ABSTRACT
Objective:To investigate whether the presynaptic dopamine neuronal depletion in different striatal subregions predicts future development of wearing-off (WO) in Parkinson′s disease (PD) patients.Methods:A retrospective longitudinal study included 57 PD patients who were referred to the Department of Neurology of Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from January 2019 to September 2020, and completed 11C-2β-carbomethoxy-3β-(4-fluorophenyl) tropane dopamine transporter (DAT) positron emission tomography scans at the initial evaluation and received dopaminergic drugs for at least 12 months during follow-up. The time of starting dopaminergic drug treatment and the occurrence of WO were recorded. After adjusting for clinical related factors, the predictive value of DAT uptake and related parameters in striatal subregions for WO was evaluated by Cox proportional hazards model. Results:During a median follow-up period of 23 months, 10 patients (18.18%) developed WO. Patients with WO exhibited less DAT uptake in the caudate nucleus and anterior putamen nucleus (0.66±0.52 vs 1.08±0.42, t=2.76, P=0.008 and 0.66±0.20 vs 0.87±0.28, t=2.27, P=0.027 respectively), especially in these subregions contralateral to the less-affected side of the body, compared to those without WO. Cox proportional hazard models revealed that after adjusting for gender, age, course of disease, baseline Unified Parkinson′s Disease Rating Scale Ⅲ score and increment of levodopa equivalent dosage, the lower the DAT uptake of the caudate ipsilateral to the less-affected side of the body ( HR=0.20, 95% CI 0.07-0.63, P=0.006), as well as the lower the DAT uptake of the caudate nucleus and posterior putamen nucleus ( HR=0.28, 95% CI 0.11-0.69, P=0.006 and HR=0.08, 95% CI 0.01-0.64, P=0.018 respectively) and the higher the ratio of putamen/caudate contralateral to the less-affected side of the body ( HR=2.33, 95% CI 1.02-5.33, P=0.045), the higher the risk of WO. Conclusion:The presynaptic dopamine neuronal loss, particularly bilateral caudate nucleus dopaminergic depletion at the early stage, has predictive value of development of WO in PD.
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Objective To review the correlation between serum uric acid (UA) level and Parkinson's disease(PD) based on the papers published from 2004 to 2014 at home and abroad,with an attempt to provide new ideas for the early diagnosis and disease evaluation of PD.Methods Major online database including PubMed,CNKI,and Wan Fang date bases were searched in March 2014.The key words we used are uric acid,Parkinson' s disease and so on.Results Totally 28 studies were enrolled,the analysis showed there were argument on the correlation UA and PD,the effect of uarthritis on PD and the effect of antiparkison drugs on UA.Conclusion It is testified in most studies that UA level is obviously lower in PD patients.The variation of UA perhaps affects the morbidity,condition and non-motor symptom among patients with PD.However,the studies are limited by the research methods 、the public surveyed and other factors.
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Objective (1) To evaluate whether the Nine Items Questionnaire (WOQ-9) for the detection of wearing-off (WO) in Parkinson Disease (PD), by means of its screening ability, is a helpful tool to assist neurologists in diagnosing WO; (2) To determine the sensitivity and the specificity of a free Brazilian Portuguese translation of WOQ-9. Method A sample obtained by convenience included 60 patients. The WOQ-9 was answered by the patients themselves before their routine consultations. The detection of the WO by the WOQ-9 was compared with the neurologist assessment. Statistical significance was 5%. Results The WOQ-9 showed sensitivity of 100%, specificity of 10.3%, positive and negative predictive values of 54.4% and 100% respectively. The identification of WO by the WOQ-9 was congruent in 54.5% of cases with neurological evaluation. Conclusion The WOQ-9 is a convenient screening tool to aid physicians to detect WO in PD patients, and it is a quick and easy self-administered questionnaire. .
Objetivo (1) Verificar se o Questionário de Nove Itens (WOQ-9) para detectar wearing-off (WO) na doença de Parkinson (DP), pela sua capacidade de triagem, seria útil aos neurologistas na identificação de WO; (2) determinar a sensibilidade e especificidade da versão livre em Português Brasileiro do WOQ-9. Método Ao todo 60 indivíduos com DP compuseram uma amostra obtida por conveniência. Os próprios pacientes responderam ao WOQ-9 antes de suas consultas rotineiras. A detecção de WO pelo WOQ-9 foi comparada com a avaliação neurológica. A significância estatística foi 5%. Resultados O WOQ-9 apresentou sensibilidade de 100%, especificidade de 10,3%, valores preditivos positivo e negativo de 54,4% e 100% respectivamente. A identificação de WO pelo WOQ-9 foi congruente em 54,5% dos casos com a avaliação neurológica. Conclusão O WOQ-9 é um método de rastreamento útil para identificar WO em pacientes com DP, e é um questionário de autoavaliação cuja aplicação é fácil e rápida. .
Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Parkinson Disease/diagnosis , Surveys and Questionnaires/standards , Brazil , Cross-Sectional Studies , Dopamine Agents/therapeutic use , Levodopa/therapeutic use , Neuropsychological Tests , Parkinson Disease/drug therapy , Reference Values , Reproducibility of Results , Sensitivity and Specificity , Statistics, Nonparametric , TranslationsABSTRACT
Parkinson's disease is a neurodegenerative disorder characterized by four major motor symptoms : resting tremor, rigidity, akinesia and postural instability. As the treatment period for Parkinson's disease is prolonged,psychological symptoms and motor complications occur frequently. Wearing-off fluctuations are the major motor complications caused by the shortening of levodopa efficacy time. They have serious influence on the quality of life (QOL) of patients with Parkinson's disease. There have been numerous reports on treatment of the behavioral and psychological symptoms of dementia (BPSD) with Kampo medicine. There have also been recent reports on treatment of the behavioral and psychological symptoms of Parkinson's with the Kampo medicine, yokukansan. On the other hand, there are few reports on treatment of the motor symptoms and motor complications of Parkinson's with yokukansan. We experienced two cases in which the levodopa-induced hallucinations and wearing-off fluctuations in Parkinson's sufferers were improved conspicuously with this Kampo medicine. These findings suggest that yokukansan improves both levodopa-induced psychological symptoms and motor complications by achieving curative effect with levodopa/carbidopa.
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This study had the objective to verify if the presence of wearing-off phenomenon in patients with Parkinson's disease (PD) could be better identified by the administration of the "Wearing-off Questionnaire Card" (QC). The participant patients were first evaluated by resident doctors in neurology and then invited to answer the QC for detection of motor and nonmotor wearing-off manifestations. Seventy and nine patients were enclosed in the study. The questionnaire revealed that 63 patients (80 percent) presented wearing-off, whereas the consultation by the resident doctors only identified 33 subjects (41 percent) with this phenomenon. The motor wearing-off manifestations were more frequent then the nonmotor. We conclude that the administration of the QC in patients with PD may be a useful tool for the diagnosis of wearing-off phenomena.
Este estudo teve como objetivo verificar se a presença do fenômeno wearing-off em pacientes com doença de Parkinson pode ser melhor identificada pela aplicação do cartão questionário wearing-off (QC). Os pacientes participantes foram avaliados pelos médicos residentes em neurologia e depois foram convidados a responder as questões do QC para detecção das manifestações motoras e não motoras do wearing-off. O número de pacientes estudados foi de 79. O questionário revelou que 63 pacientes (80 por cento) apresentaram wearing-off, enquanto que a consulta dos residentes identificou apenas 33 indivíduos (41 por cento) com este fenômeno. As manifestações motoras foram mais freqüentes do que as não motoras. Nós concluímos que a aplicação do QC em pacientes com doença de Parkinson pode ser uma ferramenta útil para o diagnostico do fenômeno wearing-off.
Subject(s)
Aged , Female , Humans , Male , Middle Aged , Antiparkinson Agents/adverse effects , Drug Tolerance , Levodopa/adverse effects , Parkinson Disease/drug therapy , Antiparkinson Agents/therapeutic use , Levodopa/therapeutic use , Sensitivity and Specificity , Severity of Illness Index , Surveys and QuestionnairesABSTRACT
BACKGROUND: The purpose of this study was to assess the efficacy and safety of entacapone, a catechol-O-methyltransferase (COMT) inhibitor in Parkinson's disease (PD) patients with wearing-off phenomenon. METHODS: A total of 197 PD patients were included in this 2-month multi-center, randomized, placebo-controlled, double blind, parallel-group study. After a 2-week screening period, each patient was randomly allocated to receive either entacapone (n=98) or placebo (n=99) as an adjunct to levodopa. The efficacy was evaluated with the changes of "on" and "off" time percentage while awake, the reduction of the levodopa dose, Unified Parkinson's Disease Rating Scale (UPDRS), and the clinical global impression (CGI) by the examiner. RESULTS: The percentage of "on" time increased by 9.4 +/- 18.0% in the entacapone group, 7.4 +/- 15.6% in the placebo group. The percentage of "off" time was reduced by 8.6 +/- 16.9% in the entacapone group, 6.6 +/- 18.2% in the placebo group. These parameters did not show a statistical significance between the two groups. However, the levodopa dose was significantly reduced in the entacapone group (51.6 +/- 154.5 mg/day) compared with the placebo group (0.7 +/- 130.0 mg/day) (p=0.009). The total and motor scores of the UPDRS were significantly decreased in the entacapone group (p=0.039, p=0.017, respectively). The most common adverse drug reactions in the entacapone group were urine discoloration (22%), dyskinesia (13%), dizziness (7%). CONCLUSIONS: Entacapone was a safe and well-tolerated drug. Although the changes of "on" and "off" time were not significant, entacapone showed an overall significant beneficial effect in the PD patients with wearing-off phenomenon.