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1.
Arq. neuropsiquiatr ; 78(4): 206-216, Apr. 2020. tab, graf
Article in English | LILACS | ID: biblio-1098084

ABSTRACT

Abstract Background: There are currently no methods to predict the development of levodopa-induced dyskinesia (LID), a frequent complication of Parkinson's disease (PD) treatment. Clinical predictors and single nucleotide polymorphisms (SNP) have been associated to LID in PD. Objective: To investigate the association of clinical and genetic variables with LID and to develop a diagnostic prediction model for LID in PD. Methods: We studied 430 PD patients using levodopa. The presence of LID was defined as an MDS-UPDRS Part IV score ≥1 on item 4.1. We tested the association between specific clinical variables and seven SNPs and the development of LID, using logistic regression models. Results: Regarding clinical variables, age of PD onset, disease duration, initial motor symptom and use of dopaminergic agonists were associated to LID. Only CC genotype of ADORA2A rs2298383 SNP was associated to LID after adjustment. We developed two diagnostic prediction models with reasonable accuracy, but we suggest that the clinical prediction model be used. This prediction model has an area under the curve of 0.817 (95% confidence interval [95%CI] 0.77‒0.85) and no significant lack of fit (Hosmer-Lemeshow goodness-of-fit test p=0.61). Conclusion: Predicted probability of LID can be estimated with reasonable accuracy using a diagnostic clinical prediction model which combines age of PD onset, disease duration, initial motor symptom and use of dopaminergic agonists.


Resumo Introdução: No momento, não há métodos para se predizer o desenvolvimento de discinesias induzidas por levodopa (DIL), uma frequente complicação do tratamento da doença de Parkinson (DP). Preditores clínicos e polimorfismos de nucleotídeo único (SNP) têm sido associados às DIL na DP. Objetivo: Investigar a associação entre variáveis clínicas e genéticas com as DIL e desenvolver um modelo de predição diagnóstica de DIL na DP. Métodos: Foram avaliados 430 pacientes com DP em uso de levodopa. A presença de DIL foi definida como escore ≥1 no item 4.1 da MDS-UPDRS Parte IV. Nós testamos a associação entre variáveis clínicas específicas e sete SNPs com o desenvolvimento de DIL, usando modelos de regressão logística. Resultados: Em relação às variáveis clínicas, idade de início da doença, duração da doença, sintomas motores iniciais e uso de agonistas dopaminérgicos estiveram associados às DIL. Apenas o genótipo CC do SNP rs2298383 no gene ADORA2A esteve associado com DIL após o ajuste. Nós desenvolvemos dois modelos preditivos diagnósticos com acurácia razoável, mas sugerimos o uso do modelo preditivo clínico. Esse modelo de predição tem uma área sob a curva de 0,817 (intervalo de confiança de 95% [IC95%] 0,77‒0,85) e sem perda significativa de ajuste (teste de qualidade de ajuste de Hosmer-Lemeshow p=0,61). Conclusão: A probabilidade prevista de DIL pode ser estimada, com acurácia razoável, por meio do uso de um modelo preditivo diagnóstico clínico, que combina a idade de início da doença, duração da doença, sintomas motores iniciais e uso de agonistas dopaminérgicos.


Subject(s)
Humans , Parkinson Disease/drug therapy , Levodopa/therapeutic use , Dyskinesia, Drug-Induced , Dopamine Agonists , Polymorphism, Single Nucleotide , Antiparkinson Agents
4.
Rev. Assoc. Med. Bras. (1992) ; 65(4): 541-546, Apr. 2019. graf
Article in English | LILACS | ID: biblio-1003059

ABSTRACT

The Guidelines Project, an initiative of the Brazilian Medical Association, aims to combine information from the medical field in order to standardize producers to assist the reasoning and decision-making of doctors. The information provided through this project must be assessed and criticized by the physician responsible for the conduct that will be adopted, depending on the conditions and the clinical status of each patient.


Subject(s)
Humans , Parkinson Disease/therapy , Deep Brain Stimulation/methods , Parkinson Disease/physiopathology , Brazil , Levodopa/therapeutic use , Risk Factors , Treatment Outcome , Deep Brain Stimulation/adverse effects , Clinical Decision-Making , Motor Activity , Antiparkinson Agents/therapeutic use
5.
CoDAS ; 31(1): e20170249, 2019. tab
Article in Portuguese | LILACS | ID: biblio-1039597

ABSTRACT

RESUMO Objetivo Analisar o efeito da levodopa na dinâmica coclear, bem como na via eferente olivococlear medial de indivíduos com doença de Parkinson idiopática (DP). Método Indivíduos com e sem DP, acompanhados em um hospital universitário, realizaram a pesquisa das emissões otoacústicas por produto de distorção (EOAPD) e do efeito inibitório das EOAPD (EIEOA) na presença de ruído contralateral. Foram estabelecidas as medidas de correlação entre os resultados das EOAPD e do EIEOA com estágio Hoehn&Yahr (H&Y), dose diária de levodopa e tempo de diagnóstico da DP. Além disso, as medidas eletroacústicas foram comparadas entre os indivíduos sem DP e com DP, estratificados de acordo com a dose de levodopa administrada diariamente. Resultados Foi identificada correlação fraca e negativa entre a amplitude das EOAPD com a dose diária de levodopa e correlações positivas, de força moderada e fraca, entre o EIEOA com a dose diária de levodopa e o tempo de diagnóstico da DP, respectivamente. A amplitude das EOAPD foi maior nos indivíduos com DP em uso de levodopa ≤ 600 miligramas quando comparada à de indivíduos sem DP e com DP, em uso de dose superior. Já o EIEOA foi menor nos indivíduos em uso de doses ≤ 600 miligramas, quando comparado aos demais grupos. Conclusão Doses diárias de levodopa iguais ou inferiores a 600 mg/dia aumentam as respostas mecanotransdutoras cocleares nas frequências de 2 e 3 kHz, enquanto que a ação dos sistemas eferentes olivococleares é reduzida nesta região.


ABSTRACT Purpose To evaluate the effect of levodopa on cochlear dynamics and on the medial olivocochlear efferent pathway of idiopathic Parkinson's disease (PD) individuals. Methods Individuals with and without PD, followed at a University Hospital, were submitted to Distortion Product Otoacoustic Emissions (DPOAE) and DPOAE Inhibitory Effect (OAEIE) in the presence of contralateral noise. Correlation measures between DPOAE and OAEIE results with Hoehn&Yahr (H&Y) stage, daily dose of levodopa and PD diagnosis period were established. Furthermore, electroacoustic measures were compared between individuals without and those with PD, stratified by dose of levodopa daily administered. Results Weak negative correlation between DPOAE amplitude and daily dose of levodopa was found, as well positive correlations between EIEOA with daily dose of levodopa and time of PD diagnosis, respectively. Higher DPOAE amplitude was found in individuals with PD using daily doses of levodopa ≤ 600 milligrams when compared to individuals without PD and those with PD using higher doses. EIEOA was lower in individuals using doses ≤ 600 milligrams, when compared to the other groups. Conclusion Daily doses of levodopa up to 600 mg / day increase the cochlear mechanical-transducer responses in 2 and 3 kHz frequencies, while the action of olivocochlear efferent systems is reduced in this region.


Subject(s)
Humans , Male , Female , Adult , Aged , Aged, 80 and over , Parkinson Disease/drug therapy , Levodopa/pharmacology , Otoacoustic Emissions, Spontaneous/drug effects , Antiparkinson Agents/pharmacology , Parkinson Disease/complications , Auditory Pathways/drug effects , Acoustic Stimulation , Middle Aged
6.
Arq. neuropsiquiatr ; 76(12): 840-848, Dec. 2018. tab, graf
Article in English | LILACS | ID: biblio-983858

ABSTRACT

ABSTRACT Optimizing idiopathic Parkinson's disease treatment is a challenging, multifaceted and continuous process with direct impact on patients' quality of life. The basic tenet of this task entails tailored therapy, allowing for optimal motor function with the fewest adverse effects. Apomorphine, a dopamine agonist used as rescue therapy for patients with motor fluctuations, with potential positive effects on nonmotor symptoms, is the only antiparkinsonian agent whose capacity to control motor symptoms is comparable to that of levodopa. Subcutaneous administration, either as an intermittent injection or as continuous infusion, appears to be the most effective and tolerable route. This review summarizes the historical background, structure, mechanism of action, indications, contraindications and side effects, compares apomorphine infusion therapy with other treatments, such as oral therapy, deep brain stimulation and continuous enteral infusion of levodopa/carbidopa gel, and gives practical instructions on how to initiate treatment.


RESUMO A optimização do tratamento da doença de Parkinson idiopática se faz um desafio, pois tem impacto direto na qualidade de vida do paciente. O melhor esquema terapêutico é o que permite o melhor controle motor com os menores efeitos adversos, através de terapêutica individualizada. A apomorfina é o único medicamento antiparkinsoniano que pode ser comparável à potência da levodopa no controle dos sintomas motores. Trata-se de um agonista dopaminérgico empregado na terapia de resgate em pacientes com flutuações motoras e também contribui para a melhora de muitos sintomas não motores. A via subcutânea, com injeções intermitentes, ou com infusão contínua, parece ser a melhor opção pela eficácia e tolerabilidade. Essa revisão resume aspectos históricos, estrutura da molécula, mecanismo de ação, indicação, contra-indicação e efeitos colaterais, compara a terapia de infusão com apomorfina com outros tratamentos, como a terapia oral, estimulação cerebral profunda e infusão enteral contínua de levodopa/carbidopa gel, e fornece instruções práticas de como iniciar o tratamento.


Subject(s)
Humans , Parkinson Disease/drug therapy , Apomorphine/administration & dosage , Dopamine Agonists/administration & dosage , Antiparkinson Agents/administration & dosage , Carbidopa , Levodopa , Deep Brain Stimulation , Drug Combinations
7.
Biomédica (Bogotá) ; 38(3): 417-426, jul.-set. 2018. tab, graf
Article in English | LILACS | ID: biblio-973994

ABSTRACT

Introduction: Parkinson's disease, whose prevalence in Colombia is 4.7 per 1,000 inhabitants, is a public health problem and a therapeutic challenge for health professionals. Objective: To determine the prescribing patterns of antiparkinson drugs and the variables associated with its use in a population from Colombia. Materials and methods: We conducted a descriptive cross-sectional study. We selected patients who had been given antiparkinson drugs uninterruptedly between January 1st and March 31st, 2015 from a systematized database of approximately 3.5 million people affiliated to the Colombian health system. We included sociodemographic, pharmacologic and comedication variables. For the multivariate analysis, we used the IBM SPSS™-22 software. Results: A total of 2,898 patients was included; the mean age was 65.1years, and 50.7% were men; 69.4% (n=2010) of people received monotherapy and 30.6% combination therapy with two to five antiparkinson drugs. The most frequently prescribed drugs were: levodopa 45.5% (n=1,318 patients), biperiden 23.1% (670), amantadine 18.3% (531) and pramipexole 16.3% (471). The most commonly used association was levodopa/carbidopa + entacapone (n=311; 10.7%). Multivariate analysis showed that being male (OR=1.56; 95%CI: 1.321-1.837), over 60 years (OR=1.41; 95%CI 1.112-1.782) and receiving treatment in the city of Barranquilla (OR=2.23; 95%CI 1.675-2.975) were statistically associated with a greater risk of using combination therapy; 68.2% (n=1,977) patients were given concomitant treatment with other drugs. Conclusions: Prescribing habits of drugs with high therapeutic value predominated, mainly in antiparkinson drugs monotherapy. Most were employed in the usual recommended doses. It is necessary to explore the clinical effectiveness of the medications studied and differentiate between disease and parkinsonian syndromes subtypes.


Introducción. La enfermedad de Parkinson, cuya prevalencia en Colombia es de 4,7 por 1.000 habitantes, constituye un problema de salud pública y un reto terapéutico para los profesionales de la salud. Objetivo. Determinar los patrones de prescripción de fármacos antiparkinsonianos y las variables asociadas con su utilización en una población colombiana. Materiales y métodos. Se hizo un estudio descriptivo de corte transversal. A partir de una base de datos de 3,5 millones de afiliados al sistema de salud, se seleccionaron pacientes con prescripción de medicamentos antiparkinsonianos de manera ininterrumpida entre el 1º de enero y el 31 de marzo de 2015. Se incluyeron variables sociodemográficas, farmacológicas y de medicación concomitante. El análisis multivariado se hizo con el programa IBM SPSS™-22. Resultados. Se hallaron 2.898 pacientes, con una edad media de 65,1 años, de los cuales el 50,7 % correspondía a hombres. El 69,4 % (n=2.010) de las personas recibía monoterapia y el 30,6 %, tratamiento combinado con dos a cinco medicamentos antiparkinsonianos. Los más prescritos eran la levodopa (45,5 %; n=1.318 pacientes), el biperideno (23,1 %; n=670), la amantadina (18,3 %; n=531) y el pramipexol (16,3 %; n=471). La asociación más utilizada fue la de levodopa-carbidopa y entacapone (n=311; 10,7 %). En el análisis multivariado se encontró que ser hombre (odds ratio, OR=1,56; IC95% 1,321-1,837), ser mayor de 60 años (OR=1,41; IC95% 1,112-1,782) y recibir tratamiento en Barranquilla (OR=2,23; IC95% 1,675-2,975), se asociaban con una mayor probabilidad de emplear el tratamiento combinado. Al 68,2 % (n=1.977) de los pacientes se les había prescrito tratamiento concomitante con otros medicamentos. Conclusión. Predominaron los hábitos de prescripción de medicamentos con gran valor terapéutico, principalmente en la monoterapia, la mayoría en las dosis usuales recomendadas. Es necesario explorar la efectividad clínica de las prescripciones estudiadas, y diferenciar entre la enfermedad y los subtipos de síndromes parkinsonianos.


Subject(s)
Parkinson Disease , Drug Prescriptions , Pharmacoepidemiology , Colombia , Drug Utilization , Antiparkinson Agents
8.
Medisan ; 22(7)jul.-ago. 2018.
Article in Spanish | LILACS | ID: biblio-986955

ABSTRACT

La enfermedad de Parkinson es un proceso degenerativo del sistema nervioso central de inicio insidioso progresivo y desarrollo lento, que es consecuencia de una lesión idiopática en el sistema extrapiramidal y cuyas manifestaciones clínicas son rigidez, temblor y bradicinesia. Se presenta en personas de edad avanzada, sin diferencias en cuanto a sexo, raza o clase socioeconómica, y su diagnóstico definitivo se determina por el método clínico. Al respecto, en este artículo se describe la conducta terapéutica que se debe seguir en los ancianos que padezcan la enfermedad, donde el tratamiento no farmacológico se debe enfocar a mejorar la situación física y psíquica del paciente y la familia, según el estadio evolutivo, y el farmacológico se basa en la levodopa como medicamento de elección, con la cual se logra elevar la calidad de vida de los ancianos afectados


Parkinson disease is a degenerative process of the central nervous system of progressive insidious beginning and slow development which is the consequence of an idiopathic lesion in the extrapiramidal system and which clinical manifestations are rigidity, tremor and bradykinesia. It is presented in people of advanced age, without differences as for sex, race or social-economic class, and its definitive diagnosis is determined through the clinical method. In this respect, the therapeutic approach that should be followed in the elderly that suffers the disease is described in this work, in which the non pharmacological treatment should be focused to improve the patient and family physical and psychical situation, according to the evolutive course, and the pharmacological treatment is based on levodopa as election drug, with which it is possible to elevate the life quality of the affected patients


Subject(s)
Humans , Male , Female , Aged , Aged, 80 and over , Parkinson Disease/drug therapy , Therapeutic Approaches , Antiparkinson Agents , Signs and Symptoms , Communication
9.
Arq. neuropsiquiatr ; 76(8): 517-521, Aug. 2018. tab
Article in English | LILACS | ID: biblio-950571

ABSTRACT

ABSTRACT The wearing-off phenomenon is common in patients with Parkinson's disease. Motor and non-motor symptoms can fluctuate in relation to the "on/off" periods. Objective: To assess the impact of motor and non-motor wearing-off on activities of daily living and quality of life of patients with PD. Methods: A cross-sectional study was carried out. All patients were evaluated using the Movement Disorders Society Unified Parkinson's Disease Rating Scale. Wearing-off was assessed using the Wearing-Off Questionnaire-19, and quality of life was assessed using the Parkinson's Disease Questionnaire-8. Results: A total of 271 patients were included; 73.4% had wearing-off; 46.8% had both motor and non-motor fluctuations. Patients with both motor and non-motor wearing-off had a worst quality of life compared with those with only motor fluctuations (p = 0.047). Conclusions: Motor and non-motor fluctuations have an impact on activities of daily living and quality of life. Non-motor wearing-off may have a higher impact.


RESUMO O fenômeno de encurtamento do fim de dose é comum em pacientes com doença de Parkinson. Tanto os sintomas motores quanto os não motores podem flutuar em relação aos períodos de "on/off". Objetivo: Avaliar o impacto das flutuações motoras e não-motoras nas atividades da vida diária e qualidade de vida em pacientes com doença de Parkinson. Métodos: Um estudo transversal foi realizado. Todos os sujeitos foram avaliados utilizando a escala unificada para a doença de Parkinson da Sociedade de Distúrbios do Movimento. O encurtamento do fim de dose foi avaliado através do questionário WOQ-19 e a qualidade de vida foi avaliada através do PDQ-8. Resultados: Um total de 271 pacientes foram incluídos, 73,4% tiveram deterioração de fim de dose. A maioria dos pacientes tiveram tanto flutuações motoras quanto não-motoras (46,8%). Os pacientes com ambos os tipos de flutuações motoras e não-motoras tiveram pior qualidade de vida do que pacientes apenas com flutuações motoras (p = 0.047). Conclusões: Pacientes com flutuações motoras e não-motoras tiveram impacto significativo nas atividades da vida diária e na qualidade de vida. As flutuações não-motoras parecem ter um impacto maior que as flutuações motoras sobre a qualidade de vida.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Parkinson Disease/physiopathology , Quality of Life , Activities of Daily Living , Motor Activity/physiology , Parkinson Disease/drug therapy , Reference Values , Levodopa/therapeutic use , Cross-Sectional Studies , Surveys and Questionnaires , Analysis of Variance , Statistics, Nonparametric , Dopamine Agonists/therapeutic use , Disability Evaluation , Educational Status , Antiparkinson Agents/therapeutic use
10.
Arq. neuropsiquiatr ; 76(2): 71-77, Feb. 2018. graf
Article in English | LILACS | ID: biblio-888359

ABSTRACT

ABSTRACT The present study investigated the effects of carvacrol on motor and memory deficits as well as hyperalgesia in the 6-OHDA-lesioned rat model of Parkinson's disease. The animals were subjected to unilateral microinjection of 6-OHDA into the medial forebrain bundle and treated with carvacrol (25, 50 and 100 mg/kg, ip) for six weeks after surgery. The 6-OHDA-lesioned rats showed contralateral rotations towards the lesion side, which was accompanied by learning and memory deficits in a passive avoidance test and a decrease in tail withdrawal latency in a tail flick test at the end of week 6. The results also showed that treatment with carvacrol at a dose of 25 mg/kg ameliorated memory deficits, with no effect on rotations and hyperalgesia in lesioned rats. In conclusion, carvacrol improves memory impairments in rats with Parkinson's disease; therefore, it may serve as an adjunct therapy for the alleviation of memory deficits in Parkinson's disease patients.


RESUMO O presente estudo investigou os efeitos do carvacrol nos déficits motores e de memória, bem como na hiperalgesia, em um modelo da doença de Parkinson (DP) em ratos com lesões 6-OHDA. Os animais foram submetidos a microinjeção unilateral de 6-OHDA no feixe mediano do prosencéfalo e tratados com carvacrol (25, 50 e 100 mg / kg, ip) durante 6 semanas após a cirurgia. Os ratos com lesões 6-OHDA mostraram rotações contralaterais para o lado da lesão, que foram acompanhadas de déficits de aprendizagem e de memória em um teste de evitação passiva, e de uma diminuição da latência de retirada da cauda em um teste de cauda no final da semana 6. Os resultados também mostraram que o tratamento crônico com carvacrol a uma dose de 25 mg / kg aliviou os déficits de memória, sem efeito sobre rotações e hiperalgesia em ratos lesados. Em conclusão, o carvacrol melhora a deficiência de memória em ratos com DP e, portanto, pode servir como uma terapia complementar para aliviar os déficits de memória em pacientes com DP.


Subject(s)
Animals , Male , Parkinson Disease/drug therapy , Monoterpenes/therapeutic use , Memory Disorders/drug therapy , Memory, Short-Term/drug effects , Antiparkinson Agents/therapeutic use , Parkinson Disease/physiopathology , Sulfhydryl Compounds/analysis , Lipid Peroxidation/drug effects , Random Allocation , Reproducibility of Results , Oxidopamine , Rats, Wistar , Monoterpenes/pharmacology , Disease Models, Animal , Cymenes , Memory Disorders/physiopathology , Motor Activity/drug effects , Neuralgia/physiopathology , Neuralgia/drug therapy , Antioxidants/therapeutic use , Antioxidants/pharmacology , Antiparkinson Agents/pharmacology
11.
Article in English | WPRIM | ID: wpr-773592

ABSTRACT

The traditionally used oriental herbal medicine Moutan Cortex Radicis [MCR; Paeonia Suffruticosa Andrews (Paeoniaceae)] exerts anti-inflammatory, anti-spasmodic, and analgesic effects. In the present study, we investigated the therapeutic effects of differently fractioned MCR extracts in a 6-hydroxydopamine (OHDA)-induced Parkinson's disease model and neuro-blastoma B65 cells. Ethanol-extracted MCR was fractionated by n-hexane, butanol, and distilled water. Adult Sprague-Dawley rats were treated first with 20 μg of 6-OHDA, followed by three MCR extract fractions (100 or 200 mg·kg) for 14 consecutive days. In the behavioral rotation experiment, the MCR extract-treated groups showed significantly decreased number of net turns compared with the 6-OHDA control group. The three fractions also significantly inhibited the reduction in tyrosine hydroxylase-positive cells in the substantia nigra pars compacta following 6-OHDA neurotoxicity. Western blotting analysis revealed significantly reduced tyrosine hydroxylase expression in the substantia nigra pars compacta in the 6-OHDA-treated group, which was significantly inhibited by the n-hexane or distilled water fractions of MCR. B65 cells were exposed to the extract fractions for 24 h prior to addition of 6-OHDA for 30 min; treatment with n-hexane or distilled water fractions of MCR reduced apoptotic cell death induced by 6-OHDA neurotoxicity and inhibited nitric oxide production and neuronal nitric oxide synthase expression. These results showed that n-hexane- and distilled water-fractioned MCR extracts inhibited 6-OHDA-induced neurotoxicity by suppressing nitric oxide production and neuronal nitric oxide synthase activity, suggesting that MCR extracts could serve as a novel candidate treatment for the patients with Parkinson's disease.


Subject(s)
Animals , Anti-Inflammatory Agents , Pharmacology , Therapeutic Uses , Antiparkinson Agents , Pharmacology , Therapeutic Uses , Cell Death , Cell Line , Disease Models, Animal , Drugs, Chinese Herbal , Chemistry , Neurons , Pathology , Nitric Oxide , Nitric Oxide Synthase Type I , Oxidopamine , Toxicity , Paeonia , Chemistry , Parkinsonian Disorders , Drug Therapy , Phytotherapy , Plant Extracts , Pharmacology , Therapeutic Uses , Plants, Medicinal , Rats , Rats, Sprague-Dawley , Substantia Nigra , Tyrosine 3-Monooxygenase , Genetics , Metabolism
12.
Article in English | WPRIM | ID: wpr-812381

ABSTRACT

The traditionally used oriental herbal medicine Moutan Cortex Radicis [MCR; Paeonia Suffruticosa Andrews (Paeoniaceae)] exerts anti-inflammatory, anti-spasmodic, and analgesic effects. In the present study, we investigated the therapeutic effects of differently fractioned MCR extracts in a 6-hydroxydopamine (OHDA)-induced Parkinson's disease model and neuro-blastoma B65 cells. Ethanol-extracted MCR was fractionated by n-hexane, butanol, and distilled water. Adult Sprague-Dawley rats were treated first with 20 μg of 6-OHDA, followed by three MCR extract fractions (100 or 200 mg·kg) for 14 consecutive days. In the behavioral rotation experiment, the MCR extract-treated groups showed significantly decreased number of net turns compared with the 6-OHDA control group. The three fractions also significantly inhibited the reduction in tyrosine hydroxylase-positive cells in the substantia nigra pars compacta following 6-OHDA neurotoxicity. Western blotting analysis revealed significantly reduced tyrosine hydroxylase expression in the substantia nigra pars compacta in the 6-OHDA-treated group, which was significantly inhibited by the n-hexane or distilled water fractions of MCR. B65 cells were exposed to the extract fractions for 24 h prior to addition of 6-OHDA for 30 min; treatment with n-hexane or distilled water fractions of MCR reduced apoptotic cell death induced by 6-OHDA neurotoxicity and inhibited nitric oxide production and neuronal nitric oxide synthase expression. These results showed that n-hexane- and distilled water-fractioned MCR extracts inhibited 6-OHDA-induced neurotoxicity by suppressing nitric oxide production and neuronal nitric oxide synthase activity, suggesting that MCR extracts could serve as a novel candidate treatment for the patients with Parkinson's disease.


Subject(s)
Animals , Anti-Inflammatory Agents , Pharmacology , Therapeutic Uses , Antiparkinson Agents , Pharmacology , Therapeutic Uses , Cell Death , Cell Line , Disease Models, Animal , Drugs, Chinese Herbal , Chemistry , Neurons , Pathology , Nitric Oxide , Nitric Oxide Synthase Type I , Oxidopamine , Toxicity , Paeonia , Chemistry , Parkinsonian Disorders , Drug Therapy , Phytotherapy , Plant Extracts , Pharmacology , Therapeutic Uses , Plants, Medicinal , Rats , Rats, Sprague-Dawley , Substantia Nigra , Tyrosine 3-Monooxygenase , Genetics , Metabolism
13.
CoDAS ; 30(5): e20170200, 2018. tab, graf
Article in English | LILACS | ID: biblio-952875

ABSTRACT

Abstract Purpose Investigate the association between levodopa therapy and vocal characteristics in Parkinson's disease patients. Search strategy Studies published at MEDLINE, LILACS, and SciELO, from 1960 to December 2016. A systematic review and meta-analysis was performed using the following keywords: Parkinson's disease; levodopa; L-dopa; voice; speech disorders; dysphonia; dysarthria. After analyzing titles and abstracts, two independent reviewers selected all clinical trials that met the eligibility criteria and selected the articles and the data recorded in a previously standardized table. Selection criteria Trials published in English between 1960 and December 2016 individuals with clinical diagnosis of Parkinson's disease; use of levodopa therapy in stable doses; acoustic analysis combined or not with auditory-perceptual analysis to evaluate the vocal parameters under investigation. Data analysis The following vocal parameters were analyzed: fundamental frequency (F 0), jitter, and vocal intensity. Standardized mean differences (SMD) were calculated using the Comprehensive Meta-analysis V2 software. Results Nine articles met the eligibility criteria and were selected, with a total of 119 individuals. From these, six articles with 83 individuals were included in the meta-analysis. During the levodopa therapy "on" state, modifications in F 0 (SMD=0.39; 95% CI - 0.21-0.57) and jitter (SMD=0.23; 95% CI - 0.02-0.45) were observed. Vocal intensity was not affected (SMD=0.09; 95% CI - 0.22-0.39) by levodopa ingestion. Data of the included studies were controversial in the auditory-perceptual analysis of voice. Conclusion Levodopa therapy modifies F0 and jitter. No changes in vocal intensity were observed in either the "on" or "off" states of levodopa therapy.


RESUMO Objetivo investigar a associação entre o uso da levodopa e as características vocais em pacientes com doença de Parkinson. Estratégia de pesquisa estudos publicados nas bases MEDLINE, LILACS e SciELO, de 1960 a dezembro de 2016. Uso dos descritores: doença de Parkinson; levodopa; L-dopa; voz; distúrbios do discurso; disfonia e disartria. Depois de analisar os títulos e os resumos, dois revisores independentes selecionaram todos os ensaios clínicos que atendiam aos critérios de seleção, selecionaram os artigos e registraram os dados em uma tabela padronizada anteriormente. Critérios de seleção ensaios publicados em inglês entre 1960 e dezembro de 2016 assuntos com diagnóstico clínico de doença de Parkinson; uso de terapia com levodopa em doses estáveis; análise acústica combinada ou não com a análise auditiva-perceptiva para avaliar os parâmetros vocais sob investigação. Análise dos dados os parâmetros vocais analisados ​​foram: frequência fundamental (F0), Jitter e intensidade vocal. As diferenças de médias padronizadas (SMD) foram calculadas com o software Metanálise Abrangente V2. Resultados 9 artigos preencheram os critérios de elegibilidade e foram selecionados, com um total de 119 indivíduos. Desses 9 artigos, 6, com 83 indivíduos, foram incluídos na metanálise. Durante a fase "on", houve uma modificação no F0 (SMD = 0,39; IC 95% 0,21-0,57) e Jitter (SMD = 0,23; IC 95% 0,02-0,45). A intensidade vocal não foi afetada (SMD = 0,09; IC 95% -0,22-0,39) pela ingestão da levodopa. Ao considerar a análise auditiva-perceptiva, os dados foram controversos entre os estudos incluídos. Conclusão a terapia com levodopa modifica F0 e Jitter. Não houve alteração na intensidade vocal nas fases "on" e "off" da terapia com levodopa.


Subject(s)
Humans , Male , Female , Parkinson Disease/complications , Parkinson Disease/drug therapy , Voice/drug effects , Levodopa/pharmacology , Dysarthria/drug therapy , Dysphonia/drug therapy , Antiparkinson Agents/pharmacology , Speech Production Measurement , Voice Quality , Levodopa/therapeutic use , Dysarthria/etiology , Dysphonia/etiology , Antiparkinson Agents/therapeutic use
14.
Rev. bras. neurol ; 53(4): 5-11, out.-dez. 2017. tab
Article in Portuguese | LILACS | ID: biblio-876883

ABSTRACT

Polineuropatia periférica (PNP) tem sido descrita na doença de Parkinson idiopática (DP), porém a prevalência e os fatores de risco não estão bem definidos. Objetivo: Investigar a prevalência e os fatores de risco para PNP na DP, em comparação com a população geral. Método: Participaram 36 pacientes com DP recrutados no ambulatório de Neurologia do Hospital Universitário Alcides Carneiro (HUAC) da Universidade Federal de Campina Grande (UFCG), Paraíba, e 30 sujeitos controles. Todos os participantes foram submetidos a caracterização clínica da PNP, ao estudo de neurocondução (ENC) dos nervos peroneal e sural bilateral e as dosagens de vitamina B12, homocisteina, ácido metilmalônico e ácido fólico. A Escala Unificada de Avaliação da Doença de Parkinson - III e a de Hoehn-Yahr foram utilizadas na avaliação motora do grupo Parkinson (GP). Resultados: Sinais e sintomas neuropáticos foram mais frequentes no GP (61%). Alterações nos parâmetros do ENC foram observadas em 44,4% do GP e 26,7% do grupo controle, sendo a PNP confirmada em três pacientes e um controle. Análise de regressão revelou associação significativa entre os sintomas neuropáticos e a DP, sem associação com aspectos clínicos e bioquímicos. Conclusão: Pacientes com DP possuem maiores escores neuropáticos e maior prevalência de PNP que controles. Os dados sugerem a própria DP como fator de risco para o desenvolvimento da PNP, minimizando o papel da vitamina B12 e de seus metabólitos neste processo.(AU)


Peripheral neuropathy (PN) has been described in idiopathic Parkinson disease (PD) however the prevalence and the risk factors are not well established. Objective: To assess the prevalence of PN and the risk factors for neuropathy in PD against the general population. Method: Participated in the study 36 PD patients recruited from Neurology Outpatient Unit of Hospital Universitário Alcides Carneiro of the Federal University of Campina Grande, Paraíba, and 30 controls. All the participants were submitted to clinical characterization of PN, nerve conduction study (NCS) and biochemical dosages (B12 vitamin, homocysteine, methylmalonic acid and folic acid). Results: Neuropathic signs and symptoms were more frequent in PD (61%). Alterations in parameters of NCS were observed in 44.4% of Parkinson group and 26.7% of control group, and PN was confirmed in 3 PD patients and 1 control. Regression analyses showed a significant association between symptoms of PN and PD, without association with clinical and biochemical features. Conclusion: PD patients have higher neuropathic scores and frequency of PN than controls. Data suggests the PD by itself as a risk factor for development of PN, reducing the role of B12 vitamin and its metabolites in this process.(AU)


Subject(s)
Humans , Male , Female , Aged , Parkinson Disease/complications , Parkinson Disease/diagnosis , Parkinson Disease/drug therapy , Peripheral Nervous System Diseases/epidemiology , Vitamin B 12/therapeutic use , Brazil/epidemiology , Levodopa/adverse effects , Levodopa/therapeutic use , Prevalence , Risk Factors , Neurologic Examination/methods , Antiparkinson Agents/therapeutic use
15.
Rev. méd. Chile ; 145(12): 1624-1625, dic. 2017. graf
Article in Spanish | LILACS | ID: biblio-902488

ABSTRACT

The main adverse effects of dopaminergic drugs used in Parkinson's disease are hypotension, somnolence, hallucinations and impulse control disorder. Less common is leg edema. We report on a 68-year-old male receiving levodopa and pramipexole consulting for severe leg edema lasting two years, whose etiology was not ascertained with multiple lab tests. This edema subsided substantially when pramipexole was discontinued and the dose of levodopa was increased to treat motor symptoms.


Subject(s)
Humans , Male , Aged , Parkinson Disease/drug therapy , Dopamine Agonists/adverse effects , Edema/chemically induced , Edema/pathology , Benzothiazoles/adverse effects , Leg/pathology , Levodopa/adverse effects , Pramipexole , Antiparkinson Agents/adverse effects
16.
Rev. bras. neurol ; 53(3): 14-18, jul.-set. 2017. tab, graf
Article in Portuguese | LILACS | ID: biblio-876870

ABSTRACT

A doença de Parkinson (DP) é a segunda doença neu-rodegenerativa mais comum. Caracteriza-se clinicamente por tremor de repouso, rigidez, bradicinesia e instabilidade postural. O presente estudo busca caracterizar clinicamente uma população com DP em nosso meio. Objetivos: Descrever o perfil clínico de pacientes com DP de um hospital terciário do Rio de Janeiro, com foco nos sinais e sintomas motores da doença, para caracterização local da mesma. Métodos: Análise retrospectiva de 115 prontuários de pacientes com DP acompanhados no ambulatório de Distúrbios do Movimento do Hospital Universitário Pedro Ernesto da Universidade do Estado do Rio de Janeiro. Os parâmetros avaliados incluíram: idade, sexo, tem-po de doença, sinais motores predominantes, dimídio mais afetado, complicações motoras e tratamento utilizado. Resultados: Foram selecionados 95 participantes com DP, sendo a média de idade da amostra de 64,7 anos, com tempo médio de doença de 9,9 anos, pre-dominando no sexo masculino, em uma proporção de 2.5 homens para 1 mulher. Em relação ao tratamento utilizado, predominou o uso da levodopa /inibidor da dopa-descarboxilase, seguindo-se o pramipexole em monoterapia ou a associação de ambos. Conclusão: Apesar da grande variação na faixa etária, observou-se maior acome-timento da doença entre 60 e 80 anos, chamando atenção o tremor como sinal predominante. Entre as complicações motoras destaca-mos o "wearing off", seguido pelas discinesias. (AU)


Parkinson's disease (PD) is the second most common neurodegenerative disease. The main clinical features are rest tremor, rigidity, bradykinesia and postural instability. The present study aims to characterize clinically a population with PD in our commu-nity. Objective: To describe the clinical profile of PD patients from a tertiary hospital in Rio de Janeiro, with emphasis on motor signs and symptoms, for its local characterization. Methods: Retrospective analysis of 115 files from PD patients followed at the Movement Disorders Outpatient Clinic at Pedro Ernesto University Hospital from the State University of Rio de Janeiro. Parameters evaluated included: age, sex, disease duration, predominant motor signs, most affected side, motor complications and treatment prescribed. Results: Ninety five PD patients were selected, with an average age of the sample of 64.7 years, average disease duration of 9.9 years, male predominance, in a proportion of 2.5 men:1 woman. Regarding treatment, levodopa/dopa decarboxylase inhibitor was the most common drug prescribed, followed by pramipexol monotherapy or both in association. Conclusion: In spite of the wide age range, the disease affected mainly individuals between 60 and 80 years old. Tremor was the pre-dominant sign. Among motor complications, wearing off and dyskinesias should be highlighted. (AU)


Subject(s)
Humans , Male , Female , Aged , Aged, 80 and over , Parkinson Disease/complications , Parkinson Disease/diagnosis , Parkinson Disease/drug therapy , Motor Disorders/diagnosis , Time Factors , Levodopa/therapeutic use , Medical Records , Retrospective Studies , Age Factors , Dopamine Agonists/therapeutic use , Antiparkinson Agents/therapeutic use
17.
Arq. neuropsiquiatr ; 75(8): 539-545, Aug. 2017. tab, graf
Article in English | LILACS | ID: biblio-888313

ABSTRACT

ABSTRACT The Bereitschaftspotential (BP) is a negative wave observed in EEG retrograde averaging, preceding a motor act. The objective was to study the BP preceding voluntary eyelid blinks in Parkinson's disease (PD) patients during off and on phases of levodopa. Methods Ten PD patients in stages 1 and 2 of the Hoehn & Yahr classification were compared to 18 healthy controls. Artifact-free EEG segments of two seconds preceding the onset of the blink potential were averaged and analyzed, and the statistical significance of the measured amplitudes were evaluated by analysis of variance models. Results The presence of a BP in the PD patients was demonstrated. The mean amplitudes at 0 ms were respectively 0.6 µV and 3.3 µV for the BP patients and the normal controls, respectively. Conclusions The BP amplitudes were significantly smaller in PD patients than normal participants. The amplitudes of the BP were not modified by levodopa.


RESUMO O Potencial de Bereitschafts (PB) é uma onda negativa observada retrogradamente no EEG precedendo um ato motor. Objetivo Estudar o PB precedendo o piscamento palpebral voluntário em pacientes com doença de Parkinson (DP) durante as fases off e on da levodopa. Foram comparados dez pacientes com DP nos estágios 1 e 2 de Hoehn & Yahr com 18 controles saudáveis. Os segmentos de EEG livres de artefatos 2 segundos antes do início do potencial foram calculados e analisados e a significância estatística das amplitudes foi medida por modelos de análise de variância. Resultados A presença de PB nos pacientes com DP foi demonstrada. As amplitudes médias a 0 ms foram respectivamente 0,6 μV e 3,3 μV para os pacientes com DP e controles respectivamente. Conclusões As amplitudes do PB foram significativamente menores nos pacientes com DP do que controles. As amplitudes do PB não foram modificadas pela levodopa.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Blinking/physiology , Levodopa/adverse effects , Contingent Negative Variation/physiology , Motor Cortex/physiology , Movement/physiology , Antiparkinson Agents/adverse effects , Parkinson Disease/physiopathology , Parkinson Disease/drug therapy , Time Factors , Case-Control Studies , Analysis of Variance , Hypokinesia/etiology , Electrodes, Implanted , Electroencephalography , Eyelids/physiology
18.
Arq. neuropsiquiatr ; 74(8): 687-689, Aug. 2016. graf
Article in English | LILACS | ID: lil-792519

ABSTRACT

ABSTRACT Most known by his literary ability, the words of the neurologist Oliver Sacks (1933-2015) also had an impact on scientific community about the role of levodopa on parkinsonisms. Different from the most authors and based on his experience described on the book “Awakenings”, he had a pessimistic opinion about levodopa, which was related on many articles written by himself and colleagues in early 1970s. We reviewed the scientific contribution of Oliver Sacks associated to levodopa therapy on parkinsonisms, and how he advised caution with its complications before the majority of physicians.


RESUMO Mais conhecido por sua habilidade literária, as palavras do neurologista Oliver Sacks (1933-2015) também tiveram um impacto sobre a comunidade científica a respeito do uso de levodopa nos parkinsonismos. Diferente da maioria dos autores e baseado em sua experiência única descrita no livro “Tempo de Despertar”, ele tinha uma opinião mais pessimista sobre a levodopa, que ficou relatada em uma série de artigos publicados por ele e colaboradores no início da década de 1970. Revisaremos a contribuição científica de Oliver Sacks referente ao tratamento dos parkinsonismos com levodopa, e como advertiu a cautela com as complicações decorrentes desta medicação antes da maioria dos médicos.


Subject(s)
History, 20th Century , Parkinson Disease/history , Levodopa/history , Neurology/history , Antiparkinson Agents/history , Parkinson Disease/drug therapy , Levodopa/adverse effects , Levodopa/therapeutic use , Antiparkinson Agents/adverse effects , Antiparkinson Agents/therapeutic use
19.
Arq. neuropsiquiatr ; 74(4): 303-306, Apr. 2016. tab
Article in English | LILACS | ID: lil-779806

ABSTRACT

ABSTRACT Increased of sexual arousal (ISA) has been described in different neurological diseases. The purpose of this study was present a case series of ISA in patients with movement disorders. Method Fifteen patients with different forms of movement disorders (Parkinson’s disease, Huntington’s disease, Tourette´s syndrome, spinocerebellar ataxia type 3), were evaluated in the Movement Disorders Unit of the Federal University of Paraná. Results Among Parkinson’s disease patients there were seven cases with different forms of ISA due to dopaminergic agonist use, levodopa abuse, and deep brain stimulation (DBS). In the group with hyperkinetic disorders, two patients with Huntington’s disease, two with Tourette’s syndrome, and four with spinocerebellar ataxia type 3 presented with ISA. Conclusions ISA in this group of patients had different etiologies, predominantly related to dopaminergic treatment or DBS in Parkinson’s disease, part of the background clinical picture in Huntington’s disease and Tourette’s syndrome, and probably associated with cultural aspects in patients with spinocerebellar ataxia type 3.


RESUMO A exacerbação do impulso sexual (EIS) tem sido descrita em diversas doenças neurológicas. O objetivo deste estudo foi apresentar uma série de casos de EIS em pacientes com distúrbios do movimento. Métodos Quinze pacientes com diferentes formas de distúrbios do movimento (Doença de Parkinson, doença de Huntington, síndrome de Tourette, ataxia espinocerebellar tipo 3), foram avaliados na Unidade de Distúrbios de Movimento-Universidade Federal do Paraná. Resultados Entre os pacientes com doença de Parkinson houve sete casos com diferentes formas de EIS devido ao uso de agonista dopaminérgico, abuso de levodopa ou estimulação cerebral profunda (DBS). No grupo com distúrbios hipercinéticos, dois pacientes com doença de Huntington, dois com síndrome de Tourette, e quatro com ataxia espinocerebelar tipo 3 apresentaram EIS. Conclusões EIS nesses pacientes decorreu de diferentes etiologias, relacionadas com o tratamento dopaminérgico ou DBS na doença de Parkinson, parte do quadro clinico na doença de Huntington e síndrome de Tourette, e provavelmente relacionado com aspectos culturais em pacientes com ataxia espinocerebelar tipo 3.


Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Young Adult , Movement Disorders/physiopathology , Sexual Dysfunctions, Psychological/etiology , Sexual Dysfunctions, Psychological/physiopathology , Antiparkinson Agents/adverse effects , Deep Brain Stimulation/adverse effects , Dopamine Agents/adverse effects , Impulsive Behavior/drug effects , Impulsive Behavior/physiology , Levodopa/adverse effects , Libido/drug effects , Libido/physiology , Prospective Studies , Sexual Behavior/drug effects , Sexual Behavior/physiology
20.
Arq. neuropsiquiatr ; 74(4): 287-292, Apr. 2016. tab
Article in English | LILACS | ID: lil-779814

ABSTRACT

ABSTRACT Studies which have investigated muscular performance during the initial stages of Parkinson´s disease (PD) without L-dopa treatments were not found. Objective to assess whether muscular performance, work and power, of the trunk and lower limbs in L-dopa naïve patients in the early stages of PD was lower than those of healthy subjects and to compare muscular performance between the lower limbs. Method Ten subjects with PD, Hoehn and Yahr (HY) I-II, L-dopa naïve and 10 subjects in the control group were assessed with the isokinetic dynamometer. Results ANOVAs revealed that work and power measures of the trunk, hip, knee, and ankle muscular groups were lower in PD compared with the control group (p < 0.05). There were no significant differences in muscular performance between the lower limbs. Conclusion The results suggested the use of specific exercises, as rehabilitation strategies, to improve the ability to produce work and power with this population.


RESUMO Estudos que investigaram o desempenho muscular durante os estágios iniciais da doença de Parkinson (DP), sem tratamento com L-dopa não foram encontrados. Objetivo Avaliar se o desempenho muscular, por meio de medidas de trabalho e potência, do tronco e dos membros inferiores em pacientes sem o uso de L-dopa nas fases iniciais da DP é menor do que o de indivíduos saudáveis e comparar o desempenho muscular entre os membros inferiores. Método Dez indivíduos com DP, Hoehn and Yahr (HY) I-II, sem L-dopa e 10 indivíduos do grupo controle foram avaliados com o dinamômetro isocinético. Resultados Medidas de trabalho e potência muscular do tronco, quadril, joelho, tornozelo foram menores no PD em comparação com o grupo controle (p < 0,05) e não houve diferenças significativas no desempenho muscular entre os membros inferiores. Conclusão O uso de exercícios específicos, como estratégias de reabilitação, pode melhorar a capacidade de produzir trabalho e potência muscular nesta população.


Subject(s)
Female , Humans , Male , Middle Aged , Muscle Strength/physiology , Parkinson Disease/physiopathology , Activities of Daily Living , Analysis of Variance , Antiparkinson Agents/therapeutic use , Case-Control Studies , Disease Progression , Levodopa/therapeutic use , Lower Extremity/physiopathology , Muscle Strength Dynamometer , Motor Activity/physiology , Parkinson Disease/rehabilitation , Reference Values , Statistics, Nonparametric , Time Factors , Torso/physiopathology
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