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1.
Acta Neurol Scand ; 136(6): 570-584, 2017 Dec.
Article in English | MEDLINE | ID: mdl-28670681

ABSTRACT

Available data indicate that there are gender differences in many features of Parkinson's disease (PD). Precise identification of the gender differences is important to tailor treatment, predict outcomes, and meet other individual and social needs in women and men with PD. The aim of this study was to review the available clinical data on gender differences in PD. Original articles and meta-analyses published between 1990 and 2016 systematically exploring gender differences in PD were reviewed. There is slight male preponderance in incidence and prevalence of PD. PD starts earlier in men. Women tend to be more prone to develop tremor-dominant PD but are less rigid than men. Motor improvement after deep brain stimulation is equal in both sexes, but women tend to show better improvement in activities of daily living. Furthermore, women with PD show better results on tests for general cognitive abilities, outperform men in verbal cognitive tasks, show more pain symptoms, and score higher on depression scales. It seems, however, that the differences in cognition, mood, and pain perception are not disease specific as similar gender differences can be found in healthy subjects and in other neurological conditions. Despite PD being the most frequently studied movement disorder, studies investigating gender differences in PD are still scarce with most of the studies being cross-sectional. Good-quality, prospective, longitudinal studies analyzing gender differences in PD and comparing them to matched healthy controls are needed in order to properly address the issues of gender differences in PD.


Subject(s)
Parkinson Disease/epidemiology , Parkinson Disease/physiopathology , Sex Factors , Activities of Daily Living , Aged , Cross-Sectional Studies , Female , Humans , Male , Middle Aged , Prospective Studies
2.
Acta Neurol Scand ; 128(4): 281-5, 2013 Oct.
Article in English | MEDLINE | ID: mdl-23550919

ABSTRACT

OBJECTIVES: Surveys of subthalamic nucleus (STN) deep brain stimulation (DBS) for Parkinson's disease (PD) have shown that this procedure is roughly twice more common in men than in women. Here, we investigate possible differences between women and men undergoing STN DBS, with respect to health-related quality of life. MATERIALS AND METHODS: Forty-nine consecutive patients (18 women) received STN DBS. The impact of PD and its surgical treatment was compared between women and men, before and at mean of 19 ± 11 months after surgery, using the Unified Parkinson Disease Rating Scale (UPDRS) and the Parkinson's Disease Questionnaire-39 (PDQ-39). RESULTS: Duration of disease at surgery and off-medication scores of the motor part of the UPDRS were similar in women and men. At baseline, women had lower doses of dopaminergic medication than men, experienced more disability due to dyskinesias, had more sensory symptoms and perceived more difficulties in mobility. Following DBS, both men and women showed equal and significant (P < 0.001) improvement in off-medication scores on the UPDRS III. On the PDQ-39, women expressed improvement in ADL to a greater extent than men. Moreover, women but not men showed a positive effect on mobility, stigma and cognition as well as on the summary score of PDQ-39. CONCLUSIONS: Although STN DBS results in equal degree of motor improvement between women and men, health-related quality of life seems to improve to a greater extent in women.


Subject(s)
Deep Brain Stimulation , Parkinson Disease/psychology , Parkinson Disease/therapy , Quality of Life/psychology , Sex Characteristics , Subthalamic Nucleus/physiology , Adult , Aged , Alkaloids , Female , Humans , Male , Middle Aged , Severity of Illness Index , Surveys and Questionnaires
3.
Acta Neurol Scand ; 127(4): 268-73, 2013 Apr.
Article in English | MEDLINE | ID: mdl-22881705

ABSTRACT

OBJECTIVES: Restless legs syndrome (RLS) has a high prevalence in the general population. Treatment with intrathecal morphine has been shown to be successful in a small number of patients. Our aim was to quantify the effect on RLS-related symptoms, health and quality of life in three patients treated with intrathecal morphine. MATERIALS AND METHODS: Three patients with medically refractory RLS received an implanted pump for delivery of intrathecal morphine. Severity of RLS and self-assessed health were rated using the International Restless Legs Syndrome Study Group (IRLSSG) rating scale and the Short Form health survey (SF-36). Assessments were made preoperatively and after 6 months of follow-up. RESULTS: Preoperatively two patients had very severe RLS, scoring 35 and 36 on the IRLSSG rating scale, and one patient had severe RLS (score, 26). All three patients were free of symptoms of RLS post-operatively and also at the 6-month follow-up. The daily doses of intrathecal morphine ranged from 73 to 199 µg. Results from the SF-36 health survey showed that all three patients had a better physical health compared to before surgery. CONCLUSION: Intrathecal morphine may be efficient in the treatment for medically refractory RLS. All three patients became completely free of symptoms, and there was also improvement in self-perceived overall health.


Subject(s)
Analgesics, Opioid/administration & dosage , Morphine/administration & dosage , Restless Legs Syndrome/drug therapy , Restless Legs Syndrome/psychology , Self Concept , Aged , Female , Humans , Injections, Spinal/methods , Male , Middle Aged , Prospective Studies , Quality of Life , Severity of Illness Index , Treatment Outcome
4.
Acta Neurol Scand ; 123(1): 20-7, 2011 Jan.
Article in English | MEDLINE | ID: mdl-20199514

ABSTRACT

OBJECTIVE: To describe activity of daily living (ADL) and quality of life (QoL) at first visit to a neurological centre, in patients subsequently diagnosed with Parkinson's disease (PD), according to subtype of disease and compared to healthy controls. MATERIALS AND METHODS: 99 patients and 31 controls were included. Patients were classified into three groups according to predominant symptoms: 50 Postural instability-gait difficulties (PIGD), 37 tremor dominant, 12 indeterminate. Evaluations included ADL-taxonomy, SF-36, and the Parkinson disease questionnaire (PDQ-39). RESULTS: Patients experienced early on limitations in ADL and QoL compared to controls. Patients with PIGD subtype had already at first visit a worse status, clinically and in ADL and QoL, than patients with tremor dominant type. CONCLUSIONS: Already at first visit to a neurological centre, patients who will eventually receive the diagnosis of PD exhibited restrictions in ADL and QoL. Patients with axial symptoms were affected most.


Subject(s)
Activities of Daily Living , Parkinson Disease , Quality of Life , Adult , Aged , Aged, 80 and over , Classification/methods , Female , Follow-Up Studies , Humans , Male , Middle Aged , Parkinson Disease/classification , Parkinson Disease/diagnosis , Parkinson Disease/psychology , Retrospective Studies , Statistics, Nonparametric , Surveys and Questionnaires
5.
Acta Neurol Scand ; 118(6): 387-94, 2008 Dec.
Article in English | MEDLINE | ID: mdl-18616684

ABSTRACT

OBJECTIVES: To report long-term effects of thalamic deep brain stimulation (DBS) on activities of daily living (ADL) and health-related quality of life (HRQoL) in patients with essential tremor (ET). MATERIALS AND METHODS: Nineteen consecutive patients were evaluated at baseline, at a mean of 1 year, then at a mean of 7 years after DBS using Tremor Rating Scale, Mini Mental Test, ADL Taxonomy, Nottingham Health Profile, Life Satisfaction Checklist, Visual Analogue Scale and interview. RESULTS: There was a decrease of DBS efficacy on tremor between 1 and 7 years post-operatively. The marked improvement in ADL at 1 year was no longer sustained at long-term, except for the ability to eat. Social life remained improved. CONCLUSION: Although there is a decrease of DBS effect on tremor at 7 years, and even though further ageing and co-morbidities may impact on the well-being of patients, there is still relevant benefit of DBS on few aspects of ADL and HRQoL in patients with ET.


Subject(s)
Activities of Daily Living/psychology , Deep Brain Stimulation , Essential Tremor/psychology , Essential Tremor/therapy , Quality of Life/psychology , Aged , Aged, 80 and over , Disability Evaluation , Essential Tremor/physiopathology , Female , Humans , Male , Neuropsychological Tests , Surveys and Questionnaires , Thalamus/anatomy & histology , Thalamus/physiopathology , Time , Treatment Outcome
6.
Br J Neurosurg ; 21(5): 504-9, 2007 Oct.
Article in English | MEDLINE | ID: mdl-17922323

ABSTRACT

Deep brain stimulation (DBS) of the nucleus ventralis intermedius thalami (Vim) in the treatment of essential tremor (ET) is well documented concerning the acute effects. Reports of the long-term effects are, however, few and the aim of the present study was to analyse the long-term efficacy of this treatment. Nineteen patients operated with unilateral Vim-DBS were evaluated with the Essential Tremor Rating Scale (ETRS) before surgery, and after a mean time of 1 and 7 years after surgery. The ETRS score for tremor of the contralateral hand was reduced from 6.8 at baseline to 1.2 and 2.7, respectively, on stimulation at follow-up. For hand function (item 11 - 14) the score was reduced from 12.7 to 4.1 and 8.2, respectively. Vim-DBS is an efficient treatment for ET, also after many years of treatment. There is, however, a decreasing effect over time, most noticeable concerning tremor of action.


Subject(s)
Deep Brain Stimulation/methods , Essential Tremor/therapy , Thalamus , Activities of Daily Living , Adolescent , Adult , Aged , Aged, 80 and over , Essential Tremor/diagnosis , Essential Tremor/surgery , Female , Follow-Up Studies , Humans , Male , Middle Aged , Prospective Studies , Treatment Outcome
7.
J Neurol Neurosurg Psychiatry ; 72(1): 47-52, 2002 Jan.
Article in English | MEDLINE | ID: mdl-11784825

ABSTRACT

OBJECTIVES: To evaluate the impact of thalamic deep brain stimulation (DBS) on disability and health-related quality of life in patients with essential tremor. METHODS: Twenty seven consecutive patients were evaluated prospectively, before surgery and at a mean of 12 months (range 6-26) after thalamic DBS. Assessment tools included the Fahn-Tolosa-Marìn tremor rating scale (TRS), activities of daily living (ADL) taxonomy, Nottingham health profile (NHP) and the visual analogue scale (VAS) for measuring impact of disease on life. Additional information on the side effects of, and expectations from surgery was obtained by interview. RESULTS: Thalamic DBS improved the ability of the patients in eating, drinking, writing, home maintenance, hobbies, and participation in society. Activities of daily life requiring bimanual skills were less improved. The emotional condition of the patients was positively affected and the negative impact of the disease on life as a whole, and on social life was decreased. Seventy per cent of the patients considered that the surgical treatment met their expectations. CONCLUSIONS: After thalamic DBS, health-related quality of life including disability in ADL and social life were improved in patients with essential tremor.


Subject(s)
Activities of Daily Living/classification , Disability Evaluation , Electric Stimulation Therapy , Essential Tremor/therapy , Quality of Life , Thalamic Nuclei/physiopathology , Adult , Aged , Electrodes, Implanted , Essential Tremor/physiopathology , Female , Follow-Up Studies , Humans , Male , Middle Aged , Stereotaxic Techniques , Treatment Outcome
8.
Mov Disord ; 15(1): 136-9, 2000 Jan.
Article in English | MEDLINE | ID: mdl-10634253

ABSTRACT

We report a patient with advanced Parkinson's disease, including severe and frequent off periods with freezing of gait, moderate dysphonia, and some cognitive impairment, who underwent bilateral subthalamic nucleus (STN) stimulation. The patient was followed for 1 year after surgery, showing persistent good mobility without off periods and without freezing, which reverted completely when stopping the stimulation. There was deterioration of cognition as well as increased aphonia and drooling, all of which remained when the stimulation was turned off. The striking improvement in motor symptoms following STN stimulation was not paralleled by improvement in disability, probably as a result of a cognitive decline, suggesting a diagnosis of Parkinson's disease with dementia. We conclude that chronic STN stimulation is efficient in alleviating akinetic motor symptoms including gait freezing; this surgery should be offered before patients start to exhibit speech or cognitive disturbances.


Subject(s)
Dementia/therapy , Dominance, Cerebral/physiology , Electric Stimulation Therapy/instrumentation , Parkinson Disease/therapy , Subthalamic Nucleus/physiopathology , Voice Disorders/therapy , Dementia/physiopathology , Disability Evaluation , Dyskinesias/physiopathology , Dyskinesias/therapy , Electrodes, Implanted , Follow-Up Studies , Humans , Male , Middle Aged , Neurologic Examination , Parkinson Disease/physiopathology , Voice Disorders/physiopathology
9.
Mov Disord ; 13(1): 78-83, 1998 Jan.
Article in English | MEDLINE | ID: mdl-9452330

ABSTRACT

Chronic thalamic stimulation (CTS) has a documented good effect on tremor in patients with Parkinson's disease (PD) and essential tremor (ET). This study evaluates whether the alleviation of impairment, i.e., tremor, translates into improvement of the patient's ability in performing instrumental activities of daily living (IADL). Thirteen patients were assessed with an occupational therapy tool called Assessment of Motor and Process Skills (AMPS). This observation-based scale rates the patient's motor and process skills needed to perform a given task. The evaluations were done at a mean of 13 months after surgery in the patient's home, and included assessments of IADL with the CTS activated and switched off, respectively. The results showed that most patients improved to variable degrees in their IADL ability when the thalamic stimulation was on. The improvement was more marked in patients operated on for tremor of their dominant hand. The improvement concerned mainly the skill items related to the patients' abilities of coordination, calibration, endurance, and accommodation during IADL task performance. The authors concluded that for some patients with tremor, CTS can improve independence in domestic activities of daily living.


Subject(s)
Activities of Daily Living , Electric Stimulation Therapy , Motor Skills/physiology , Occupational Therapy/methods , Parkinson Disease/rehabilitation , Thalamus , Tremor/rehabilitation , Adult , Aged , Disability Evaluation , Female , Humans , Longitudinal Studies , Male , Matched-Pair Analysis , Middle Aged , Regression Analysis , Severity of Illness Index , Treatment Outcome
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