ABSTRACT
ABSTRACT Falls are common among persons with Parkinson's disease (PD). On the other hand, predicting falls is complex as there are both generic and PD-specific contributors. In particular, the role of non-motor symptoms has been less studied. Objective: The objective of this study was to identify the role of non-motor predictors of falling in persons with PD (PwP). Methods: A cross-sectional study was carried out in PwP recruited from a movement disorders clinic. Clinical and demographical data were collected. All PwP were assessed using the Movement Disorders Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS) and the Non-Motor Symptoms Scale (NMSS). Variables were assessed at the bivariate level. Significant variables were put into a logistic regression model. Results: A total of 179 PwP were included. Overall, 16.8% of PwP had fallen in the past 12 months, with 53.3% of them being recurrent fallers. The mean number of monthly falls was 2.5 ± 3.3. Factors associated with falling in the bivariate analysis included the disease duration, Hoehn and Yahr stage, MDS-UPDRS part I and II, postural instability/gait disturbance (PIGD) subtype, NMSS urinary domain, NMSS miscellaneous domain, and non-motor severity burden (all p-values < 0.05). After multivariate analysis, only the disease duration (p = 0.03) and PIGD (p = 0.03) remained as independent risk factors. Conclusion: Disease duration and the PIGD subtype were identified as relevant risk factors for falls in PwP Non-motor symptoms appear to have a less important role as risk factors for falls.
RESUMEN Las caídas son frecuentes entre las personas con Parkinson (EP). La predicción de caídas es compleja ya que existen contribuyentes genéricos y específicos. El papel de los síntomas no motores ha sido menos estudiado. Objetivo: Identificar el papel de los factores no motores en caídas en personas con EP (PcP). Métodos: Estudio transversal en PcP reclutadas en una clínica de trastornos del movimiento. Se incluyeron datos clínicos y demográficos. Todos los PcP se evaluaron con la Escala Unificada de Enfermedad de Parkinson modificada por la Sociedad Internacional de Trastornos del Movimiento (MDS-UPDRS) y la Escala de Síntomas No Motores (NMSS). Se incluyeron variables significativas en un modelo de regresión logística. Resultados: Se incluyeron un total de 179 PcP El 16.8% había presentado una caída en los últimos doce meses y el 53.3% de forma recurrente. El número medio de caídas mensuales fue de 2.5 ± 3.3. Los factores asociados con la caída en el análisis bivariado fueron la duración de la enfermedad, Hoehn e Yahr, MDS-UPDRS parte I y II, subtipo de alteración de la marcha/inestabilidad postural (PIGD), dominio urinario del NMSS, dominio misceláneo del NMSS y carga de severidad no motora (todos los valores de p < 0.05). Después del análisis multivariado, solo la duración de la enfermedad (p = 0.03) y PIGD (p = 0.03) permanecieron como un factor de riesgo independiente. Conclusión: La duración de la enfermedad y PIGD se identificaron como factores de riesgo para caídas. Los síntomas no motores parecen tener un papel menos relevante en las caídas.
Subject(s)
Humans , Male , Female , Middle Aged , Aged , Parkinson Disease/complications , Parkinson Disease/physiopathology , Accidental Falls/statistics & numerical data , Motor Disorders/complications , Motor Disorders/physiopathology , Time Factors , Severity of Illness Index , Logistic Models , Cross-Sectional Studies , Multivariate Analysis , Risk Factors , Statistics, Nonparametric , Risk Assessment , Gait Disorders, Neurologic/complications , Gait Disorders, Neurologic/physiopathology , Postural Balance/physiologyABSTRACT
ABSTRACT Motor and non-motor manifestations are common and disabling features of hereditary spastic paraplegia (HSP). Botulinum toxin type A (Btx-A) is considered effective for spasticity and may improve gait in these patients. Little is known about the effects of Btx-A on non-motor symptoms in HSP patients. Objective To assess the efficacy of Btx-A on motor and non-motor manifestations in HSP patients. Methods Thirty-three adult patients with a clinical and molecular diagnosis of HSP were evaluated before and after Btx-A injections. Results Mean age was 41.7 ± 13.6 years and there were 18 women. Most patients had a pure phenotype and SPG4 was the most frequent genotype. The Btx-A injections resulted in a decrease in spasticity at the adductor muscles, and no other motor measure was significantly modified. In contrast, fatigue scores were significantly reduced after Btx-A injections. Conclusion Btx-A injections resulted in no significant functional motor improvement for HSP, but fatigue improved after treatment.
RESUMO Manifestações motoras e não motoras são comuns e incapacitantes nas paraparesias espásticas hereditárias (PEH). Toxina botulínica do tipo A (TB-A) é considerada eficaz no tratamento da espasticidade e pode melhorar a marcha nesses pacientes. Pouco se sabe sobre os efeitos da TB-A sobre sintomas não-motores. Objetivo avaliar a eficácia da TB-A sobre manifestações motoras e não-motoras nas PEH. Método trinta e três pacientes adultos com PEH foram avaliados antes e depois das aplicações de TB-A. Resultados A média de idade foi 41,7 ± 13,6 anos e havia 18 mulheres. A maioria dos pacientes portava a forma pura e o genótipo mais comum foi SPG4. Houve diminuição da espasticidade dos músculos adutores da coxa sem melhora da marcha. A pontuação da fadiga reduziu após as injeções. Conclusão As aplicações de TB-A não melhoraram a marcha nos pacientes mas a redução da fadiga foi significativa após o tratamento.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Spastic Paraplegia, Hereditary/physiopathology , Spastic Paraplegia, Hereditary/drug therapy , Botulinum Toxins, Type A/therapeutic use , Motor Disorders/physiopathology , Motor Disorders/drug therapy , Neuromuscular Agents/therapeutic use , Reproducibility of Results , Treatment Outcome , Age of Onset , Muscle Fatigue/drug effects , Muscle Fatigue/physiology , Gait/drug effects , Gait/physiology , Injections, Intramuscular , Muscle Spasticity/drug therapyABSTRACT
ABSTRACT Purpose To investigate potential associations among executive, physical and food functions in the acute phase after stroke. Methods This is a cross-sectional study that evaluated 63 patients admitted to the stroke unit of a public hospital. The exclusion criteria were other neurological and/or psychiatric diagnoses. The tools for evaluation were: Mini-Mental State Examination and Frontal Assessment Battery for cognitive functions; Alberta Stroke Program Early CT Score for quantification of brain injury; National Institutes of Health Stroke Scale for neurological impairment; Modified Rankin Scale for functionality, and the Functional Oral Intake Scale for food function. Results The sample comprised 34 men (54%) and 29 women with a mean age of 63.6 years. The Frontal Assessment Battery was significantly associated with the other scales. In multivariate analysis, executive function was independently associated with the Functional Oral Intake Scale. Conclusion Most patients exhibited executive dysfunction that significantly compromised oral intake.
RESUMO Objetivo Investigar potenciais associações entre funções executiva, física global e de alimentação na fase aguda do acidente vascular cerebral (AVC). Métodos Trata-se de estudo transversal envolvendo 63 pacientes admitidos em unidade de AVC de um hospital público. Os critérios de exclusão foram outros diagnósticos neurológicos e/ou psiquiátricos. Os instrumentos utilizados foram: Mini-Exame do Estado Mental e Bateria de Avaliação Frontal para avaliar funções cognitivas; Alberta Stroke Program Early CT Score para quantificação da lesão cerebral; National Institutes of Health Stroke Scale para comprometimento neurológico; Escala Modificada de Rankin para funcionalidade e Functional Oral Intake Scale para função alimentar. Resultados A amostra compreendeu 34 homens e 29 mulheres, sendo a idade média de 63,6 anos. A Bateria de Avaliação Frontal correlacionou significativamente com as demais escalas. Na análise multivariada, a variável independentemente associada com a função executiva foi a Functional Oral Intake Scale. Conclusão A maioria dos pacientes com AVC apresenta alterações das funções executivas que comprometem significativamente a alimentação oral.
Subject(s)
Humans , Male , Female , Middle Aged , Aged , Stroke/complications , Stroke/physiopathology , Eating/physiology , Executive Function/physiology , Motor Disorders/etiology , Motor Disorders/physiopathology , Severity of Illness Index , Linear Models , Acute Disease , Cross-Sectional Studies , Multivariate Analysis , Cognition/physiology , Statistics, Nonparametric , Cognitive Dysfunction/etiology , Cognitive Dysfunction/physiopathology , Mental Status and Dementia Tests , Motor Skills/physiology , Neuropsychological TestsABSTRACT
Minimal hepatic encephalopathy is more common than the acute syndrome. Losartan, the first angiotensin-II receptor blocker (ARB), and candesartan, another widely-used ARB, have protected against developing fibrogenesis, but there is no clear data about their curative antifibrotic effects. The current study was designed to examine their effects in an already-established model of hepatic fibrosis and also their effects on the associated motor dysfunction. Low-grade chronic liver failure (CLF) was induced in 3-month old Sprague-Dawley male rats using thioacetamide (TAA, 50 mg·kg−1·day−1) intraperitoneally for 2 weeks. The TAA-CLF rats were randomly divided into five groups (n=8) treated orally for 14 days (mg·kg−1·day−1) as follows: TAA (distilled water), losartan (5 and 10 mg/kg), and candesartan (0.1 and 0.3 mg/kg). Rats were tested for rotarod and open-field tests. Serum and hepatic biochemical markers, and hepatic histopathological changes were evaluated by H&E and Masson's staining. The TAA-CLF rats showed significant increases of hepatic malondialdehyde, hepatic expression of tumor necrosis factor-α (TNF-α), and serum ammonia, alanine aminotransferase, γ-glutamyl transferase, TNF-α, and malondialdehyde levels as well as significant decreases of hepatic and serum glutathione levels. All treatments significantly reversed these changes. The histopathological changes were moderate in losartan-5 and candesartan-0.1 groups and mild in losartan-10 and candesartan-0.3 groups. Only candesartan significantly improved TAA-induced motor dysfunction. In conclusion, therapeutic antifibrotic effects of losartan and candesartan in thioacetamide-induced hepatic fibrosis in rats are possibly through angiotensin-II receptor blocking, antioxidant, and anti-inflammatory activities. Improved motor dysfunction by candesartan could be attributed to better brain penetration and slower "off-rate" from angiotensin-II receptors. Clinical trials are recommended.
Subject(s)
Animals , Male , Angiotensin II Type 1 Receptor Blockers/therapeutic use , Benzimidazoles/therapeutic use , End Stage Liver Disease/complications , Losartan/therapeutic use , Motor Disorders/drug therapy , Tetrazoles/therapeutic use , Alanine Transaminase/blood , Ammonia/blood , Angiotensin II Type 1 Receptor Blockers/pharmacology , Benzimidazoles/pharmacology , Disease Models, Animal , End Stage Liver Disease/pathology , End Stage Liver Disease/physiopathology , Enzyme-Linked Immunosorbent Assay , gamma-Glutamyltransferase/blood , Glutathione/analysis , Liver Cirrhosis/complications , Liver Cirrhosis/pathology , Liver Cirrhosis/physiopathology , Liver/drug effects , Liver/pathology , Locomotion/physiology , Losartan/pharmacology , Malondialdehyde/analysis , Motor Disorders/etiology , Motor Disorders/physiopathology , Random Allocation , Rats, Sprague-Dawley , Reproducibility of Results , Reverse Transcriptase Polymerase Chain Reaction , Tetrazoles/pharmacology , Thioacetamide , Treatment Outcome , Tumor Necrosis Factor-alpha/bloodABSTRACT
ABSTRACT Objective Patients with Parkinson’s disease (PD) may present with unusual motor and non-motor symptoms and signs in the early stage of the disease. Methods Cases were collected over a five-year period at two tertiary movement disorders clinics. All had a diagnosis of PD with unusual presentations defined retrospectively as the presence of complaints not objectively related to any of the classic cardinal signs of parkinsonism or the typical early non-motor features of PD. Results A total of 15 early PD patients fulfilled the proposed criteria, presenting with symptoms such as atypical tremors, shoulder pain, signs related to the rigid akinetic syndrome, as well as cases of asthenia, rhinorrhea, parosmia, dysgeusia, nocturnal sialorrhea, and color discrimination disorders. Conclusions Unusual motor and non-motor symptoms and signs in the early stage of PD can be difficult to interpret. Specialists should be aware of these conditions as clues to a potential diagnosis.
RESUMO Objetivo Pacientes com doença de Parkinson (DP) podem apresentar sintomas e sinais motores e não motores pouco comuns na fase inicial da doença. Métodos Os casos foram coletados em um período de cinco anos, em dois centros terciários de distúrbios do Movimento. Todos os pacientes tinham o diagnóstico de DP com apresentações clínicas iniciais pouco comuns. Resultados Um total de 15 pacientes com DP na fase inicial, apresentando sintomas e sinais tais como, tremores atípicos, dor no ombro, sinais relacionados com a síndrome rígido-acinética, bem como casos com astenia, rinorréia, parosmia, disgeusia, sialorréia noturna e distúrbios da discriminação de cores. Conclusões Sintomas e sinais motores e não motores pouco comuns na fase inicial da DP podem ser de difícil interpretação. Neurologistas devem estar a par destas condições, como pistas para o potencial diagnóstico.
Subject(s)
Humans , Male , Female , Middle Aged , Aged , Parkinson Disease/diagnosis , Parkinson Disease/physiopathology , Symptom Assessment , Motor Disorders/diagnosis , Motor Disorders/physiopathology , Tremor/diagnosis , Tremor/physiopathology , Brazil , Retrospective Studies , Hypokinesia/diagnosis , Hypokinesia/physiopathology , Early Diagnosis , Motor Activity/physiologyABSTRACT
Abstract Objective: To review the epidemiology and update the scientific knowledge on the problems of development and behavior in childhood, and the recommendations for the role of the pediatrician in identifying and managing delays and disturbances in child development and mental health. Sources: A search for relevant literature was performed in the PubMed and Scopus databases and publications of the National Scientific Council on the Developing Child. Summary of the findings: With the decline in the incidence of communicable diseases in children, problems with development, behavior, and emotional regulation are increasingly becoming a part of the work of pediatricians, yet many are not trained and feel uncomfortable about this extension of their role. The available screening tools for child development and behavior are reviewed, and a ‘school readiness’ checklist is presented, together with recommendations on how the pediatrician can incorporate developmental surveillance into routine practice, aware of the need for children to acquire social, emotional, and cognitive skills so that they can develop their full potential. Conclusions: The pediatrician's role in the future will include both physical and mental health, recognizing that social development, resilience, and emotional maturity are as important as physical growth and neuromotor skills in a child's life course.
Resumo Objetivo: Revisar a epidemiologia e atualizar os conhecimentos científicos sobre os problemas do desenvolvimento e do comportamento na infância e das recomendações do papel do pediatra na identificação e conduta frente aos transtornos da saúde mental infantil. Fontes de dados: Pesquisamos a literatura relevante nas bases de dados PubMed e Scopus e em publicações do National Scientific Council on the Developing Child. Síntese dos dados: Com o declínio na incidência de doenças transmissíveis em crianças, problemas do desenvolvimento, comportamento e regulação emocional fazem cada vez mais parte do trabalho do pediatra, mas muitos ainda não estão treinados e se sentem desconfortáveis com essa extensão do seu papel. Os instrumentos de triagem do desenvolvimento e comportamento foram revisados e uma lista de verificação da “prontidão escolar” foi apresentada, juntamente com orientações sobre como o pediatra pode incorporar a vigilância da saúde mental em sua de rotina de atendimento, consciente da necessidade da aquisição das habilidades sociais, emocionais e cognitivas para que a criança possa desenvolver toda sua potencialidade. Conclusões: O papel do pediatra no futuro irá abranger tanto a saúde física quanto a mental e reconhecer que o desenvolvimento social, a resiliência e o amadurecimento emocional são tão importantes quanto o crescimento físico e as habilidades neuromotoras no curso da vida de uma criança.
Subject(s)
Humans , Child , Physician's Role , Child Behavior Disorders/diagnosis , Developmental Disabilities/diagnosis , Motor Disorders/diagnosis , Mental Disorders/diagnosis , Brazil , Child Behavior Disorders/physiopathology , Child Development/physiology , Developmental Disabilities/physiopathology , Mass Screening/methods , Mental Health , Motor Disorders/physiopathology , Mental Disorders/physiopathology , Motor Skills/physiologyABSTRACT
A pesar de que los niños con discapacidad motora exclusiva no tienen discapacidad intelectual y deberían concurrir a escolaridad común, en la práctica pediátrica observamos un alto nivel de heterogeneidad en la escolaridad de estos niños. El objetivo de nuestro estudio fue establecer la prevalencia de disfunción escolar en niños con discapacidad motora exclusiva que concurren a un hospital de referencia y explorar si existen variables demográficas, sociales, médicas y/o escolares relacionadas con la disfunción. Se realizó un estudio trasversal, observacional, analítico y comparativo. Se incluyeron 288 pacientes con discapacidad motora exclusiva de 5 a 19 años (septiembre de 2011-febrero de 2012). El 25% (72) presentó disfunción escolar. El antecedente de cirugía (OR= 10,8 [4,23-27,57]), la baja escolaridad materna (OR= 4,20 [1,18-14,9]), el dolor crónico (OR= 3,62 [1,77-7,40]) y el uso de silla de ruedas (OR 3,01 [1,48-6,10]) resultaron factores de riesgo estadísticamente significativos para presentar disfunción escolar. El ser hijo único (OR= 0,09 [0,01-0,54]) fue, en esta muestra, un factor protector.
Although children with only motor disabilities have no intellectual disabilities and should attend a regular school, in the pediatric practice it has been observed that there is a high level of heterogeneity in their education. The objective of our study was to establish the prevalence of school dysfunction in children with only motor disabilities who are seen in a reference hospital, and explore if there are socio-demographic, medical and/or school outcome measures related to school dysfunction. The study was cross-sectional, observational, analytical, and comparative. Two hundred and eighty-eight 5 to 19 year old patients with only motor disabilities were included (September 2011-February 2012). Of them, 25% (72) had school dysfunction. A history of surgery (OR= 10.8 [4.23-27.57]), a poor maternal education (OR= 4.20 [1.18-14.9]), chronic pain (OR= 3.62 [1.77-7.40]), and the use of a wheelchair (OR= 3.01 [1.48-6.10]) were found to be statistically significant risk factors for school dysfunction. In our sample, being an only child (OR= 0.09 [0.01-0.54]) was a protective factor
Subject(s)
Humans , Child, Preschool , Child , Adolescent , Young Adult , Educational Status , Motor Disorders/physiopathology , Argentina , Referral and Consultation , Cross-Sectional Studies , Disabled PersonsABSTRACT
Introdução: A Doença de Parkinson (DP) é a forma mais freqüente de parkinsonismo que se caracteriza por apresentar rigidez muscular, tremor de repouso, bradicinesia e instabilidade postural. A estes sinais clássicos de comprometimento da função motora, podem associar-se outras disfunções consideradas não motoras. Embora a terapêutica farmacológica seja primordial para a DP, com a progressão desta doença neurodegenerativa, não há estabilidade clínica da mesma, ocorrendo agravamento dos sintomas e/ou aparecimento de efeitos adversos a medicação. Vários estudos têm demonstrado a importância do tratamento fisioterapêutico na recuperação motora da doença e sua influência na melhora da vida diária desses indivíduos quando associado ao tratamento medicamentoso. Objetivos: Procurou-se realizar esta revisão com objetivo de verificar a repercussão dos principais programas de reabilitação e dos exercícios físicos sobre os sintomas motores da marcha ocasionados pela DP. Material e Métodos: Foram selecionados 62 artigos do banco de dados computadorizados como Pubmed, Scielo e Lilacs e disponíveis on-line no portal de Periódicos da CAPES. Resultados e Discussão: Sob distintos aspectos foram observadas as atividades sensório-motoras empregadas nos distúrbios da marcha e as estratégias motoras empregadas nos principais sintomas da doença, assim como os exercícios físicos regulares e os resistidos. Conclusão: Verificou-se que o processo reabilitatório utilizando atividades de exercícios fisioterapêuticos são fundamentais para atenuar e melhorar os distúrbios motores da marcha na DP, especialmente quando direcionados para as especificidades e necessidades funcionais de cada indivíduo, sendo, entretanto, de extrema importância sua associação ao tratamento medicamentoso.
Background: Parkinson's disease (PD) is the most frequent form of parkinsonism characterized by muscle stiffness, resting tremor, bradykinesia and postural instability. Other non motor dysfunctions can be associated to these classic symptoms of the motor function. Although the pharmacological therapeutics is essential for PD, with the progression of this neurodegenerative disease there is no clinical stability, thus the symptoms worsen and/or there are adverse effects to medication. Several studies have demonstrated the importance of physiotherapeutic treatment for the motor recovery of the disease and its influence in the improvement of the patients' daily life when it is associated to drug treatment. Objective: This review was performed with the purpose of checking the repercussion of the main rehabilitation programs and the physical exercises on the motor symptoms caused by PD. Methods: Sixty-two articles published in journals available online in CAPES Journal Gateway and on computerized databases such as Pubmed, Scielo e Lilacs were selected. Results and Discussion: Under different aspects the sensory motor area activities employed in gait disorders, motor strategies for the disease's main symptoms as well as regular physical and resistance exercises were studied. Conclusions: It was found that the rehabilitating process using physical therapeutic exercises are essential to ease and improve PD's motor dysfunctions, especially when directed to the functional specificities and needs of each person, and that its association with drug treatments is extremely important.