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1.
Rev Esp Med Nucl ; 28(3): 114-20, 2009.
Article in Spanish | MEDLINE | ID: mdl-19558951

ABSTRACT

INTRODUCTION: Changes in regional cerebral blood flow (rCBF) have been reported in idiopathic Parkinson's disease (PD). Nonetheless, their typical pattern still remains controversial regarding some features, such as basal ganglia involvement and the main cortical regions affected. Functional neuroimaging makes it possible to identify the brain dysfunctions of the neural circuits underlying the disease. Voxel-based analysis methods make it possible to increase the reliability of the results. OBJECTIVE: To assess the rCBF changes in patients with PD and their relation with disease duration. MATERIALS AND METHODS: Thirty PD adult patients without dementia underwent evaluation with (99m)Tc-ECD SPECT. SPM5 was used for statistical comparison with 25 normal controls of similar ages. The disease course duration in years was added as a covariate. Additionally, patients with a 6-year evolution or less and those with more than 6 years were compared separately with normal controls. RESULTS: Significant hypoperfusion was detected in bilateral premotor and posterior parietal cortex and increase of perfusion was present in the cerebellum. These changes correlated with the years of evolution of the illness. Patients with longer evolution also presented thalamic, subthalamic and basal ganglia hypoperfusion. CONCLUSIONS: We describe rCBF changes in PD in neural circuits related with control of movements. These changes are more manifest in patients with a longer duration of the disease.


Subject(s)
Cerebrovascular Circulation , Parkinson Disease/physiopathology , Adult , Aged , Cerebellum/blood supply , Cerebellum/diagnostic imaging , Cerebral Cortex/blood supply , Cerebral Cortex/diagnostic imaging , Confounding Factors, Epidemiologic , Female , Humans , Male , Middle Aged , Parkinson Disease/diagnostic imaging , Prospective Studies , Time Factors , Tomography, Emission-Computed, Single-Photon
2.
Rev. esp. med. nucl. (Ed. impr.) ; 28(3): 114-120, mayo 2009. ilus
Article in Spanish | IBECS | ID: ibc-73573

ABSTRACT

Introducción: En la enfermedad de Parkinson idiopática (EP) se han observado alteraciones del flujo sanguíneo cerebral regional (FSCr) cuyo patrón característico aún presenta aspectos controvertidos, como la existencia de alteraciones gangliobasales y las áreas corticales más afectadas. La neuroimagen funcional permite observar las disfunciones de circuitos neuronales existentes en estos pacientes. Los métodos de análisis estadístico basado en vóxeles permiten incrementar la validez de los resultados. Objetivo: Investigar los cambios de la perfusión cerebral existentes en pacientes con EP y su relación con la duración de los síntomas. Materiales y métodos: Treinta pacientes adultos con EP sin demencia fueron estudiados mediante SPECT cerebral con 99mTc-ECD. Se utilizó SPM5 para su comparación estadística con un grupo control de 25 sujetos sanos de edades similares. Se introdujo, como covariable en dicha comparación, el tiempo de evolución en años y se analizaron por separado los pacientes con 6 años o menos de evolución y aquellos con más de 6 años. Resultados: Se detectó hipoperfusión significativa en la corteza premotora y parietal posterior bilateral y aumento del flujo en el cerebelo. Estas alteraciones se correlacionaron con los años de evolución de la enfermedad. Los pacientes con evolución más prolongada presentaron además hipoperfusión talámica, subtalámica y gangliobasal. Conclusiones: Describimos alteraciones del FSCr en la EP que se relacionan con los circuitos implicados en el control del movimiento. Las mismas son más evidentes en los pacientes con evolución más prolongada de la enfermedad(AU)


Introduction: Changes in regional cerebral blood flow (rCBF) have been reported in idiopathic Parkinson's disease (PD). Nonetheless, their typical pattern still remains controversial regarding some features, such as basal ganglia involvement and the main cortical regions affected. Functional neuroimaging makes it possible to identify the brain dysfunctions of the neural circuits underlying the disease. Voxel-based analysis methods make it possible to increase the reliability of the results. Objective: To assess the rCBF changes in patients with PD and their relation with disease duration. Materials and methods: Thirty PD adult patients without dementia underwent evaluation with 99mTc-ECD SPECT. SPM5 was used for statistical comparison with 25 normal controls of similar ages. The disease course duration in years was added as a covariate. Additionally, patients with a 6-year evolution or less and those with more than 6 years were compared separately with normal controls. Results: Significant hypoperfusion was detected in bilateral premotor and posterior parietal cortex and increase of perfusion was present in the cerebellum. These changes correlated with the years of evolution of the illness. Patients with longer evolution also presented thalamic, subthalamic and basal ganglia hypoperfusion. Conclusions: We describe rCBF changes in PD in neural circuits related with control of movements. These changes are more manifest in patients with a longer duration of the disease(AU)


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Cerebellum , Cerebral Cortex , Cerebrovascular Circulation , Parkinson Disease/physiopathology , Tomography, Emission-Computed, Single-Photon , Cerebellum/blood supply , Confounding Factors, Epidemiologic , Parkinson Disease , Prospective Studies , Time Factors
4.
Adv Neurol ; 53: 519-26, 1990.
Article in English | MEDLINE | ID: mdl-2122654

ABSTRACT

1. Of 22 parkinsonians with fluctuations under long-dating dopatherapy in whom standard Madopar was substituted by the HBS form, 16 who performed the trial longer than 1 year were particularly studied to evaluate some parameters of this long-term follow-up (30-36 months). 2. The outstanding beneficial effects were an enhancement of the antiparkinsonian response, improvement or disappearance of motor oscillations, longer "on" periods, less severe "off" periods, and a more sustained nocturnal antiparkinsonian effect with a reduction of dystonias and pain at night and decreased or absent early morning parkinsonism. 3. The decrease or disappearance of dystonia was observed since the early stages of the trial and can be explained by the more sustained dopaminergic effect. 4. Surprisingly, dyskinesias also decreased in spite of the higher dopaminergic effect. The avoidance of sharp and repeated plasmatic peaks and the lower levels of L-dopa under HBS could explain this phenomenon. 5. The negative aspects of Madopar HBS are a lower bioavailability that means a dosage increase and a longer latency for the therapeutic response in the morning. 6. The dosage increase went up by 80% to 100% in relation to standard Madopar during the long-term treatment. 7. As Madopar HBS is a sustained release preparation, we had to increase the initially reduced the number of intakes, again in order to obtain better results. In the most severe cases with poor or absent response, benefits were achieved only when administering the HBS intake every hour.(ABSTRACT TRUNCATED AT 250 WORDS)


Subject(s)
Benserazide/administration & dosage , Carboxy-Lyases/antagonists & inhibitors , Levodopa/administration & dosage , Parkinson Disease/drug therapy , Aged , Delayed-Action Preparations , Drug Combinations , Follow-Up Studies , Humans , Long-Term Care , Middle Aged , Motor Skills/drug effects , Neurologic Examination
5.
Acta Neurol Scand Suppl ; 126: 127-37, 1989.
Article in English | MEDLINE | ID: mdl-2515718

ABSTRACT

Thirteen parkinsonians with a long duration of the disease and long-term dopa therapy, seven of them showing severe on-off oscillations and 6 an "end-of-dose impairment", were treated with a controlled release (HBS) preparation of L-DOPA/benserazide for more than 3 years. Thereafter, selegiline was added in a progressively increasing dosage up to a maximum of 10 mg/day during 4 months, with the aim of a) further improving the long-term results and b) reducing the doses of the new formula of L-DOPA. A significant decrease of early morning parkinsonism and reduction of motor disability throughout the day were observed; "wearing-off" cases showed better results compared with those presenting "on-off" oscillations. A mean reduction of 20% in the doses of levodopa was achieved. Likewise, a mild reduction of dyskinesias and a mild-moderate enhancement of dystonias were recorded. Only one patient did not tolerate selegiline and two others received lower doses due to side-effects. Selegiline was capable of enhancing the antiparkinsonian effect of the new formula of L-DOPA, while allowing a reduction of the doses administered. It must also be emphasized that such improvement was achieved in complicated patients, most of whom showed some deterioration of response in the late stages of long-term sustained-release levodopa treatment.


Subject(s)
Levodopa/therapeutic use , Parkinson Disease/drug therapy , Phenethylamines/therapeutic use , Selegiline/therapeutic use , Adult , Aged , Benserazide/administration & dosage , Benserazide/therapeutic use , Delayed-Action Preparations , Drug Therapy, Combination , Female , Humans , Levodopa/administration & dosage , Male , Middle Aged , Selegiline/administration & dosage
6.
J Neural Transm Suppl ; 27: 61-70, 1988.
Article in English | MEDLINE | ID: mdl-3042913

ABSTRACT

At the first stage of a pilot study involving 14 parkinsonians with motor fluctuations, treatment with standard Madopar was substituted by a sustained-release form, Madopar HBS, which attenuated fluctuations in patients with end-of-dose impairment, but achieved only moderate improvement in patients with on-off phenomena. In a second phase of the trial, 4 parkinsonians exhibiting the most severe fluctuations of mobility and the poorest response to Madopar HBS (Hydrodynamically Balanced System) were selected for treatment with a combined regimen utilizing subcutaneous lisuride infusions as the additional component. The sequence of the trial was as follows: 1. standard Madopar, 2. Madopar HBS, 3. standard Madopar combined with lisuride infusions and 4. Madopar HBS combined with lisuride infusions. Steady improvement was observed along the lines of this schedule, but the best results were obtained when Madopar HBS was combined with lisuride infusions. Subsequently motor fluctuations were less marked or disappeared, early-morning Parkinson symptoms decreased and dystonia was not recorded any longer. Even better results could be accomplished in an extended trial attempting to establish the best dosage ratio of the combination, possibly admitting increased dosage. The tolerance of the combined regimen was excellent, except in one patient who transiently exhibited delusions and postural hypotension. The combination of sustained-release Madopar and continuous infusions of the dopaminergic agonist lisuride seems to prove a more physiological and effective regimen for the treatment of severe motor fluctuations.


Subject(s)
Benserazide/administration & dosage , Ergolines/administration & dosage , Hydrazines/administration & dosage , Levodopa/therapeutic use , Lisuride/administration & dosage , Parkinson Disease/drug therapy , Administration, Oral , Benserazide/therapeutic use , Clinical Trials as Topic , Drug Administration Schedule , Drug Combinations/therapeutic use , Drug Therapy, Combination , Drug Tolerance , Humans , Infusion Pumps , Lisuride/therapeutic use , Severity of Illness Index
8.
Eur Neurol ; 27 Suppl 1: 59-67, 1987.
Article in English | MEDLINE | ID: mdl-3428309

ABSTRACT

Fourteen parkinsonian patients, 10 of them showing severe and long-standing 'on-off' effects and 4 'end-of-dose impairment', received Madopar HBS instead of standard Madopar. At the end of the dosage adaptation phase (9 weeks) most patients improved; in patients with 'on-off' phenomenon, parkinsonism became less severe, on periods were longer, and fluctuations decrease; end-of-dose impairment resolved in 4 patients. However, a longer delay in the onset of the therapeutic effect was observed after the first daily drug intake in those patients still showing severe early-morning parkinsonism. With Madopar HBS, L-dopa dosage was increased by 116%. In spite of a greater dopaminergic effect, dyskinesias were reduced, and dystonias became less marked or even disappeared.


Subject(s)
Benserazide/therapeutic use , Hydrazines/therapeutic use , Levodopa/therapeutic use , Movement Disorders/drug therapy , Parkinson Disease/drug therapy , Aged , Aged, 80 and over , Benserazide/administration & dosage , Benserazide/pharmacokinetics , Biological Availability , Delayed-Action Preparations , Dose-Response Relationship, Drug , Drug Combinations/administration & dosage , Drug Combinations/pharmacokinetics , Drug Combinations/therapeutic use , Drug Tolerance , Female , Humans , Levodopa/administration & dosage , Levodopa/pharmacokinetics , Male , Middle Aged , Movement Disorders/etiology , Parkinson Disease/complications , Parkinson Disease/physiopathology
9.
Lancet ; 1(8493): 1303-4, 1986 Jun 07.
Article in English | MEDLINE | ID: mdl-2872433

ABSTRACT

12 subjects, 8 women and 4 men, presented with extrapyramidal motor signs and psychic depression after treatment with flunarizine for between 3 weeks and 15 months. One woman presented with severe symptoms and 20 months after stopping flunarizine she still had dyskinesia and akathisia. The other patients showed partial or complete improvement after withdrawal of the drug.


Subject(s)
Akathisia, Drug-Induced , Cinnarizine/analogs & derivatives , Dyskinesia, Drug-Induced/etiology , Parkinson Disease, Secondary/chemically induced , Aged , Cinnarizine/adverse effects , Depressive Disorder/chemically induced , Female , Flunarizine , Humans , Male , Middle Aged , Psychoses, Substance-Induced/etiology
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