Algorithms for the treatment of motor problems in Parkinson's disease

Dietrichs, Espen; Odin, Per

doi:10.1111/ane.12733

Cited by 49 publications

(39 citation statements)

References 69 publications

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“…However, in the absence of a biomarker, a diagnostic test, or a gold standard index to determine the severity of PD (based on the motor and nonmotor symptoms), clinicians often rely on varied clinical evaluation and medical history to determine staging in PD [2]. Recently published systematic reviews and consensus articles acknowledge the growing need to establish guidelines for the different treatment approaches for advanced PD patients [3][4][5][6][7][8]. At this stage, it is important to ensure timely referral of patients to a movement disorder specialist before deterioration of quality of life (QoL) and development of complications of advancing disease [9,10].…”

Section: Introductionmentioning

confidence: 99%

5-2-1 Criteria: A Simple Screening Tool for Identifying Advanced PD Patients Who Need an Optimization of Parkinson’s Treatment

Santos‐García

Fonticoba

Castro

et al. 2020

Parkinson's Disease

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Objective. 5-(5 times oral levodopa tablet taken/day) 2-(2 hours of OFF time/day) 1-(1 hour/day of troublesome dyskinesia) criteria have been proposed by a Delphi expert consensus panel for diagnosing advanced Parkinson's disease (PD). e aim of the present study is to compare quality of life (QoL) in PD patients with "5-2-1 positive criteria" vs QoL in PD patients without "5-2-1 positive criteria" (defined as meeting ≥1 of the criteria). Methods. is is a cross-sectional, observational, monocenter study. ree different instruments were used to assess QoL: the 39-Item Parkinson's Disease Quality of Life Questionnaire Summary Index Score (PDQ-39SI); a subjective rating of perceived QoL (PQ-10); and the EUROHIS-QOL 8-Item Index (EUROHIS-QOL8). Results. From a cohort of 102 PD patients (65.4 ± 8.2 years old, 53.9% males; disease duration 4.7 ± 4.5 years), 20 (19.6%) presented positive 5-2-1 criteria: 6.9% for 5, 17.6% for 2, and 4.9% for 1. 37.5% (12/32) and 25% (5/20) of patients with motor complications and dyskinesia, respectively, presented 5-2-1 negative criteria. Both health-related (PDQ-39SI, 25.6 ± 14 vs 12.1 ± 9.2; p < 0.0001) and global QoL (PQ-10, 6.1 ± 2 vs 7.1 ± 1.3; p � 0.007; EUROHIS-QOL8, 3.5 ± 0.5 vs 3.7 ± 0.4; p � 0.034) were worse in patients with 5-2-1 positive criteria. Moreover, nonmotor symptoms burden (Non-Motor Symptoms Scale total score, 64.8 ± 44.8 vs 39.4 ± 35.1; p < 0.0001) and autonomy for activities of daily living (ADLS scale, 73.5 ± 13.1 vs 89.2 ± 9.3; p < 0.0001) were worse in patients with 5-2-1 positive criteria. Patient's principal caregiver's strain (Caregiver Stain Index, 4.3 ± 3 vs 1.5 ± 1.6; p < 0.0001), burden (Zarit Caregiver Burden Inventory, 28.4 ± 12.5 vs 10.9 ± 9.8; p < 0.0001), and mood (Beck Depression Inventory II, 12.2 ± 7.2 vs 6.2 ± 6.1; p < 0.0001) were worse in patients with 5-2-1 positive criteria as well. Conclusions. QoL is worse in patients meeting ≥1 of the 5-2-1 criteria. is group of patients and their caregivers are more affected as a whole. ese criteria could be useful for identifying patients in which it is necessary to optimize Parkinson's treatment.

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Section: Introductionmentioning

confidence: 99%

5-2-1 Criteria: A Simple Screening Tool for Identifying Advanced PD Patients Who Need an Optimization of Parkinson’s Treatment

Santos‐García

Fonticoba

Castro

et al. 2020

Parkinson's Disease

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“…Here, because most patients were on medications, whether rigidity could be further reduced is unknown. Yet the potential remains that rigidity could be considered during medication changes along with concerns such as wearing off or fluctuations …”

Section: Discussionmentioning

confidence: 99%

“…Yet the potential remains that rigidity could be considered during medication changes along with concerns such as wearing off or fluctuations. [33][34][35] How might lower limb rigidity contribute to falls? Although abnormal deep tendon reflexes are not a key parkinsonian feature, 36 rigid patients exhibit increased long-latency electromyographic responses to passive joint movements 37,38 and possibly increased tonic muscle activity, 39 both of which may increase joint stiffness.…”

Section: Discussionmentioning

confidence: 99%

Lower Limb Rigidity Is Associated with Frequent Falls in Parkinson's Disease

McKay

Hackney

Factor

et al. 2019

Movement Disord Clin Pract

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Background and Objective The role of muscle rigidity as an etiological factor of falls in Parkinson's disease (PD) is poorly understood. Our objective was to determine whether lower leg rigidity was differentially associated with frequent falls in PD compared to upper limb, neck, and total rigidity measures. Methods We examined the associations between Unified Parkinson's Disease Rating Scale–Part III (motor) rigidity subscores and the history of monthly or more frequent falls in 216 individuals with PD (age, 66 ± 10 years; 36% female; disease duration, 7 ± 5 years) with logistic regression. Results A total of 35 individuals were frequent fallers. Significant associations were identified between lower limb rigidity and frequent falls (P = 0.01) after controlling for age, sex, PD duration, total Unified Parkinson's Disease Rating Scale– Part III score, and presence of freezing of gait. No significant associations (P ≥ 0.14) were identified for total, arm, or neck rigidity. Conclusion Lower limb rigidity is related to frequent falls in people with PD. Further investigation may be warranted into how parkinsonian rigidity could cause falls.

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“…Review Article / JAPR ISSN: 2357-0539 (Online) El Sayed et al, 2018, 2 (3 therefore, a potent treatment is urgently needed. 136 At the beginning of treatment, L-dopa is particularly effective to control symptoms of PD such as bradykinesia and rigidity, and it is well-tolerated, which called "honeymoon". However, there is a probability that approximately 40 % of patients develop motor complications after 4-6 years of L-dopa therapy.…”

Section: Issn: 2357-0547 (Print)mentioning

confidence: 99%

“…At the early stage of PD, initial treatment with MAO-B Inhibitor can delay the progression of the signs and symptoms of PD. 136 Selegiline is the first selective inhibitor for MAO-B used in treatment of PD. It was reported that selegiline can delay the need for L-dopa by retarding the progression of PD.…”

Section: Mao-b Inhibitorsmentioning

confidence: 99%

Parkinson's disease: A Review about Pathogenesis, Pharmaceutical Treatment and Experimental Models

Sayed

Eissa

Nofal

et al. 2018

Journal of Advanced Pharmacy Research

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Parkinson disease (PD) is the second most common age-related neurodegenerative disease after Alzheimer disease, characterized by loss of dopaminergic neurons in substantia nigra pars compacta, accompanied by motor and non-motor symptoms. Idiopathic PD is the most common cause of Parkinsonism (primary Parkinsonism) while, certain medication and different groups of neurological disorder may be causes of secondary Parkinsonism. The presence of intraneuronal proteinaceous cytoplasmic inclusions "Lewy Bodies" and the loss of the nigrostriatal dopaminergic neurons are the main neuropathological hallmarks of PD. However, the etiology of the disease is still undefined; several studies assume that oxidative stress, mitochondrial defects, neuroinflammation, apoptosis and excitotoxicity play vital roles in the pathogenesis and progress of the disease. Experimental models of PD can be induced by several neurotoxins such as 1methyl-4-phenyl-1,2,3,6-tetrahydropyridine, 6-hydroxydopamine, rotenone and paraquat which produce neuropathological and neurochemical changes that are identical to those seen in PD. The primary drug for PD treatment is L-dopa; however, drug-induced dyskinesia and motor complications restricted its use as long term treatment. Dopamine agonists are alternative options for initial treatment of PD and have been reported to retard the onset of motor complications. Combination of L-dopa with other medications, such as catechol-O-methyltransferase inhibitors and monoamine oxidase B inhibitors has the ability to alleviate L-dopa-induced motor complications. Anticholinergic drugs can be used to control the symptoms of PD but their cognitive and autonomic side effects make them unsuitable for the elderly.

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Algorithms for the treatment of motor problems in Parkinson's disease

Cited by 49 publications

References 69 publications

5-2-1 Criteria: A Simple Screening Tool for Identifying Advanced PD Patients Who Need an Optimization of Parkinson’s Treatment

5-2-1 Criteria: A Simple Screening Tool for Identifying Advanced PD Patients Who Need an Optimization of Parkinson’s Treatment

Lower Limb Rigidity Is Associated with Frequent Falls in Parkinson's Disease

Parkinson's disease: A Review about Pathogenesis, Pharmaceutical Treatment and Experimental Models

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