Plasma oxidative and inflammatory markers in patients with idiopathic Parkinson's disease.

Parkinson's disease (PD) is the most common neurodegenerative disorder after alzheimer's disease. Neuroinflammation and oxidative damage are implicated to be responsible for the pathogenesis of neurodegenerative diseases. However, there are a few studies showing the changes in the biomarkers for neuroinflammation and oxidative damage in neurodegenerative diseases. In our study we aimed to examine the role of the molecules that are involved in oxidative stress and inflammation in PD patients taking L: -dopa treatment. Oxidized-LDL (ox-LDL), high-sensitivity C-reactive protein (hs-CRP) and the soluble intracellular adhesion molecule (ICAM) were chosen as biomarkers for systemic inflammation and oxidative damage. The patients were classified according to the Hoehn-Yahr staging system. Forty-five idiopathic L: -dopa-given PD patients and 25 age-matched healthy controls were examined. Plasma ox-LDL and ICAM levels were significantly higher in PD patients when compared with controls (p < 0.001 and p < 0.05, respectively). PD patients at all stages had significantly higher plasma ox-LDL levels than controls (p < 0.001). Plasma ICAM levels at stage 1 and 2 and CRP levels at stage 2 patients were significantly higher than controls (p < 0.05, p < 0.05, and p < 0.01, respectively). We insist that further studies have to be conducted to establish neuroinflammation and oxidative damage in PD. Establishing the roles of these pathological processes in PD might be the key to effective therapy at an early stage by antioxidants and/or anti-inflammatory drugs.

Clinical approach to nonmotor sensory fluctuations in Parkinson's disease.

UNLABELLED: Many nonmotor fluctuations (NMFs) may occur in addition to the classic motor fluctuations (MFs) in patients with Parkinson's disease (PD) within several years of initiation of dopaminergic treatment. Patients can experience these NMFs in the "on" and/or "off" periods. NMFs can be divided into three groups: Autonomic, cognitive/psychiatric, and sensory. Nonmotor sensory fluctuations (NMSFs) occurring in association with "on" period are more frequently recognized than those in the "off" state. NMSFs commonly reported include pain, numbness, paresthesia/dysesthesia, akathisia, rest-legs syndrome (RLS), dyspnea, and internal tremor (IT). Proposed treatments of NMSFs are based on whether they occur during "off" or "on" state. These include reduction of dopaminergic medication, use of long-acting dopamine agonists or controlled released levodopa (LD), surgical intervention, and/or targeted pharmacological intervention to minimize dopaminergic side effects. NMSFs might be related to dopaminergic mechanisms although difficulty in managing these symptoms with dopaminergic therapy suggests a different pathway. CONCLUSION: Recognition of NMSFs is important in the care of patients with Parkinson disease to prevent unnecessary interventions and for appropriate medication regimen adjustments.

Nonmotor fluctuations in Parkinson's disease: clinical spectrum and classification.

UNLABELLED: The majority of patients with Parkinson's disease (PD) on levodopa (LD) treatment usually experience motor fluctuations (MFs) within several years of initiation of treatment. Besides the classic MFs, many nonmotor fluctuations (NMFs) may occur in PD. NMFs appear both in the "on" state and "off" state. However, the clinical spectrum and the frequency of these symptoms are not well recognized. NMFs are usually mild and less disabling than MFs but sometimes can lead to unnecessary tests and therapies. NMFs occurring in association with the "on" state are better known and therefore more frequently diagnosed than those occurring in the "off" state. NMFs can be classified into three groups: autonomic, cognitive/psychiatric, and sensory. They include gastrointestinal and urinary symptoms, drenching sweats, temperature and blood-pressure changes, depression, anxiety, hallucinations, hypomania, moaning/screaming, confusion, cognitive dysfunction, sexual deviations and dopamine dysregulation syndrome (DDS), pain, akathisia, internal tremor, numbness/parasthesia, and dyspnea. CONCLUSION: Recognition of NMFs may prevent unnecessary diagnostic tests and may lead to treatment modifications aimed to minimize their occurrence.

Association of the C677T and A1298C polymorphisms of methylenetetrahydrofolate reductase gene in patients with essential tremor in Turkey.

Essential tremor (ET) is a most common human movement disorder of unknown etiology. Previous reports have shown that the C677T polymorphism of methylenetetrahydrofolate reductase gene has been associated with neurodegenerative disorders. To investigate the role of methylenetetrahydrofolate reductase gene polymorphisms in essential tremor, we analyzed the alleles and genotypes of methylenetetrahydrofolate reductase (MTHFR) C677T and MTHFR A1298C in a total of 158 unrelated essential tremor patients and compared them with those of 246 unrelated healthy control subjects, using a polymerase chain reaction restriction fragment length polymorphism method. The allele frequency of MTHFR 677T was 35.76% in the essential tremor cases and 30.08% in the controls. We obtained statistically significant results for MTHFR677 and also for MTHFR1298. The MTHFR T677T genotype was overrepresented and was statistically significant. The T677T/A1298A and C677C/C1298C compound genotypes were similarly statistically significant. The C677C/A1298A compound genotype provided protection for essential tremor. In conclusion, the MTHFR 677T, 1298C alleles and MTHFR T677T genotype and T677T/A1298A, and C677C/C1298C compound genotypes are genetic risk factors for essential tremor in Turkey.