atrophy with predominant cerebellar ataxia (MSA-C) subtype. Conclusions: Considering the heterogeneity of patients with ataxia, we propose a method to approach them.
Subject(s)
Humans , Male , Female , Child, Preschool , Child , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Ataxia/etiology , Ataxia/epidemiology , Ataxia/pathology , Chile/epidemiology , Sex Factors , Medical Records , Retrospective Studies , Analysis of Variance , Age Factors , Sex Distribution , Age DistributionABSTRACT
Background: Deep brain stimulation is an essential therapeutic tool in Parkinson's disease. Aim: To assess the results of a series of patients with Parkinson's disease treated with micro-electrode guided subthalamic nucleus stimulation. Material and Methods: Twenty patients with idiopathic Parkinson's disease were studied (10 males). Three months after surgery, we analyzed the change in motor disturbances, medication need to control symptoms and quality of life. Results: We observed a significant improvement in all the assessed variables. Motor involvement determined as OFF hours and expressed as percentage of the day changed from 30 ± 15 to 10 ± 7% in the preoperative and postoperative periods, respectively. ON hours without dyskinesia changed from 17 ± 16 to 78 ± 21%. ON hours with dyskinesia changed from 53 ± 23 to 12 ± 15%. Medication need changed from 1,505 ± 499 to 1,214 ± 528 levodopa equivalents. Parkinson's Disease Questionnaire 39 score changed from 62.9 ± 22.7 to 34.3 ± 18.5. During the 5-year follow-up a continuous improvement of symptoms was observed. Conclusions: Micro-electrode guided subthalamic nucleus functional surgery in patients with Parkinson's disease has good immediate and late results.
Subject(s)
Humans , Male , Female , Middle Aged , Parkinson Disease/surgery , Subthalamic Nucleus/surgery , Deep Brain Stimulation/methods , Quality of Life , Severity of Illness Index , Retrospective Studies , Treatment Outcome , Deep Brain Stimulation/adverse effectsSubject(s)
Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Parkinson Disease/mortality , Chile/epidemiology , Death Certificates , Sex DistributionABSTRACT
Huntington's disease (HD) is a rare neurodegenerative disease with a multitude of symptoms, which requires access to specialized multidisciplinary care for adequate management. The aim of this study was to survey the characteristics of care in various HD centers in South America (SA).
A questionnaire was sent to 24 centers involved in the care for HD patients in SA.
Of the total 24 centers, 19 (79.2%) are academic units. The majority of centers (62.5%) are general movement disorders clinics. Multidisciplinary care is available in 19 (79.2%) centers and in 20 (83.3%) care is provided free of charge. Genetic testing and counseling are available in 25 and 66.6% of centers, respectively. The majority of centers (83.3%) have no institutional support for end-stage care.
Although HD centers in SA are committed to providing multidisciplinary care, access to genetic counseling and end-stage care are lacking in most centers.
A doença de Huntington (DH) é uma doença neurodegenerativa rara que requer tratamento multidisciplinar especializado para manejo adequado. O objetivo do presente trabalho foi pesquisar as características da assistência à saúde em centros de DH na América do Sul (AS).
Um questionário foi enviado para 24 centros envolvidos no cuidado de pacientes com DH na AS.
Dos 24 centros, 19 (79,2%) são unidades acadêmicas. A maioria (62,5%) são clínicas de distúrbios dos movimentos. Cuidado multidisciplinar é disponível em 19 (79,2%) dos centros e em 20 (83,3%), o tratamento é gratuito. O teste e o aconselhamento genético estão disponíveis em 25 e 66,6% dos centros, respectivamente. Não há suporte institucional para cuidado terminal em 83,3% dos centros.
Apesar dos centros de DH na AS terem compromisso com o provimento de cuidados multidisciplinares, o acesso a aconselhamento genético e a tratamento na fase terminal são falhos na maioria dos centros.
Subject(s)
Humans , Comprehensive Health Care/statistics & numerical data , Delivery of Health Care/statistics & numerical data , Huntington Disease/therapy , Genetic Counseling , Genetic Testing , Patient-Centered Care/statistics & numerical data , South America , Surveys and QuestionnairesABSTRACT
Botulinum neurotoxin is widely used to treat a variety of movement disorders, especially dystonia and spasticity. There botúlica different preparations of botulinum type A, that because biologics are difficult to compare. AbobotulinumtoxinA (Dysport ®) has recently been introduced in Chile for treating dystonia and spasticity. The aim of this paper is to provide a review by experts on the existing evidence and propose a practical guide to the use of the drug. Methods and Results: A group of Chilean experts met on 6 and 7 July 2012 to review AbobotulinumtoxinA doses along with injection protocols for dystonia, spasticity and other movement disorders. We worked in two groups, one composed of neurologists who reviewed the on dystonias and other by physiatrists who reviewed the indications for spasticity. Conclusions: Finally, there is a proposal in terms of dose, injection points and recommendations for dystonia and spasticity...
La neurotoxina botulínica es ampliamente usada para tratar una variedad de trastornos del movimiento, especialmente la distonía y la espasticidad. Existen diferentes preparados de toxina botúlica tipo A, que por ser productos biológicos resultan difícilmente comparables. La abobotulinumtoxinA (Dysport®) ha sido introducida en Chile recientemente para el tratamiento de la distonía y la espasticidad. El objetivo de este trabajo es entregar una revisión hecha por expertos sobre la evidencia existente y plantear una guía práctica para el uso del medicamento. Métodos y Resultados: Un grupo de expertos chilenos se reunieron el 6 y 7 julio de 2012 para revisar las dosis abobotulinumtoxin A, junto con los protocolos de inyección para la distonía, la espasticidad y otros trastornos del movimiento. Se trabajó en dos grupos, uno compuesto por neurólogos que revisaron las indicaciones en distonías y otro por fisiatras que revisaron las indicaciones para espasticidad. Conclusiones: Finalmente, se realiza una propuesta en cuanto a dosis, puntos a inyectar y recomendaciones para la distonia y espasticidad...
Subject(s)
Humans , Dystonia/drug therapy , Muscle Spasticity/drug therapy , Neuromuscular Agents/administration & dosage , Botulinum Toxins, Type A/administration & dosage , Chile , Consensus , Evidence-Based Medicine , Neuromuscular Agents/adverse effects , Practice Guidelines as Topic , Botulinum Toxins, Type A/adverse effectsABSTRACT
Background: Parkinson disease (EPI) patients often require being assisted by others. These caregivers are exposed to a decrease in their quality of Ufe. Aim: To explore Parkinson disease patient features associated with a greater burden among their caregivers. Material ana Methods: Fifty one patients with Parkinson disease (aged 67 ± 12years, 29 men, with 8 ± 5years of disease) and their caregivers, were studied. Patients were assessed with the Unified Parkinson Disease Rating Scale III, the Hoehn & Yahr stage standardization, Parkinson s minimental test, the neurop-sychiatric inventory and the Beck Depression Inventory (IDB). The Zarit Burden Interview (ESZ) was applied to caregivers. Results: According to IDB, 45% of patients whose caregiverspresented little or no burden had a depression, compared to 78% of those whose caregivers had modérate or intense burden. (p < 0.01). The ESZ score of caregivers correlated significantly with Parkinson patients' age, IDB and axial involvement in the UPDRS-III (correlation coefficients ofOAp < 0.01, 0.6p < 0.01 and 0.46p < 0.01, respectively). Conclusions: Motor alterations, cognitive impairment and most importantly depression of patients with Parkinson disease are deteminants of burden for their caregivers.
Subject(s)
Aged , Female , Humans , Male , Middle Aged , Caregivers/psychology , Cost of Illness , Depression/psychology , Parkinson Disease/nursing , Caregivers/statistics & numerical data , Depression/epidemiology , Psychiatric Status Rating Scales , Quality of Life/psychology , Surveys and Questionnaires , Risk FactorsABSTRACT
Parkinson's disease (PD) is a progressive neurodegenerative disease with a high impact on individuals who experience it and their families. In 2010, the Chilean Health System included PD in the Health's explicit guarantees, and clinical guidelines were developed for the diagnosis and management of PD. We reviewed the guidelines for diagnosis and treatment of PD published in the literature worldwide, in order to adapt them to our country's reality from the perspective of a national group of experts.
La enfermedad de Parkinson (EP) es una enfermedad neurodegenerativa progresiva de alto impacto para las personas que la sufren y sus familiares. El año 2010 el Ministerio de Salud de Chile la incorporó al sistema de garantías explicitas en Salud, lo que dio origen al desarrollo de las guías clínicas para el manejo de la EP. Un grupo de expertos nacionales realizó una revisión de las guías sobre diagnóstico y tratamiento de la EPpublicadas en la literatura a nivel mundial, con el propósito de evaluarlas y adaptarlas a la realidad chilena.
Subject(s)
Humans , Evidence-Based Medicine , Parkinson Disease/diagnosis , Parkinson Disease/therapy , Chile , ConsensusSubject(s)
Humans , Male , Female , Parkinson Disease , Amantadine , Antiparkinson Agents , Dopamine Agonists , Levodopa , SelegilineABSTRACT
Presentamos 3 casos con lesión medular traumática alta, secuelados con tetraplejia y espasticidad de difícil manejo, en los que se evalúa la seguridad y eficacia del uso de baclofeno intratecal. Para evaluar la respuesta a baclofeno intratecal, previo a la implantación de la bomba, los pacientes fueron sometidos a una prueba terapéutica con bolos de baclofeno en dosis de 25, 50, 75 y 100 gamas, administradas por punción lumbar, con lo que se obtuvo una significativa disminución de la rigidez y espasticidad por más de 8 horas en todos los casos, evaluados con las escalas de Ashworth y de espasmos de Penn. A estos 3 pacientes se les implantó una bomba programable con un catéter intratecal para infusión de baclofeno a nivel dorsal. Los pacientes se controlaron neurológicamente cada 3 meses. Se logró mantener una respuesta clínicamente satisfactoria, debiéndose ajustar progresivamente dosis de baclofeno. No se han observado complicaciones significativas
Subject(s)
Humans , Male , Adult , Baclofen/administration & dosage , Infusion Pumps, Implantable , Muscle Spasticity/drug therapy , Injections, Spinal , Spinal Cord Injuries/complicationsABSTRACT
Background: Tourette's syndrome is a childhood-onset hereditary neurobehavioural disorder believed to occur without geographical restrictions. Although there have been reports of this disorder worldwide just a few are from Latin America. Aim: To report a preliminary experience with a series of 70 patients and to review recent advances in this disorder. Patients and Method: We reviewed patients seen in pediatric and adult neurological clinics in Santiago, Chile, all of whom fulfilled clinical diagnostic criteria for Tourette Syndrome. Results: Seventy patients were studied, 54 males (77.1 percent) and 16 females (22.8 percent), their mean age at first evaluation was 13.6 years (range 2-46). The mean age of onset of symptoms was 6.4 (range 2-20), the mean time of follow-up was 3 years. Fifty-eight patients showed simple motor tics (blinking, facial grimacing, shoulder shrugging), whereas dystonic tics like head jerking were seen in 38 patients, torticollis in 6 and oculogyric movements in 2. Complex motor tics like jumping, antics, trunk bending and head shaking were present in 16 subjects. Vocal tics were predominantly of the simple type: sniffing, throat clearing, blowing, and whistling. Complex vocal tics were seen in 12 patients, five cases showed palilalia, 3 echolalia and only six displayed coprolalia (8.5 percent). Tics were of mild to moderate severity in most patients. Obsessive-compulsive disorder was observed in 22.8 percent and attention deficit and hyperactivity disorder were present in 35.7 percent. Forty-five patients (64.2 percent) had a first degree relative with tics, nine patients (12.8 percent) had a family history of obsessive-compulsive disorder. The current evidence involving desinhibition of cortico-striatum-thalamic-cortical neuronal circuits in the pathogenesis of this disorder is analyzed. Conclusion: Our report supports the recognized clinical homogeneity and genetical basis of TouretteÕs syndrome regardless of geographical region and ethnic origin
Subject(s)
Humans , Male , Female , Child, Preschool , Adolescent , Adult , Tic Disorders/diagnosis , Tourette Syndrome/diagnosis , Basal Ganglia/abnormalities , Echolalia/epidemiology , Haloperidol/administration & dosage , Obsessive-Compulsive Disorder/complications , Attention Deficit and Disruptive Behavior Disorders/epidemiology , Tourette Syndrome/drug therapyABSTRACT
Background: The high costs of adequate pharmacological treatment for Parkinson disease preclude the universal access of patients to this medication. Aim: To assess the accessibility to pharmacological treatment of Chilean patients with Parkinson disease. Patients and methods: An inquiry about socioeconomic stratification, medical controls, disease features and costs of pharmacological therapy, was applied to 95 patients (56 male, aged 32 to 89 years old) attending the Chilean League Against Parkinson Disease. Results: Among studied patients, the disease had a mean duration of 7.9ñ6 years. There was a direct relationship between family income, the frequency of visits to physicians and the dose and cost of pharmacological therapy. Conclusions: The accessibility to pharmacological therapy among patients with Parkinson disease, depends on their socioeconomic level. Measures to correct this situation and improve the quality of life of these patients should be undertaken by health services
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Parkinson Disease/drug therapy , Parkinson Disease/epidemiology , Antiparkinson Agents/economics , Social Class , Levodopa/adverse effects , Drug Costs/statistics & numerical data , Cost of Illness , Income , Socioeconomic SurveyABSTRACT
La levodopa continúa siendo la terapia más efectiva en la enfermedad de Parkinson (EP), el desarrollo de diferentes formulaciones ha respondido a las distintas necesidades de los pacientes con EP avanzada. Las formulaciones líquidas o dispersables se han orientado a optimizar la farmacocinética periférica de la levodopa. Se diseñaron 4 experiencias diferentes: la primera con soluciones a diferentes concentraciones de levodopa (1 a 4 mg/ml); el segundo grupo soluciones a 1 mg/ml de levodopa con y sin filtrarlas; el tercero, igual concentración con las diferentes formas comerciales; y 4 las soluciones preparadas por los pacientes
Subject(s)
Humans , Carbidopa/pharmacokinetics , Levodopa/pharmacokinetics , Parkinson Disease/drug therapy , Drug Stability , Parkinson Disease/metabolism , SolubilityABSTRACT
Los pacientes con EP pueden presentar poliaquiuria y poliuria nocturna en un 38 a 71 por ciento, un síntoma que interfiere con el sueño. Material y métodos: Se evaluaron 3 pacientes con enfermedad de Parkinson idiopática, que presentaban poliaquiuria nocturna. Se descartó infección urinaria y enfermedades nefrourológicas. Dos hombres y una mujer de 67, 67 y 77 años de edad, con entre 14 y 17 años de enfermedad de Parkinson y en tratamiento con levodopa. Todos los casos eran avanzados con Hoehn y Yahr, 4 con complicaciones evolutivas de la EP. Se le prescribe desmopresina ascetato en spray nasal, 10 µg intranasal por una semana al acostarse, la segunda semana 20 µg. Resultados. Nuestros dos casos presentaron una buena respuesta sintomática con una disminución del número de veces que orinaron en la noche. Em ambos casos hubo una clara redistribución del volumen de orina de 24 horas, con una disminución del 30 por ciento del volumen nocturno. En ambos casos no hubo cambios significativos en el sodio y la osmolaridad plasmática. Caso 3. Este caso suspendió la terapia por presentar severa exacerbación de las distonías dolorosas que el paciente presentaba previamente. Si bien el número de pacientes estudiados en esta experiencia no permite conclusiones definitivas, los resultados obtenidos hacen plantear que el uso de desmopresina intranasal en algunos pacientes parkinsonianos puede ser una herramienta terapéutica útil, la cual debe ser monitorizada clínicamente y con el laboratorio, para prevenir desequilibrio hidroelectrolítico como la hiponatremia
Subject(s)
Humans , Male , Female , Aged , Deamino Arginine Vasopressin/pharmacology , Parkinson Disease/complications , Polyuria/drug therapy , Administration, Intranasal , Deamino Arginine Vasopressin , Levodopa/therapeutic use , Osmolar Concentration , Parkinson Disease/drug therapy , Polyuria/etiologyABSTRACT
La disfunción neurológica aguda por daño a nivel del estriado en la infancia puede presentarse con diferentes formas clínica y en una amplia variedad de patología con diferentes pronósticos. Se presentan dos pacientes, y se revisa y discute la literatura
Subject(s)
Humans , Male , Female , Child, Preschool , Basal Ganglia Diseases/diagnosis , Corpus Striatum/physiopathology , Basal Ganglia Diseases/physiopathology , Movement Disorders/diagnosis , Tomography, Emission-ComputedABSTRACT
Reportamos un estudio en que se evalúa el uso de dieta rica en fibras (DRF) en el manejo de la constipación en la enfermedad de Parkinson (EP).Se evalúan 14 pacientes con edad media 66.5ñ6.7 años, tiempo de evolución de 7.5ñ5.6. La escala unificada para evaluar EP en su punto III tiene una media de 39.9ñ9.6 puntos. Todos los pacientes presentaban contipación y se les instruyó para consumir DRF (30 gr), fueron evaluados en forma basal y posteriormente al mes. El número de evacuaciones espontáneas antes del uso de DRF fue de 0.5ñ1.0 por semana y al mes de usar DRF 2.2ñ2.0 (p<0.05). Otros parámetros como consistencia de las heces, esfuerzo defecatorio y uso de laxantes presentaron mejprías significativas. La frecuencia de presentación de dolor o disconfort en la defecación y las evacuaciones incompletas no presentaron variaciones de significación