Enfermedad de Parkinson avanzada. Características clínicas y tratamiento (parte I)

Abstract

Severe motor fluctuations and dyskinesias, axial motor symptoms resistant to levodopa, and cognitive decline are the main signs in the clinical phenotype of advanced PD.

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

“…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].…”

Epothilone B Benefits Nigral Dopaminergic Neurons by Attenuating Microglia Activation in the 6-Hydroxydopamine Lesion Mouse Model of Parkinson’s Disease

“…Parkinson’s disease (PD) is one of the most common and debilitating age-associated human neurodegenerative disorders, characterized by a variety of symptoms such as resting tremor, bradykinesia, rigidity and postural instability (Mullin and Schapira, 2015 ; Kabra et al, 2018 ). The pathogenesis of PD is a progressive loss of dopamine (DA) neurons in the substantia nigra pars compacta (SNc) and a subsequent reduction in striatal DA levels (Kulisevsky et al, 2013 ). The present clinical intervention for PD aims principally to ameliorate the clinical manifestations of the disorder (Jeon et al, 2010 ; Kulisevsky et al, 2013 ), there is no effective cure that can stop or slow the degeneration of DA neurons.…”

Estimulación cerebral profunda en enfermedad de Parkinson

“…Estos síntomas suelen ser de inicio y evolución asimétrica, inician en miembros superiores y se hacen bilaterales en un promedio de tres años (12,13). En las etapas avanzadas, se presentan manifestaciones refractarias al tratamiento como discinesias, fluctuaciones motoras, trastornos de la postura, marcha, disfagia, y disartria (14). Los síntomas no motores pueden preceder a la clínica motora e incluyen trastornos del sueño, síntomas autonómicos, gastrointestinales, cognitivos, dolor y otros (5,14).…”

“…En las etapas avanzadas, se presentan manifestaciones refractarias al tratamiento como discinesias, fluctuaciones motoras, trastornos de la postura, marcha, disfagia, y disartria (14). Los síntomas no motores pueden preceder a la clínica motora e incluyen trastornos del sueño, síntomas autonómicos, gastrointestinales, cognitivos, dolor y otros (5,14). A medida que avanza la enfermedad se hacen evidentes síntomas psiquiátricos como ludopatía, hipersexualidad, compras compulsivas, agresión, celos y fobias, principalmente en aquellos que abusan de fármacos dopaminérgicos (14,15).…”