Subject(s)
Alcohol Deterrents/adverse effects , Brain Injuries/chemically induced , Brain Injuries/pathology , Corpus Striatum/metabolism , Disulfiram/adverse effects , Dopamine Plasma Membrane Transport Proteins/metabolism , Aged , Alcoholism/drug therapy , Brain Injuries/diagnostic imaging , Corpus Striatum/diagnostic imaging , Corpus Striatum/drug effects , Dopamine/metabolism , Female , Humans , Magnetic Resonance Imaging/methods , Middle Aged , Protein Binding/drug effects , Tomography, Emission-Computed, Single-Photon/methodsABSTRACT
Patients with Parkinson's disease (PD) often lose weight, but after subthalamic nucleus deep brain stimulation (STN-DBS), they gain weight. We compared daily energy intake (DEI), resting energy expenditure (REE) and substrate oxidation rates (measured by indirect calorimetry) in nineteen STN-DBS-treated patients (Group S), thirteen others on pharmacologic treatment by levodopa (Group L) and eight control subjects. We also determined the acute effects of STN-DBS and levodopa on REE and substrate oxidation rates. STN-DBS treated patients gained 9.7 (SEM 7.1) kg after surgery, whereas patients on pharmacologic treatment lost 3.8 (SEM 10.0) kg since diagnosis. In STN-DBS-treated patients, REE (-16.5 %; P<0.001), lipid oxidation (-27 %; P<0.05) and protein oxidation (-46 %; P<0.05) were decreased, whereas glucose oxidation was elevated (+81 %; P<0.05) as compared to patients on pharmacologic treatment. Levodopa acutely reduced REE (-8.3 %; P<0.05) and glucose oxidation (-37 %; P<0.01) with a slight hyperglycaemic effect (after levodopa challenge: 5.6 (SEM 0.8) v. before levodopa challenge: 5.3 (SEM 0.6) mmol/l; P<0.01). Switching 'on' STN-DBS acutely reduced REE (-17.5 %; P<0.01) and lipid oxidation (-24 %; P<0.001) 30 min after starting stimulation. Fasting glycaemia was slightly but significantly reduced (5.4 (SEM 1.4) v. 5.5 (SEM 1.3) mmol/l; P<0.01). After STN-DBS, the normalization of REE and the reduction in lipid and protein oxidation contribute to the restoration of weight. As levodopa decreases glucose oxidation, the reduction in daily dose of levodopa in STN-DBS-treated patients helps prevent the effect of weight gain on glycaemia.
Subject(s)
Antiparkinson Agents/therapeutic use , Energy Metabolism/physiology , Levodopa/therapeutic use , Parkinson Disease/physiopathology , Subthalamic Nucleus/physiopathology , Blood Glucose/metabolism , Blood Proteins/metabolism , Electric Stimulation/methods , Energy Intake/physiology , Energy Metabolism/drug effects , Fasting/physiology , Female , Glucose/metabolism , Humans , Lipids/blood , Male , Middle Aged , Oxidation-Reduction/drug effects , Parkinson Disease/drug therapy , Weight Gain/drug effects , Weight Gain/physiologyABSTRACT
Adult polyglucosan body disease (APGBD) is a rare disorder affecting the central and peripheral nervous systems and in which parkinsonism is unusual. A 71-year-old man presented levodopa-unresponsive parkinsonism with urinary incontinence and recurrent syncopes of 6 years standing masquerading as atypical parkinsonism of the multiple system atrophy (MSA-P) type. Brain histopathology demonstrated massive accumulation of polyglucosan bodies particularly in the putamen. In addition, there were dense alpha-synuclein-positive cytoplasmic oligodendroglial inclusions in the pons and in the middle cerebellar peduncle. These inclusions may be either due to the chance association of MSA-P with APGBD, or pathologically related to APGBD.
Subject(s)
Glucans/metabolism , Multiple System Atrophy/etiology , Nerve Tissue Proteins/metabolism , Parkinsonian Disorders/complications , Parkinsonian Disorders/metabolism , Aged , Glial Fibrillary Acidic Protein/metabolism , Humans , Immunohistochemistry/methods , Inclusion Bodies/metabolism , Inclusion Bodies/pathology , Lewy Bodies/metabolism , Lewy Bodies/pathology , Male , Multiple System Atrophy/pathology , Parkinsonian Disorders/pathology , Review Literature as Topic , Staining and Labeling/methods , Synucleins , alpha-SynucleinSubject(s)
Brain/pathology , Hypertension/complications , Supranuclear Palsy, Progressive/complications , Supranuclear Palsy, Progressive/pathology , Aged , Antibodies/immunology , Brain/metabolism , Humans , Magnetic Resonance Imaging , Male , Nerve Tissue Proteins/immunology , Nerve Tissue Proteins/metabolism , Neurons/metabolism , Supranuclear Palsy, Progressive/metabolism , tau ProteinsABSTRACT
Weight, body mass index (BMI) and energy expenditure/energy intake (EE/EI) was studied in 19 Parkinson's disease (PD) patients after subthalamic deep brain stimulation (STN-DBS) versus 14 nonoperated ones. Operated patients had a significant weight gain (WG, + 9.7 +/- 7 kg) and BMI increase (+ 4.7 kg/m2). The fat mass was higher after STN-DBS. Resting EE (REE; offdrug/ON stimulation) was significantly decreased in STN-DBS patients, while their daily energy expenditure (DEI) was not significantly different. A significant correlation was found among WG, BMI increase, and pre-operative levodopa-equivalent daily dose, their reduction after STN-DBS, and the differential REE related to stimulation and the REE in the offdrug/OFF stimulation condition. In conclusion, STN-DBS in PD induces a significant WG associated with a reduction in REE without DEI adjustment.
Subject(s)
Dominance, Cerebral/physiology , Electric Stimulation Therapy/adverse effects , Parkinson Disease/therapy , Subthalamic Nucleus/physiopathology , Weight Gain/physiology , Aged , Antiparkinson Agents/administration & dosage , Antiparkinson Agents/adverse effects , Body Composition/physiology , Body Mass Index , Combined Modality Therapy , Dyskinesia, Drug-Induced/physiopathology , Dyskinesia, Drug-Induced/therapy , Energy Metabolism/physiology , Female , Follow-Up Studies , Humans , Levodopa/administration & dosage , Levodopa/adverse effects , Male , Middle Aged , Parkinson Disease/physiopathology , Prospective Studies , Treatment OutcomeABSTRACT
The purpose of the study was to evaluate electrophysiologically phrenic nerve involvement in multifocal motor neuropathy (MMN) and chronic inflammatory demyelinating polyneuropathy (CIDP). The response latencies following phrenic nerve stimulation were increased in 11 of 14 (80%) patients in the CIDP group but in only 1 of 14 (8%) patients in the MMN group. The mean diaphragmatic compound muscle action potential (CMAP) was significantly lower in amplitude in the CIDP group compared to the MMN group and to a control group of 8 subjects (P < 0.001). There were no significant differences between the MMN and control groups. Only the reduction in CMAP amplitude correlated with the presence of restrictive lung function. Phrenic nerve conduction measurement should be performed more systematically, especially in CIDP and, when diaphragmatic CMAPs are reduced in amplitude, pulmonary function tests should be performed to look for a restrictive lung syndrome.
Subject(s)
Motor Neuron Disease/complications , Phrenic Nerve/physiopathology , Polyradiculoneuropathy, Chronic Inflammatory Demyelinating/complications , Respiration Disorders/etiology , Respiration Disorders/physiopathology , Adult , Aged , Diaphragm/innervation , Diaphragm/physiopathology , Electric Stimulation , Female , Humans , Lung/physiopathology , Male , Middle Aged , Motor Neuron Disease/physiopathology , Neural Conduction/physiology , Polyradiculoneuropathy, Chronic Inflammatory Demyelinating/physiopathology , Prospective Studies , Reaction Time/physiology , Respiration Disorders/diagnosis , Respiratory Function TestsABSTRACT
During a period of intensive practice, 2 petanque players developed freezing of shoulder flexion impeding boule throwing. This movement disorder was consistent with the diagnosis of task-specific focal dystonia. Polymyography showed that freezing was associated with bursts of low amplitude. In the absence of motor or sensory deficits, a motor apraxia could be considered.
