RESUMEN
The objective of this study was to investigate how acetylcholinesterase inhibitor (ChEI) treatment affects brain function in Parkinson's disease (PD). Twelve patients with PD and either dementia or mild cognitive impairment underwent task-free functional magnetic resonance imaging before and after 3 months of ChEI treatment and were compared with 15 age- and sex-matched neurologically healthy controls. Regional spontaneous brain activity was measured using the fractional amplitude of low-frequency fluctuations. At baseline, patients showed reduced spontaneous brain activity in regions important for motor control (eg, caudate, supplementary motor area, precentral gyrus, thalamus), attention and executive functions (eg, lateral prefrontal cortex), and episodic memory (eg, precuneus, angular gyrus, hippocampus). After treatment, the patients showed a similar but less extensive pattern of reduced spontaneous brain activity relative to controls. Spontaneous brain activity deficits in the left premotor cortex, inferior frontal gyrus, and supplementary motor area were restored such that the activity was increased posttreatment compared with baseline and was no longer different from controls. Treatment-related increases in left premotor and inferior frontal cortex spontaneous brain activity correlated with parallel reaction time improvement on a test of controlled attention. PD patients with cognitive impairment show numerous regions of decreased spontaneous brain function compared with controls, and rivastigmine is associated with performance-related normalization in the left frontal cortex function.
Asunto(s)
Inhibidores de la Colinesterasa/uso terapéutico , Lóbulo Frontal/efectos de los fármacos , Fármacos Neuroprotectores/uso terapéutico , Enfermedad de Parkinson/tratamiento farmacológico , Fenilcarbamatos/uso terapéutico , Nivel de Alerta/efectos de los fármacos , Atención/efectos de los fármacos , Señales (Psicología) , Función Ejecutiva/efectos de los fármacos , Femenino , Lateralidad Funcional , Movimientos de la Cabeza/fisiología , Humanos , Procesamiento de Imagen Asistido por Computador , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Pruebas Neuropsicológicas , Enfermedad de Parkinson/fisiopatología , Enfermedad de Parkinson/psicología , Desempeño Psicomotor/efectos de los fármacos , Recuperación de la Función , Rivastigmina , Resultado del TratamientoRESUMEN
BACKGROUND: Improvement after bilateral globus pallidus internus deep brain stimulation (DBS) in primary generalized dystonia has been negatively associated with disease duration and age, but no predictive factors have been identified in primary cervical dystonia (CD). METHODS: Patients treated with bilateral globus pallidus internus DBS for primary CD from 2 DBS centers with preoperative and postoperative Toronto Western Spasmodic Torticollis Rating Scales (TWSTRS) were studied retrospectively to explore possible predictors of response. RESULTS: Patients showed significantly improved TWSTRS total and severity scores (n = 28, mean 55.6% and 50.8%, respectively, both P < .001). Patients with lateral shift at baseline had less improvement in TWSTRS severity subscores (P = .02). No correlations between outcomes and disease duration, age at dystonia onset or surgery, baseline scores, or other included variables were found. CONCLUSIONS: Although this is the largest study supporting efficacy of bilateral pallidal DBS in primary CD, no major clinical predictive outcomes of surgical benefit were identified.
Asunto(s)
Estimulación Encefálica Profunda/métodos , Globo Pálido/fisiología , Tortícolis/congénito , Adulto , Edad de Inicio , Anciano , Interpretación Estadística de Datos , Distonía/congénito , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Examen Neurológico , Valor Predictivo de las Pruebas , Pronóstico , Tortícolis/fisiopatología , Tortícolis/terapia , Resultado del Tratamiento , Adulto JovenRESUMEN
The Minnesota Center Against Violence and Abuse (MINCAVA) was established in 1994 through an appropriation of the Minnesota Legislature. Located at the University of Minnesota, MINCAVA conducts original research, develops extensive collections of translational materials, provides higher education training on family violence prevention, and disseminates information globally. Over a dozen professional and student staff work on projects funded by federal, state, and private sources and collaborate closely with national and global advisory boards and partner agencies as well as local community-based and national advocacy organizations. The Center operates multiple project-specific and general websites that receive millions of unique visits each year from dozens of countries.