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Parkinsn Current Topics

TITLE: Respiratory function in Parkinson's disease.
AUTHORS: Shill H; Stacy M
AUTHOR AFFILIATION: Barrow Neurological Institute, Phoenix, Arizona, USA.
SOURCE: Clin Neurosci 1998;5(2):131-5
CITATION IDS: PMID: 10785839 UI: 20247545
ABSTRACT: This article reviews the spectrum of respiratory dysfunction in Parkinson's disease (PD). It includes the primary effects of PD on the ventilation, response to medications, and pulmonary complications of antiparkinson therapy. Primary pulmonary abnormalities include a restrictive change mainly secondary to chest wall rigidity and upper airway obstruction; both are responsive to dopaminergic modulation. Respiratory dyskinesia, a side effect of levodopa therapy, may produce both restrictive and dyskinetic ventilation. Therapy with ergot derivatives may result in pleuropulmonary fibrosis. Lastly, pulmonary infection as a consequence of disordered respiratory mechanics continues to contribute significantly to morbidity and mortality in PD.

2000/05
2000/16 09:00


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TITLE: Pharmacotherapy for advanced Parkinson's disease.
AUTHORS: Stacy M
AUTHOR AFFILIATION: Muhammad Ali Parkinson Center, Barrow Neurological Institute, Phoenix, Arizona 85213, USA.
SOURCE: Pharmacotherapy 2000 Jan;20(1 Pt 2):8S-16S
CITATION IDS: PMID: 10641987 UI: 20104973
ABSTRACT: Medical management of Parkinson's disease consists of two strategies. A presynaptic strategy attempts to maintain physiologic synaptic concentrations of dopamine, usually by individualizing delivery of levodopa (or exogenous dopamine) by varying the rate of gastrointestinal absorption or blood-brain barrier passage. A postsynaptic strategy bypasses degenerating nigrostriatal neurons by stimulating striatal neurons directly with dopamine agonists. With advancing disease, motor fluctuations appear, related to physiologic changes that narrow the window of levodopa concentration in which symptoms are under control. Then it becomes necessary to add dopamine agonists to therapy.

2000/01
2000/21 09:00


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TITLE: Parkinson's disease: therapeutic choices and timing decisions in patient management [interview by Wayne Kuznar]
AUTHORS: Stacy M
AUTHOR AFFILIATION: National Parkinson Foundation, Phoenix, AZ, USA.
SOURCE: Geriatrics 1999 Oct;54(10):44-9; quiz 50
CITATION IDS: PMID: 10542860 UI: 20010573
ABSTRACT: Parkinson's disease is a progressive neurodegenerative disorder characterized by striatal dopaminergic loss. Carbidopa/levodopa is the most effective drug treatment for disease management. It reduces bradykinesia and rigidity, but is less effective against tremor. Whether carbidopa/levodopa should be used at the time of initial diagnosis or delayed until symptoms become disabling is controversial. A clinical trial is in progress to help resolve this dilemma. As carbidopa/levodopa loses efficacy with continued use, adjunct therapies using catechol-O-methyl-transferase inhibitors or dopamine agonists may be considered. In younger patients exhibiting parkinsonian symptoms, dopamine agonists may be used as first-line therapy. A new, reversible surgical intervention known as deep-brain stimulator placement is being used to control disabling tremor in patients not responding to optimal drug therapy.

1999/10
1999/30 09:00


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TITLE: Differential diagnosis of Parkinson's disease and the parkinsonism plus syndromes.
AUTHORS: Stacy M; Jankovic J
AUTHOR AFFILIATION: Department of Neurology, University of Missouri, School of Medicine, Columbia.
SOURCE: Neurol Clin 1992 May;10(2):341-59
CITATION IDS: PMID: 1584178 UI: 92261523
ABSTRACT: Although Parkinson's disease (PD) is thought to represent a specific clinical-pathologic entity, up to 20% of patients diagnosed as having PD will have another disorder at autopsy. Furthermore, pathologic features typically associated with PD can also be observed in patients with other neurodegenerative disorders. This article attempts to point out the difficulties in differentiating PD from progressive supranuclear palsy and other parkinsonism plus syndromes and various causes of parkinsonism associated with cognitive changes. The clinical and pathologic differentiation of these disorders are discussed. These disorders are usually associated with postsynaptic receptor changes and therefore levodopa and dopamine agonists provide limited benefit.

1992/05
1992/01 00:00


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TITLE: Tardive tremor.
AUTHORS: Stacy M; Jankovic J
AUTHOR AFFILIATION: Department of Neurology, Baylor College of Medicine, Houston, Texas 77030.
SOURCE: Mov Disord 1992;7(1):53-7
CITATION IDS: PMID: 1348352 UI: 92212338
ABSTRACT: A variety of hyperkinetic movement disorders has been associated with the use of neuroleptics (dopamine receptor blocking drugs), but tardive tremor has not been previously documented. We describe five patients in whom tremor occurred after chronic treatment with neuroleptics, was aggravated by and persisted after neuroleptic withdrawal, and improved after treatment with the dopamine depleting drug tetrabenazine. This involuntary oscillatory movement, with a frequency range of 3-5 Hz, was most prominent during maintenance of a posture, but was also present at rest and during a goal-directed movement. The tremor was accompanied by other tardive movement disorders, including akathisia, chorea, dystonia, myoclonus, and stereotypy. There was no family history or other explanation for tremor in these patients. We suggest that this hitherto unreported movement disorder is best termed "tardive tremor."

1992/01
1992/01 00:00


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