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Journal of Neural Transmission (Vienna,... Aug 2018The purpose of review is to review the current status of positron emission tomography (PET) molecular imaging of serotonergic system in Parkinson's patients who... (Review)
Review
The purpose of review is to review the current status of positron emission tomography (PET) molecular imaging of serotonergic system in Parkinson's patients who experience levodopa-induced (LIDs) and graft-induced dyskinesias (GIDs). PET imaging studies have shown that Parkinson's disease is characterized by progressive loss of dopaminergic and serotonergic neurons. Parkinson's patients who experienced LIDs and GIDs have an aberrant spreading of serotonergic terminals, which lead to an increased serotonergic/dopaminergic terminals ratio within the putamen. Serotonergic terminals convert exogenous levodopa into dopamine in a non-physiological manner and release an abnormal amount of dopamine without an auto-regulatory feedback. This results in higher swings in synaptic levels of dopamine, which leads to the development of LIDs and GIDs. The modulation of serotonergic terminals with 5-HT and 5-HT receptors agonists partially reduced these motor complications. In vivo PET studies confirmed that abnormal spreading of serotonergic terminals within the putamen has a pivotal role in the development of LIDs and GIDs. However, glutamatergic, adenosinergic, opioid systems, and phosphodiesterases 10A may also play a role in the development of these motor complications. An integrative multimodal imaging approach combining PET and MRI imaging techniques is needed to fully understand the mechanisms underlying the development of LIDs and GIDs.
Topics: Dyskinesia, Drug-Induced; Humans; Parkinson Disease; Positron-Emission Tomography; Serotonergic Neurons
PubMed: 29264660
DOI: 10.1007/s00702-017-1823-7 -
The Journal of Clinical Psychiatry 2017Many treatment interventions for tardive dyskinesia have been studied, but some have better evidence than others. Read this CME activity to get an expert's perspectives... (Comparative Study)
Comparative Study Review
Many treatment interventions for tardive dyskinesia have been studied, but some have better evidence than others. Read this CME activity to get an expert's perspectives on the evidence for older and newer treatments so that you can minimize abnormal movements in your patients.
Topics: Antipsychotic Agents; Humans; Tardive Dyskinesia
PubMed: 29345877
DOI: 10.4088/JCP.tv17016tx3c -
IEEE Transactions on Bio-medical... Jan 2018Fluctuations in response to levodopa in Parkinson's disease (PD) are difficult to treat as tools to monitor temporal patterns of symptoms are hampered by several...
OBJECTIVE
Fluctuations in response to levodopa in Parkinson's disease (PD) are difficult to treat as tools to monitor temporal patterns of symptoms are hampered by several challenges. The objective was to use wearable sensors to quantify the dose response of tremor, bradykinesia, and dyskinesia in individuals with PD.
METHODS
Thirteen individuals with PD and fluctuating motor benefit were instrumented with wrist and ankle motion sensors and recorded by video. Kinematic data were recorded as subjects completed a series of activities in a simulated home environment through transition from off to on medication. Subjects were evaluated using the unified Parkinson disease rating scale motor exam (UPDRS-III) at the start and end of data collection. Algorithms were applied to the kinematic data to score tremor, bradykinesia, and dyskinesia. A blinded clinician rated severity observed on video. Accuracy of algorithms was evaluated by comparing scores with clinician ratings using a receiver operating characteristic (ROC) analysis.
RESULTS
Algorithm scores for tremor, bradykinesia, and dyskinesia agreed with clinician ratings of video recordings (ROC area > 0.8). Summary metrics extracted from time intervals before and after taking medication provided quantitative measures of therapeutic response (p < 0.01). Radar charts provided intuitive visualization, with graphical features correlated with UPDRS-III scores (R = 0.81).
CONCLUSION
A system with wrist and ankle motion sensors can provide accurate measures of tremor, bradykinesia, and dyskinesia as patients complete routine activities.
SIGNIFICANCE
This technology could provide insight on motor fluctuations in the context of daily life to guide clinical management and aid in development of new therapies.
Topics: Aged; Algorithms; Biomechanical Phenomena; Cohort Studies; Drug Monitoring; Dyskinesias; Female; Humans; Levodopa; Male; Middle Aged; Parkinson Disease; ROC Curve; Wearable Electronic Devices
PubMed: 28459677
DOI: 10.1109/TBME.2017.2697764 -
BMC Psychiatry May 2013To identify the incidence rate of spontaneous dyskinesia (SD) and tardive dyskinesia (TD) in a general population and to examine the association between dykinesia and...
BACKGROUND
To identify the incidence rate of spontaneous dyskinesia (SD) and tardive dyskinesia (TD) in a general population and to examine the association between dykinesia and potential risk factors (exposure to metoclopramide [MCP], antipsychotic drugs, and history of diabetes and psychoses).
METHODS
A retrospective cohort study was conducted for the years 2001 through 2010, based on medical claims data from the Deseret Mutual Benefit Administrators (DMBA).
RESULTS
Thirty-four cases of TD and 229 cases of SD were identified. The incidence rate of TD among persons previously prescribed an antipsychotic or metoclopramide (MCP) (per 1,000) was 4.6 (1.6-7.7) for those with antipsychotic drug use only, 8.5 (4.8-12.2) for those with MCP use only, and 15.0 (2.0-28.1) for those with both antipsychotic and MCP use. In the general population, the incidence rate (per 100,000 person-years) of TD was 4.3 and of probable SD was 28.7. The incidence rates of TD and SD increased with age and were greater for females. Those with diabetes or psychoses had almost a 3-fold greater risk of TD than those without either of these diseases. Persons with schizophrenia had 31.2 times increased risk of TD than those without the disease. Positive associations also existed between the selected diseases and the incidence rate of probable SD, with persons with schizophrenia having 4.4 times greater risk of SD than those without the disease.
CONCLUSIONS
SD and TD are rare in this general population. Diabetes, psychoses, and especially schizophrenia are positively associated with SD and TD. A higher proportion of those with SD present with spasm of the eyelid muscles (blepharospasm) compared more with the TD cases who present more with orofacial muscular problems.
Topics: Adult; Antipsychotic Agents; Dyskinesia, Drug-Induced; Dyskinesias; Female; Humans; Incidence; Male; Metoclopramide; Middle Aged; Retrospective Studies; Risk Factors; Schizophrenia; Sex Factors; United States
PubMed: 23714238
DOI: 10.1186/1471-244X-13-152 -
Movement Disorders : Official Journal... Dec 2021
Topics: COVID-19; ChAdOx1 nCoV-19; Dyskinesias; Humans; SARS-CoV-2; Vaccination
PubMed: 34581453
DOI: 10.1002/mds.28796 -
Neuropsychopharmacologia Hungarica : a... Dec 2015Parkinson's disease is the second most common neurodegenerative disorder around the world. Levodopa has remained the "gold standard" of the therapy even several decades... (Review)
Review
Parkinson's disease is the second most common neurodegenerative disorder around the world. Levodopa has remained the "gold standard" of the therapy even several decades after its introduction. Chronic levodopa treatment is associated with the development of motor complications in most patients. Advanced Parkinson's disease is characterized by these complications: motor and non-motor fluctuation and disturbing dyskinesia. Continuous dopaminergic stimulation might reduce these complications. In advanced Parkinson's disease levodopa is still effective. In the treatment of this stage there are several advanced or device-aided therapies: apomorphine pump, deep brain stimulation and levodopa/carbidopa intestinal gel. Levodopa/carbidopa intestinal gel is an aqueous gel that can be delivered to the jejunum via a percutaneous gastrojejunostomy tube which is connected to an infusion pump dosing the levodopa gel continuously to the place of absorption. Levodopa/carbidopa gel infusion can be used as monotherapy, can be tested, can be used individually and this therapy is reversible. Several clinical trials demonstrated that levodopa/carbidopa intestinal gel therapy is of long-term benefit, improves the quality of life of the patients and can reduce motor fluctuation and dyskinesia.
Topics: Antiparkinson Agents; Carbidopa; Dopamine Agents; Dyskinesias; Gastrostomy; Gels; Humans; Intestines; Jejunostomy; Levodopa; Parkinson Disease; Quality of Life
PubMed: 26727723
DOI: No ID Found -
Neurorehabilitation and Neural Repair Jul 2021Parkinson disease (PD) and other related diseases with α-synuclein pathology are associated with a long prodromal or preclinical stage of disease. Predictive models... (Review)
Review
Parkinson disease (PD) and other related diseases with α-synuclein pathology are associated with a long prodromal or preclinical stage of disease. Predictive models based on diagnosis of idiopathic rapid eye movement (REM) sleep behavior disorder (iRBD) make it possible to identify people in the prodromal stage of synucleinopathy who have a high probability of future disease and provide an opportunity to implement neuroprotective therapies. However, rehabilitation providers may be unaware of iRBD and the motor abnormalities that indicate early motor system dysfunction related to α-synuclein pathology. Furthermore, there is no existing rehabilitation framework to guide early interventions for people with iRBD. The purpose of this work is to (1) review extrapyramidal signs of motor system dysfunction in people with iRBD and (2) propose a framework for early protective or preventive therapies in prodromal synucleinopathy using iRBD as a predictive marker. Longitudinal and cross-sectional studies indicate that the earliest emerging motor deficits in iRBD are bradykinesia, deficits performing activities of daily living, and abnormalities in speech, gait, and posture. These deficits may emerge up to 12 years before a diagnosis of synucleinopathy. The proposed rehabilitation framework for iRBD includes early exercise-based interventions of aerobic exercise, progressive resistance training, and multimodal exercise with rehabilitation consultations to address exercise prescription, progression, and monitoring. This rehabilitation framework may be used to implement neuroprotective, multidisciplinary, and proactive clinical care in people with a high likelihood of conversion to PD, dementia with Lewy bodies, or multiple systems atrophy.
Topics: Dyskinesias; Exercise Therapy; Humans; Neurological Rehabilitation; Prodromal Symptoms; REM Sleep Behavior Disorder; Synucleinopathies
PubMed: 33978530
DOI: 10.1177/15459683211011238 -
Journal of Clinical Sleep Medicine :... Jul 2019mutations cause early-onset hyperkinetic movement disorders comprising diurnal and nocturnal paroxysmal dyskinesia, and patient-reported sleep fragmentation. We aimed...
STUDY OBJECTIVES
mutations cause early-onset hyperkinetic movement disorders comprising diurnal and nocturnal paroxysmal dyskinesia, and patient-reported sleep fragmentation. We aimed to characterize all movements occurring during sleep and in the transition from sleep to awakening, to ascertain if there is a primary sleep disorder, or if the sleep disturbance is rather a consequence of the dyskinesia.
METHODS
Using video polysomnography, we evaluated the nocturnal motor events and abnormal movements in 7 patients with -related dyskinesia and compared their sleep measures with those of 14 age- and sex-matched healthy controls.
RESULTS
We observed an increased occurrence of abnormal movements during wake periods compared to sleep in patients with -related dyskinesia. While asleep, abnormal movements occurred more frequently during stage N2 and REM sleep, in contrast with stage N3 sleep. Abnormal movements were also more frequent during morning awakenings compared to wake periods before falling asleep. The pattern of the nocturnal abnormal movements mirrored those observed during waking hours. Compared to controls, patients with -related dyskinesia had lower sleep efficiencies due to prolonged awakenings secondary to the abnormal movements, but no other differences in sleep measures. Notably, sleep onset latency was short and devoid of violent abnormal movements.
CONCLUSIONS
In this series of patients with -related dyskinesia, nocturnal paroxysmal dyskinesia were not associated with drowsiness or delayed sleep onset, but emerged during nighttime awakenings with subsequent delayed sleep, whereas sleep architecture was normal.
Topics: Adenylyl Cyclases; Adolescent; Adult; Aged; Dyskinesias; Female; Humans; Male; Polysomnography; Sleep Wake Disorders; Time
PubMed: 31383240
DOI: 10.5664/jcsm.7886 -
Clinical Medicine (London, England) Mar 2020
Topics: Chorea; Diabetes Mellitus; Dyskinesias; Humans; Hyperglycemia; Neurology
PubMed: 32409348
DOI: 10.7861/clinmed.20-2-s21 -
Revista de Neurologia Sep 2013Paroxysmal events in childhood are a challenge for pediatric neurologists, given its highly heterogeneous clinical manifestations, often difficult to distinguish between... (Review)
Review
Paroxysmal events in childhood are a challenge for pediatric neurologists, given its highly heterogeneous clinical manifestations, often difficult to distinguish between phenomena of epileptic seizure or not. The non-epileptic paroxysmal episodes are neurological phenomena, with motor, sensory symptoms, and/or sensory impairments, with or without involvement of consciousness, epileptic phenomena unrelated, so no electroencephalographic correlative expression between or during episodes. From the clinical point of view can be classified into four groups: motor phenomena, syncope, migraine (and associated conditions) and acute psychiatric symptoms. In this paper we analyze paroxysmal motor phenomena in awake children, dividing them according to their clinical manifestations: extrapyramidal episodes (paroxysmal kinesiogenic, non kinesiogenic and not related to exercise dyskinesias, Dopa responsive dystonia) and similar symptoms of dystonia (Sandifer syndrome); manifestations of startle (hyperekplexia); episodic eye and head movements (benign paroxysmal tonic upward gaze nistagmus deviation); episodic ataxia (familial episodic ataxias, paroxysmal benign vertigo); stereotyped and phenomena of self-gratification; and myoclonic events (benign myoclonus of early infancy). The detection of these syndromes will, in many cases, allow an adequate genetic counseling, initiate a specific treatment and avoid unnecessary additional studies. Molecular studies have demonstrated a real relationship between epileptic and non-epileptic basis of many of these entities and surely the identification of the molecular basis and understanding of the pathophysiological mechanisms in many of them allow us, in the near future will benefit our patients.
Topics: Anticonvulsants; Ataxia; Benign Paroxysmal Positional Vertigo; Child; Child, Preschool; Diagnosis, Differential; Dyskinesias; Dystonia; Electroencephalography; Exercise; Humans; Movement Disorders; Myoclonus; Seizures; Self Stimulation; Stereotypic Movement Disorder; Stiff-Person Syndrome; Vertigo; Wakefulness
PubMed: 23897137
DOI: No ID Found