(Rev Méd Chile 2006; 134: 893-901D esde su introducción en la medicina a inicios de la década de 1960, la L-3,4-dihidroxifenilalanina o levodopa se ha convertido en uno de los fármacos más sorprendentes en neurología. Su capacidad de inducir una mejoría casi milagrosa en sujetos portadores de enfermedad de Parkinson (EP), rápidamente la convirtieron en el medicamento de elección para esta enfermedad 1 . Han pasado casi 50 años desde aquella irrupción de la levodopa en la neurología y continúa siendo el principal fármaco para tratar la EP, al que todos los portadores de esta enfermedad recurrirán durante su evolución.En los últimos años, diversas investigaciones han aportado nuevos conocimientos sobre los mecanismos de acción y la fisiopatología de las complicaciones inducidas por ella. También han surgido nuevas formas de administración y combinaciones terapéu-ticas con levodopa. Todo esto ha revitalizado el debate sobre este compuesto y ha introducido nuevos aspectos a considerar para su uso.El objetivo de esta revisión es repasar estos aspectos y entregar algunas recomendaciones actualizadas para su empleo en la EP en etapa inicial.
Los autores no refieren posibles conflictos de interés. ARTÍCULO ORIGINALThe International Classification of Functioning, Disability, and Health (ICF) aims to supply a reliable, standardized and common language that can be applied in different cultures allowing a description of human functioning and disability, using a universal view of disability. It belongs to a group of classifications from the World Health Organization providing an integral approach to the patient. It establishes a paradigm which approaches the problems of the patient linking the different components of functionality in a circular way where one system influences others, with mutual relationships between them. The model is established with two main parts: the first part includes the functioning and disability with two components a) body structure and function and b) activities and participation. The second part includes the so called contextual factors with two components c) environmental factors and d) personal factors. Each part is divided in domains and these in structures giving a branched structure to the classification. The usefulness of this classification is multiple. It can be used in various disciplines and also across them. It looks for providing a scientific basis for the understanding and study of health and the states related to it, to improve communication among users, such as health professionals, investigators, designers of health policies, and general population, including disabled people. It allows the comparison of data between countries, sanitary disciplines, services, and different periods of time. It gives a system of codification to be applied in the systems of sanitary information and clinical practice.
Motor slowness is the most characteristic motor deficit in Parkinson Disease (PD). The tapping test is a timed motor performance task which has been widely used in evaluation of PD. We study kinematics parameters of tapping test in PD and health control. Methods: Subjects consisted on 12 patients (2 women) with Parkinson's disease (PD) and 6 healthy control subjects (2 women). The mean age 63 ± 9.7 years PD and 64.8 ± 13.3 years control. Duration of disease was 5.8 ± 4.1 years. All patients were on levodopa medication. Procedures: All participants performed repetitive Hand/Arm movements between two points placed 25 cm apart horizontally for 20 successive taps ("as fast as possible"). The test was performed independently for each hand. Parkinson patients performed under the best ON condition. We assessed patients clinically using the motor section of the Unified Parkinson Disease Rating Scale (UPDRS). Informed consent was obtained. Apparatus: One standard video camera positioned perpendicularly from two target points recorded movement and referential xy system. A light reflective marker was attached to middle finger. The middle finger marker was manually digitized at a rate of 30 Hz using Kinematics Analysis software. Statistical analysis Kuskal-wallis one way analysis of variance, r spearman correlation. A p value < 0.05 was considered statistically significant. Results: Median Velocity in normal control was 94 ± 11 cm/s and in PD was 67 ± 15 cm/s (p < 0.001). Maximal velocity in normal control was 198 ± 20 cm/s and in PD was 143 ± 33 cm/s (p < 0.001). Median acceleration in normal control was 1630 ± 331 cm/s2 in PD was 966 ± 285 cm/s2 (p < 0.001). Median Movement amplitude in Y plane; in normal control was 28 ± 5 cm and in PD was 21 ± 8 cm (p < 0.01). Median Movement amplitude in Y plane correlated significantly with bradykinesia summary score (r =-0.59, p < 0.001). Conclusion: The kinematics studio provides a very good quantitative approximation to bradykinesia in PD. The UPDRS III score is only a partial assessment of bradykinesia and tapping tests obtain objective complementary information.
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