RESUMO
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Assuntos
Humanos , Doença de Parkinson/fisiopatologia , Demência/diagnóstico , Tomografia por Emissão de Pósitrons , Doença por Corpos de Lewy/diagnósticoRESUMO
Continuous subcutaneous apomorphine infusion (CSAI) is, at present, an alternative option for advanced Parkinson's disease (PD) with motor fluctuations. We studied the evolution of patients with PD and severe motor fluctuations long-term treated with CSAI. We reviewed data from 82 patients with PD (mean age, 67 +/- 11.07; disease duration, 14.39 +/- 5.7 years) and severe motor fluctuations referred to 35 tertiary hospitals in Spain. These patients were long-term treated (for at least 3 months) with CSAI and tolerated the procedure without serious side effects. We compared the baseline data of these 82 patients (before CSAI) with those obtained from the last follow-up visit of each patient. The mean follow-up of CSAI was 19.93 +/- 16.3 months. Mean daily dose of CSAI was 72.00 +/- 21.38 mg run over 14.05 +/- 1.81 hours. We found a statistically significant reduction in off-hours, according to self-scoring diaries (6.64 +/- 3.09 vs. 1.36 +/- 1.42 hours/day, P < 0.0001), total and motor UPDRS scores (P < 0.0001), dyskinesia severity (P < 0.0006), and equivalent dose of antiparkinsonian therapy (1,405 +/- 536.7 vs. 800.1 +/- 472.9 mg of levodopa equivalent units P < 0.0001). CSAI is an effective option for patients with PD and severe fluctuations, poorly controlled by conventional oral drug treatment.
Assuntos
Antiparkinsonianos/administração & dosagem , Apomorfina/administração & dosagem , Doença de Parkinson/tratamento farmacológico , Atividades Cotidianas/classificação , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Marcha/efeitos dos fármacos , Humanos , Bombas de Infusão , Assistência de Longa Duração , Masculino , Pessoa de Meia-Idade , Atividade Motora/efeitos dos fármacos , Exame Neurológico/efeitos dos fármacos , Doença de Parkinson/diagnóstico , Resultado do TratamentoRESUMO
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Assuntos
Masculino , Adulto , Humanos , Coreia/complicações , Síndrome das Pernas Inquietas/complicações , Abetalipoproteinemia/fisiopatologia , Pulmão Hipertransparente/fisiopatologiaRESUMO
BACKGROUND AND OBJECTIVE: Parkinsonism is a group of neurological disorders characterized by extrapiramidal signs. Often, the differential diagnosis between parkinsonism, essential tremor and drug-induced parkinsonism is difficult. The aim of the study was to evaluate the utility of (123I)-FP-CIT SPECT in patients with movement disorders. PATIENTS AND METHOD: 52 patients were referred from the neurology department to characterize those with parkinsonism. Patients were clinically evaluated and those with Parkinson's disease were assessed using the rating scale Hoehn & Yahr and the UPDRS motor score. Subsequently, a (123I)-FP-CIT SPECT was performed with a qualitative analysis. RESULTS: All patients with essential tremor and drug-induced parkinsonism had a normal SPECT. All patients with parkinsonism displayed SPECT defects, except for four who had a normal SPECT result. Two of them were categorized as vascular parkinsonisms, one patient had a Shy-Drager's syndrome and the another one had probably a Parkinson's disease. The sensitivity and specificity were 90.47% (38/42; CI95%, 81.59%-99.35%) and 100% (10/10; CI95%, 69.15%-100%), respectively. CONCLUSIONS: (123I)-FP-CIT SPECT is an effective tool to study the integrity of the dopaminergic nigrostriatal system. Moreover, it permits to characterize the different types of parkinsonism.
