ABSTRACT
Striatal cholinergic dysfunction may be important in Huntington disease (HD). We studied whether donepezil improves chorea, cognition, and quality of life (QoL) in HD. Thirty patients were randomly assigned to treatment with donepezil or placebo. At the doses studied, donepezil did not improve chorea, cognition, or QoL. Adverse events were similar between both groups. Based on this small sample study, donepezil was not an effective treatment for HD.
Subject(s)
Chorea/prevention & control , Cognition Disorders/prevention & control , Huntington Disease/drug therapy , Indans/therapeutic use , Piperidines/therapeutic use , Quality of Life , Recovery of Function/drug effects , Chorea/etiology , Cognition Disorders/etiology , Donepezil , Female , Humans , Huntington Disease/complications , Male , Middle Aged , Nootropic Agents/therapeutic use , Outcome Assessment, Health Care , Placebo Effect , Treatment OutcomeABSTRACT
Questionnaire studies have found that parkinsonism worsens in women during the premenstrual period, when estrogen and progesterone levels are presumably at their nadir. To assess this patient-based observation and correlate motor signs with hormonal levels, the authors prospectively studied 10 menstruating women with PD in their "off" state, on 5 successive weeks. Although PD severity fluctuated during the study period, there was no significant correlation between the objective or subjective measures of parkinsonism and estrogen and progesterone levels.
Subject(s)
Menstrual Cycle/physiology , Parkinson Disease/physiopathology , Adult , Estrogens/blood , Female , Humans , Parkinson Disease/blood , Progesterone/blood , Surveys and QuestionnairesABSTRACT
Patients with truncal extension dystonia, manifested by involuntary back arching, often associated with pain and severe motor disability, have not consistently responded to pharmacologic agents. We evaluated 4 women and 1 man (mean age, 41.8 years; dystonia duration, 9.8 years) with severe idiopathic (2 patients) or tardive (3 patients) truncal and cervical dystonia. Using electromyographic guidance, we injected botulinum toxin into the paravertebral muscles of the lumbar region in four to six sites using 25-50 U per site. We reevaluated patients 2-4 weeks after injection. The mean dose of botulinum toxin into back muscles was 210 U (range, 150-300 U). By blinded videotape evaluation, objective improvement was found in three patients with a mean truncal dystonia score improving by 37%. Patient evaluation showed improvement in movement ranging from 20-80% (mean, 46%) after botulinum toxin. In all patients with pain as a result of dystonia, there was substantial improvement. None of the patients worsened and no adverse effects occurred. Botulinum toxin injections offer a potent new treatment for truncal dystonia.
Subject(s)
Botulinum Toxins, Type A/administration & dosage , Dystonia/drug therapy , Adult , Back , Dystonia/etiology , Electromyography/drug effects , Female , Humans , Injections, Intramuscular , Male , Middle Aged , Neurologic Examination/drug effects , Torticollis/drug therapy , Torticollis/etiology , Treatment OutcomeABSTRACT
The objective of this study was to examine the experience of spouses caregiving for their spouse with Parkinson's disease (PD) and to determine whether their experiences differed by stage of disease. By using a cross-sectional design and mail questionnaire data from 380 spouse caregivers across 23 sites of the Parkinson Study Group, key caregiver variables were examined by stage of PD. Three categories of variables--caregiver role strain (10 measures), caregiver situation (four measures), and caregiver characteristics (four measures)--were analyzed by using t tests with Bonferroni correction. Specific types and amounts of role strain accumulated as the disease progressed, and they differed significantly between stages (p < 0.05). In the caregiving situation, the mean number of caregiving tasks tripled by stage 4/5. Negative changes in lifestyle plus decreases in predictability in caregivers' lives increased significantly in late-stage disease (p < 0.05). Caregiver characteristics of physical health and preparedness did not significantly differ across stages of disease. Depression was significantly higher by stage 4/5. Mutuality, the positive quality of the relationship as perceived by the caregiving spouse, declined beginning at stage 2. Caregiver strain is experienced across all stages of PD and accumulates significantly as the disease progresses. This study defines types and amounts of strain by stage of disease, which will be helpful in designing formal intervention trials to provide more effective help for spouse caregivers.
