RESUMO
This study proposes a Speech Therapy treatment for individuals with sialorrhea (saliva production perceived by patient as excessive) as a consequence of Parkinson Disease (PD). Method: A prospective study in 18 individuals with PD diagnosis was taken and divided into two groups: A) received only Cognitive Behavioral Therapy (CBT) (swallowing process awareness), while B) received CBT plus Thermal Tactile Stimulation (TTS) (cold sensory stimulation to the pharyngeal anterior pillars and oral cavity). The intervention lasted 5 weeks. The purpose of this research was to prove the effectiveness of Speech Therapy in dealing with sialorrhea and to assess a significant difference between CBT and CBT plus TTS. A t-student parameter test and the Mann-Withney test were used. Resulted: The assessment by the Clinical Scale for Parkinson Sialorrhea (SCS-PD) prior to therapy was CBT group was 2.6 and 11.5 ± 9.4 ± 4.2 group difference was not statistically significant. After therapy was 3.5 ± 2.8 and 4.6 ± 3.5 both showed a statistically significant difference compared to baseline (p < 0.001), not having statistically significant difference between them. Conclusion: These tests showed that both treatments are effective to decrease sialorrhea perception in individuals with PD. Nevertheless, no statistical significant differences were noted between both treatments.
Introducción: Este estudio propone un tratamiento Fonoaudiológico para trabajar con personas que presentan sialorrea (producción de saliva que el paciente percibe como excesiva) producto de la Enfermedad de Parkinson (EP). Método: Dieciocho personas con diagnóstico de EP y sialorrea, las cuales se dividieron en dos grupos; A: recibió sólo Terapia Cognitivo Conductual (TCC) (concientización del proceso deglutorio), mientras el B: recibió TCC más Estimulación Termo Táctil (ETT) (se realiza estimulación sensorial con frío a los pilares faríngeos anteriores y cavidad oral), la intervención se realizó por 5 semanas. El objetivo de la presente investigación es evidenciar la efectividad de la terapia Fonoaudiológica en el abordaje de la sialorrea y evaluar si existe una diferencia significativa entre la TCC y la TCC más ETT. Se utilizó la prueba paramétrica t-student, y Test de Mann-Withney, se consideró significativo un p < 0,05. Resultados: La valoración mediante la Escala Clínica de la Sialorrea para Parkinson (SCS-PD) previo a la terapia en grupo con TCC 11,5 ± 2,6 y el grupo 9,4 ± 4,2 diferencia que no es estadísticamente significativa. Posterior a la terapia fue 3,5 ± 2,8 y 4,6 ± 3,5 ambos presentaron una diferencia estadísticamente significativa respecto a la basal (p < 0,001), no habiendo diferencia estadísticamente significativa entre ellas. Conclusión: Estas pruebas demostraron que ambos tratamientos son efectivos para disminuir la percepción de sialorrea en las personas con EP. Sin embargo, no se evidencian diferencias estadísticamente significativas entre ambos tratamientos.
Assuntos
Humanos , Masculino , Feminino , Idoso , Doença de Parkinson , Sialorreia , Terapêutica , Terapia Cognitivo-Comportamental , Estudos ProspectivosRESUMO
BACKGROUND: Olfactory deficits and executive dysfunction have been reported in Parkinson's disease (PD). However, the association between these deficits has not been thoroughly examined. METHODS: We studied 44 PD subjects and 17 age-matched controls. In PD subjects, symptoms were assessed with the Unified Parkinson's Disease Rating Scale and the Hoehn and Yahr scale. Cognition in both groups was assessed by a neuropsychological battery. Olfactory identification and sensitivity was evaluated with the Sniffin' Sticks® test and olfactory detection threshold, respectively. RESULTS: PD subjects showed significant deficits in olfactory function and working memory, executive function, speed of information processing, visuospatial skills and phonological verbal fluency tests when compared with the control group. Moreover, there was a significant correlation between olfactory sensory deficits and executive dysfunction. In PD patients with up to 12 months of motor symptoms, results were equivalent. CONCLUSION: Our preliminary results suggest a significant association between olfactory deficits and impairments of executive functions in PD.
Assuntos
Transtornos Cognitivos/etiologia , Transtornos do Olfato/etiologia , Doença de Parkinson/complicações , Idoso , Estudos de Casos e Controles , Transtornos Cognitivos/diagnóstico , Progressão da Doença , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Exame Neurológico , Testes Neuropsicológicos , Transtornos do Olfato/diagnóstico , Estatísticas não ParamétricasRESUMO
We report the clinical features of the original Chilean family with Kufor-Rakeb syndrome (KRS) that led to the discovery of the ATP13A2 gene at the PARK9 locus. KRS is a rare juvenile-onset autosomal recessive disease characterized by progressive Parkinsonism, pyramidal signs, and cognitive decline in addition to vertical gaze palsy and facial-faucial-finger minimyoclonus. Neurological and neuropsychological examination during a 10-year period, videotaping, neuroimaging, and measurement of DNA methylation of the ATP13A2 promoter region were performed. The youngest 5 of 17 children of nonconsanguineous parents, carrying compound-heterozygous ATP13A2 mutations, had normal development until ages â¼10 to 12 years, when school performance deteriorated and slowness, rigidity, and frequent falls developed. Examination revealed bradykinesia, subtle postural/action tremor, cogwheel rigidity, spasticity, upward gaze palsy, smooth pursuit with saccadic intrusions, and dementia. Additional signs included facial-faucial-finger minimyoclonus, absent postural reflexes, visual/auditory hallucinations, and insomnia. Levodopa response could not be fully judged in this family. T2* magnetic resonance imaging sequences revealed marked diffuse hypointensity of the caudate (head and body) and lenticular nucleus bilaterally. Disease progression was slow including epilepsy, cachexia, and anarthria. Four affected members died after 28.5 ± 5.5 (mean ± SD) years of disease. Two heterozygous carriers, the mother and eldest sibling, showed jerky perioral muscle contractions and clumsiness of hand movements. There was no significant correlation between DNA methylation of the ATP13A2 promoter region and disease progression. The marked caudate and lenticular nucleus T2*-hypointensity suggests that KRS might belong to the family of neurodegenerative diseases associated with brain iron accumulation.
Assuntos
Encéfalo/fisiopatologia , ATPases Translocadoras de Prótons/genética , Idade de Início , Encéfalo/patologia , Chile , Metilação de DNA , Progressão da Doença , Testes Genéticos , Humanos , Imageamento por Ressonância Magnética , Exame Neurológico , Testes Neuropsicológicos , Transtornos Parkinsonianos/genética , Transtornos Parkinsonianos/patologia , Transtornos Parkinsonianos/fisiopatologia , Linhagem , Regiões Promotoras GenéticasRESUMO
Parkinson's disease (PD) is a common progressive neurodegenerative disorder. Dopamine replacement therapy considerably reduces motor handicap. Although levodopa continues as the gold standard for efficacy, its chronic use is associated with potentially disabling motor complications. Strategies to treat levodopa-related motor complications are only partially effective. Best results are currently achieved with invasive strategies via subcutaneous (s.c.) or intraduodenal delivery of apomorphine or levodopa, or deep brain stimulation of the subthalamic nucleus. This presentation will develop the current treatment principles for PD: (1) L-dopa does not accelerate disease progression, (2) no treatment modality exerts neuroprotective effects, (3) L-dopa is more effective than dopamine agonists in alleviating motor symptoms and improving the activities of daily living (ADL) score, in parkinsonian patients, (4) Treatment with dopamine agonist is associated with fewer motor complications than L-dopa. (5) Dopamine agonist therapy is associated with more frequent adverse events than L-dopa therapy, such as hallucinations and somnolence. There is no evidence of a long-term benefit with initial dopamine agonist therapy.
Assuntos
Antiparasitários/uso terapêutico , Doença de Parkinson/tratamento farmacológico , Antiparasitários/efeitos adversos , Distúrbios do Sono por Sonolência Excessiva/induzido quimicamente , Agonistas de Dopamina/efeitos adversos , Agonistas de Dopamina/uso terapêutico , Alucinações/induzido quimicamente , Humanos , Levodopa/efeitos adversos , Levodopa/uso terapêutico , Inibidores da Monoaminoxidase/uso terapêutico , Doença de Parkinson/psicologiaRESUMO
Parkinson's disease (PD) is a neurodegenerative disorder, predominantly characterized by the presence of motor symptoms. However, the non motor manifestations (NMM) are a frequent complaint in the PD patients. There is a lack of information about the risk factors associated with the NMM in these patients. The aim of this study is to evaluate the prevalence of the more common NMM in a population of PD patients and to determine the features associated with its development. We studied 124 ambulatory PD patients. NMM were defined by the presence of neuropsychiatric manifestations, cognitive disorder, autonomic dysfunction or sleep related problems. In a multivariate analysis we found that the years of evolution of the PD and the presence of cognitive dysfunction are the risk factors for the neuropsychiatric and autonomic manifestations, whereas axial impairment is a risk factor for cognitive disorders and dyskinesias is for sleep related problems. In conclusion, this study shows that the features related to the PD progression appear as the main risk factors associated with NMM.
Assuntos
Doenças do Sistema Nervoso Autônomo/etiologia , Transtornos Cognitivos/etiologia , Doença de Parkinson/complicações , Transtornos do Sono-Vigília/etiologia , Idoso , Antiparkinsonianos/uso terapêutico , Feminino , Humanos , Masculino , Análise Multivariada , Doença de Parkinson/tratamento farmacológico , Estudos Prospectivos , Fatores de RiscoRESUMO
Parkinson's disease (PD) is a neurodegenerative disorder, predominantly characterized by the presence of motor symptoms. However, the non motor manifestations (NMM) are a frequent complaint in the PD patients. There is a lack of information about the risk factors associated with the NMM in these patients. The aim of this study is to evaluate the prevalence of the more common NMM in a population of PD patients and to determine the features associated with its development. We studied 124 ambulatory PD patients. NMM were defined by the presence of neuropsychiatric manifestations, cognitive disorder, autonomic dysfunction or sleep related problems. In a multivariate analysis we found that the years of evolution of the PD and the presence of cognitive dysfunction are the risk factors for the neuropsychiatric and autonomic manifestations, whereas axial impairment is a risk factor for cognitive disorders and dyskinesias is for sleep related problems. In conclusion, this study shows that the features related to the PD progression appear as the main risk factors associated with NMM.
La enfermedad de Parkinson (EP) es un trastorno neurodegenerativo, caracterizado predominan-temente por la presencia de síntomas motores. No obstante, la presencia de manifestaciones no motoras (MNN) son frecuentes en los pacientes con EP. Existe escasa información sobre los factores de riesgo asociados con la aparición de MNN en dichos pacientes. El objetivo de este estudio fue evaluar la prevalencia de las MNN más comunes en una población de pacientes portadores de EP y determinar los factores de riesgo asociados con su aparición. Estudiamos 124 pacientes portadores de EP atendidos en forma ambulatoria. La presencia de MNN fue definida por la aparición de manifestaciones neuropsiquiátricas, trastorno cognitivo, disfunción autonómica o alteraciones del sueño. En el análisis multivariado encontramos que los años de evolución de la EP y la presencia de disfunción cognitiva son los principales factores de riesgo para las manifestaciones neuropsiquiátricas y autonómicas, mientras que el compromiso axial es el mayor factor de riesgo para la aparición de manifestaciones cognitivas y la presencia de discinesias es el principal factor asociado con la aparición de trastornos del sueño. En conclusión, este estudio muestra que los factores asociados a la progresión de la EP son los principales factores de riesgo para la aparición de las MNN en nuestra población.
Assuntos
Idoso , Feminino , Humanos , Masculino , Doenças do Sistema Nervoso Autônomo/etiologia , Transtornos Cognitivos/etiologia , Doença de Parkinson/complicações , Transtornos do Sono-Vigília/etiologia , Antiparkinsonianos/uso terapêutico , Análise Multivariada , Estudos Prospectivos , Doença de Parkinson/tratamento farmacológico , Fatores de RiscoRESUMO
Se estima que entre el 0,8 y 1,42% de la población general presenta algún grado de disfunción olfativa. En estudios epidemiológicos de población general han demostrado que esto aumenta con la edad, llegando a afectar al 29% de las personas entre 70 y 79 años. Las causas más comunes del déficit de olfacción en el adulto mayor son trauma de cráneo, inflamación del tracto respiratorio alto de etiología tanto infecciosa como alérgica y las enfermedades degenerativas del sistema nervioso central como la enfermedad de Alzheimer y de Parkinson. El 60 al 90% de los pacientes con Enfermedad de Párkinson tiene déficit olfativo, siendo uno de los síntomas más frecuentes de la enfermedad. Se presenta en forma precoz y bilateral, el déficit en general no es a todos los olores, permaneciendo la habilidad de reconocer algunos. En esta revisión, se caracteriza la forma de presentación de este trastorno y su impacto como un marcador biológico en la enfermedad de Parkinson...
Between 0,8 to 1,42% of the population presents some grade of smell dysfunction. Several epidemiological studies have demonstrated that this increases with the age, affecting to 29% of subjects between 70 and 79 years. The more common causes of this dysfunction are skull trauma, inflammation of upper respiratory tract of infectious or allergic etiologies and the degenerative diseases of the central nervous system, mainly Alzheimer and Parkinson disease. Between 60 to 90% of the patients with Parkinson Disease have smell deficit, being one of the more common symptoms in this disease. Usually this smell dysfunction is presented bilaterally and it appears early in the course of the disease. In this review is characterized the clinical presentation of this dysfunction and its impact as a biological marker in the PD...
Assuntos
Doenças Neurodegenerativas , Transtornos do Olfato , Doença de Parkinson , Olfato , Sistema Nervoso CentralRESUMO
BACKGROUND: There are doubts wether generic medications have the same bioavailability and efficacy compared with the original drugs developed by pharmaceutical companies with research capabilities. AIM: To compare the pharmacokinetics and clinical (motor) responses of Sinemet and Grifoparkin (generic carbidopa/levodopa 250/25 mg) in patients with advanced Parkinson's disease. PATIENTS AND METHODS: Patients were randomly assigned to Sinemet (15 patients 62 +/- 12 years old; mean disease duration 11 +/- 7 years) or Grifoparkin (15 patients, 64 +/- 11 years old; mean disease duration 12 +/- 4 years) groups. Medication and food were withheld 12 h before the study. Fifteen blood samples were collected (starting 9 AM) immediately before (sample 1, t = 0 min) and after (samples 2-15, t = 20-360 min) oral administration of a single dose of Sinemet or Grifoparkin, and plasmatic L-DOPA was quantified using HPLC with electrochemical detection. Additionally, each patient was clinically evaluated every 20 minutes, using the tapping test and the unified Parkinson's disease scale Hoehn & Yarh. RESULTS: Tmax (time at which the maximal L-DOPA concentration was reached) were 69 +/- 12 min and 64 +/- 11 min for Sinemet and Grifoparkin respectively (NS). Cmax (maximal L-DOPA concentration reached) was 3161 +/- 345 ng/ml for Sinemet and 3274 +/- 520 ng/ml for Grifoparkin (NS). The t1/2 (half life time), CL (clearance) and volume of distribution (Vd) values calculated were 159 +/- 32 min, 51.7 +/- 5.1 1/h and 3.6 +/- 1.2 l/kg for Sinemet and 161 +/- 48 min, 58.7 +/- 8 l/h and 3.0 +/- 0.7 l/kg for Grifoparkin (NS). UPDRS-III value for the best "on state" and for the worst "off state" were 23 +/- 11 and 50 +/- 19 for Sinemet and 20 +/- 7 and 46 +/- 13 for Grifoparkin respectively (NS). CONCLUSION: The results obtained showed that both drugs are bioequivalent in patients with advanced Parkinson's disease.
Assuntos
Antiparkinsonianos/farmacocinética , Carbidopa/farmacocinética , Levodopa/farmacocinética , Doença de Parkinson/metabolismo , Antiparkinsonianos/administração & dosagem , Disponibilidade Biológica , Carbidopa/administração & dosagem , Método Duplo-Cego , Combinação de Medicamentos , Feminino , Humanos , Levodopa/administração & dosagem , Masculino , Pessoa de Meia-Idade , Doença de Parkinson/tratamento farmacológicoRESUMO
A dos décadas de la aparición de las primeras publicaciones sobre los usos terapéuticos de la toxina botulínica (TB), presentamos una revisión sobre la situación de esta terapia en pacientes con distonía, analizando efectividad, seguridad y complicaciones. Se comentan aspectos en controversia tales como: valor de la determinación de anticuerpos, correlación de éstos con la respuesta clínica y homologación de las unidades de TB, para las formulaciones de tipos A y B, disponibles en el mercado.
Assuntos
Humanos , Distonia/tratamento farmacológico , Toxinas Botulínicas/administração & dosagem , Toxinas Botulínicas/efeitos adversos , Toxinas Botulínicas/uso terapêuticoRESUMO
La distonía se define como una co-contracción de músculos agonistas y antagonistas sostenida que puede causar torsión, movimientos involuntarios o posturas anormales. Las distonías ocupacionales corresponden a un grupo especial de patología secundaria a un esfuerzo repetitivo relacionado con la actividad profesional que realiza el afectado, como en guitarristas, violinistas y trompetistas. En su fisiopatología se describen alteraciones a nivel del sistema nervioso periférico y central. Estudios en monos han demostrado que los movimientos repetitivos mediante una estimulación sensitiva pueden producir anomalías centrales en la corteza somatosensorial con un crecimiento de los campos receptivos estimulados y deformación de las separaciones entre dichos campos. La reeducación sensorial con el uso de una férula y esquemas de ejercicio aparece como una alternativa terapéutica. Se revisa la evidencia acumulada que apoya la hipótesis de que las distonías ocupacionales producidas por una estimulación repetitiva presentan alteraciones a nivel sensitivo cortical con compromiso del rendimiento motor que se benefician con terapia de reeducación sensorial.
Assuntos
Humanos , Distonia/diagnóstico , Riscos Ocupacionais , Transtornos Traumáticos CumulativosRESUMO
Se reporta el seguimiento de un año del efecto sobre los síntomas motores en 3 pacientes portadores de una enfermedad de parkinson que fueron tratados con terapia electroconvulsiva. Los pacientes fueron evaluados uno, seis y doce meses posteriores a la terapia electroconvulsiva y los resultados sugieren el efecto benéfico sobre los síntomas motores de la enfermedad de parkinson que resulta limitado en el tiempo a menos de 6 meses. Se discute el papel actual de este tipo de terapia en el manejo de la enfermedad de parkinson
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Eletroconvulsoterapia , Doença de Parkinson/terapia , Antiparkinsonianos/uso terapêutico , Desempenho Psicomotor/fisiologia , Seguimentos , Avaliação de Resultados em Cuidados de Saúde/estatística & dados numéricos , Tempo de ReaçãoRESUMO
Se presenta un caso clínico de intoxicación aguda por metanol con amaurosis y paraparesia espástica secuelares que no han respondido al tratamiento esteroidal oral ni intratecal. Se detallan los resultados de su estudio electroencefalográfico, electromiográfico y tomográfico axial computado que reveló hipodensidad putaminal bilateral con cisternas silvianas dilatadas. Se revisa en forma general la clínica y el tratamiento de la intoxicación aguda por metanol, señalando suas probables proyecciones a futuro. Se hace una revisión bibliográfica de las secuelas de la intoxicación por metanol, enfatizando las motoras descritas sólo a partir de 1950