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TITLE: Tremor-predominant Parkinson's disease. Approaches to treatment [In Process Citation]
AUTHORS: Marjama-Lyons J; Koller W
AUTHOR AFFILIATION: Department of Neurology, University of Florida, Jacksonville, USA. jm.lyons@jax.ufl.edu
SOURCE: Drugs Aging 2000 Apr;16(4):273-8
[MEDLINE record in process]
CITATION IDS: PMID: 10874522 UI: 20332696
ABSTRACT: Parkinson's disease is a neurodegenerative disorder that manifests clinically with variable degrees of tremor, muscle rigidity, bradykinesia and postural instability. Tremor-predominant Parkinson's disease is characterised by prominent tremor of one or more limbs with a relative lack of significant rigidity and bradykinesia. Despite the lack of other disabling motor symptoms, the tremor of tremor-predominant Parkinson's disease can be very disabling, especially if a postural and kinetic component exists. A wide variety of treatments for Parkinson's disease tremor are currently available and include use of oral medications, injections with botulinum toxin and neurosurgical procedures. Some of the first line medications (levodopa, dopamine agonists, anticholinergics) are very effective in controlling tremor. However, some patients with Parkinson's disease tremors are unresponsive to first line drugs and treatment with second line medications (clozapine, amantadine, clonazepam, propranolol, neurontin) should be attempted. In the small number of patients with disabling tremor that is refractory to all medications, neurosurgical intervention should be considered. Both thermocoagulation and deep brain stimulation at several different neuroanatomical sites (thalamus, globus pallidus, subthalamic nucleus) offer good to excellent tremor control with relatively low risk to the patient.


2000/06
2000/30 11:00


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TITLE: Linear pharmacokinetic behavior of ropinirole during multiple dosing in patients with Parkinson's disease [In Process Citation]
AUTHORS: Hubble J; Koller WC; Atchison P; Taylor AC; Citerone DR; Zussman BD; Friedman CJ; Hawker N
AUTHOR AFFILIATION: Ohio State University Parkinson's Disease Center, Columbus 43210, USA.
SOURCE: J Clin Pharmacol 2000 Jun;40(6):641-6
[MEDLINE record in process]
CITATION IDS: PMID: 10868315 UI: 20326297
ABSTRACT: The objectives of this study were to measure the pharmacokinetics of ropinirole at steady state when the drug is used as an adjunct to L-dopa and evaluate the long-term tolerability of ropinirole in this indication. Twenty-four patients who were taking L-dopa for Parkinson's disease and experiencing a lack of symptomatic control were recruited. Patients received open-label adjunctive treatment with ropinirole for up to 2 years. The starting dose was 0.5 mg bid, which could be titrated to a maximum of 6.0 mg tid. Ropinirole demonstrated approximately dose-linear pharmacokinetics at steady state; corresponding values were higher during tid than bid dosing. A reduction in mean L-dopa dose was maintained throughout the trial. The combination of L-dopa and ropinirole was generally well tolerated, with only 1 patient withdrawing from treatment because of adverse events. Thus, ropinirole shows approximately linear steady-state pharmacokinetics and a good safety profile when administered with L-dopa.


2000/06
2000/27 11:00


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TITLE: Surgical treatment of essential tremor.
AUTHORS: Pahwa R; Lyons K; Koller WC
AUTHOR AFFILIATION: Department of Neurology, University of Kansas Medical Center, Kansas City, Kansas 66160, USA.
SOURCE: Neurology 2000;54(11 Suppl 4):S39-44
CITATION IDS: PMID: 10854351 UI: 20312906
ABSTRACT: Surgical treatment for essential tremor (ET) has been used since the early 1950s. Initially, different areas were targeted for tremor control. However, the optimal target was eventually determined to be the ventralis intermedius (VIM) nucleus of the thalamus. Thalamotomy improves contralateral tremor in more than 90% of patients. Long-term studies of thalamotomy indicate that the benefits continue in most patients. Persistent morbidity associated with thalamotomy, which occurs in less than 10% of patients, includes dysarthria, dysequilibrium, weakness, and cognitive impairment. Bilateral thalamotomy is associated with substantial morbidity and is usually avoided. Studies demonstrate that chronic stimulation of the VIM is safe and effective for tremor. Adverse effects of chronic stimulation include paresthesia, dysarthria, dysequilibrium, and localized pain. In many patients, bilateral thalamic stimulation is performed without a substantial increase in morbidity. ET patients with disabling medication-resistant tremor are reasonable candidates for these stereotactic procedures.

2000/07
2000/08 11:00


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TITLE: Pharmacologic treatment of essential tremor.
AUTHORS: Koller WC; Hristova A; Brin M
AUTHOR AFFILIATION: Department of Neurology, University of Miami School of Medicine, Miami, Florida 33136, USA.
SOURCE: Neurology 2000;54(11 Suppl 4):S30-8
CITATION IDS: PMID: 10854350 UI: 20312905
ABSTRACT: Essential tremor (ET) is a common movement disorder that often causes functional disability, potentially leading to physical and emotional difficulties. The paucity of data available regarding the underlying pathophysiologic mechanism of ET hinders the development of innovative approaches to pharmacotherapeutic treatments. Options for drug therapy include the use of primidone, beta-adrenergic blockers, such as propranolol, alcohol, and other drugs, such as benzodiazepines, gabapentin, carbonic anhydrase inhibitors, clozapine, flunarizine, clonidine, and the methylxanthine derivative theophylline. Chemodenervation with botulinum toxin type A may be a therapeutic option for selected patients with ET. Each drug is classified as to the quality of evidence for efficacy and the suggested strength of therapeutic recommendation. In general clinical practice, primidone and propranolol have proven efficacy in ET.

2000/07
2000/08 11:00


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TITLE: Essential tremor: clinical characteristics.
AUTHORS: Jankovic J
AUTHOR AFFILIATION: Department of Neurology, Baylor College of Medicine, Houston, Texas 77030, USA.
SOURCE: Neurology 2000;54(11 Suppl 4):S21-5
CITATION IDS: PMID: 10854348 UI: 20312903
ABSTRACT: Essential tremor (ET) is the most common movement disorder. However, only a small percentage of people affected by this genetically transmitted neurologic disorder seek medical attention. Lack of consensus on the diagnostic criteria for ET is an impediment to accurate diagnosis and leads to difficulty in accessing accurate prevalence data. Although a positive family history, alcohol sensitivity, and propranolol responsiveness are characteristic of ET, these factors should not be considered necessary for the diagnosis of ET. ET can produce substantial physical and psychosocial disabilities. The occasional coexistence of ET and Parkinson's disease (PD) in the same individual may present a diagnostic challenge.

2000/07
2000/08 11:00


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TITLE: Motor initiation and execution in essential tremor and Parkinson's disease [In Process Citation]
AUTHORS: Montgomery EB Jr; Baker KB; Lyons K; Koller WC
AUTHOR AFFILIATION: Department of Neurology, Lerner Research Institute, Cleveland Clinic Foundation, Ohio 44195, USA.
SOURCE: Mov Disord 2000 May;15(3):511-5
[MEDLINE record in process]
CITATION IDS: PMID: 10830417 UI: 20289229
ABSTRACT: Clinical differentiation of essential tremor (ET) from idiopathic Parkinson's disease (iPD) is based on the lack of akinesia and bradykinesia. Nevertheless, early tremor-predominant iPD often is difficult to distinguish from ET. Motor initiation and execution in ET, iPD, and normal control (NC) subjects were investigated. Individuals with iPD, ET and NC performed a reaction-time wrist flexion and extension task. Motor performances were similar between ET and iPD and both were different than normal control subjects. Both the patients with iPD and ET had longer reaction times and slower movement velocities than NC subjects. This may help to explain some of the difficulties in distinguishing patients with these two diseases. The similarities of motor performance suggest that while ET and iPD may be separate disease entities, they may share similar pathogenic motor mechanisms from the perspective of an integrated motor system that drives the motor cortex.

2000/06
2000/01 09:00

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TITLE: Time course of loss of clinical benefit following withdrawal of levodopa/carbidopa and bromocriptine in early Parkinson' s disease [In Process Citation]
AUTHORS: Hauser RA; Koller WC; Hubble JP; Malapira T; Busenbark K; Olanow CW
AUTHOR AFFILIATION: Parkinson's Disease and Movement Disorders Center, University of South Florida, Tampa 33606, USA.
SOURCE: Mov Disord 2000 May;15(3):485-9
[MEDLINE record in process]
CITATION IDS: PMID: 10830413 UI: 20289225
ABSTRACT: Putative neuroprotective agents for Parkinson's disease can be assessed in untreated patients using progression of clinical disability as an index of disease progression. To avoid the confound associated with symptomatic therapy, progression of the underlying disease can be assessed by evaluating the progression of clinical disability from an untreated baseline to a final visit following wash-out of symptomatic medication. In this type of analysis it is critical to use a washout of sufficient duration to ensure elimination of symptomatic effects. To assess the time course of resolution of symptomatic effects, we evaluated 31 patients at days 1, 8, and 15 following discontinuation of levodopa/carbidopa and bromocriptine. Mean total Unified Parkinson's Disease Rating Scale scores (+/- standard error) increased (worsened) by 7.4+/-1.5 from day 1 to day 15 (p <0.0001), 4.5+/-1.2 from day 1 to day 8 (p = 0.0009), and 2.9+/-1.0 from day 8 to day 15 (p = 0.01). We conclude that a wash-out of at least 2 weeks is required to eliminate the symptomatic effects of levodopa/carbidopa and bromocriptine in patients with early Parkinson's disease.


2000/06
2000/01 09:00


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TITLE: The behavioral complications of pallidal stimulation: a case report.
AUTHORS: Miyawaki E; Perlmutter JS; Troster AI; Videen TO; Koller WC
AUTHOR AFFILIATION: Department of Neurology, The University of Kansas Medical Center, Kansas City, KS 66160-7314, USA. emiyawak@kumc.edu
SOURCE: Brain Cogn 2000 Apr;42(3):417-34
CITATION IDS: PMID: 10753488 UI: 20218810
ABSTRACT: We report a case of recurrent manic episodes associated with chronic deep brain stimulation (DBS) targeting globus pallidus (GP) in the treatment of Parkinson's disease (PD). Cardinal PD symptoms and dyskinesia improved with DBS, and neuropsychological testing found improvements in visuospatial measures associated with left DBS and in verbal memory with right DBS when compared to the patient's preoperative baseline. Under conditions of right, left, and bilateral DBS, the patient experienced bouts of mania and hypomania lasting several days at a time. Positron emission tomography (PET) with (15)O-labeled water was performed after his first manic episode under four conditions: no stimulation, right DBS, left DBS, and bilateral DBS. Although no manic switch occurred during the course of the PET study, all three DBS conditions were associated with decreases in regional flow in the left parahippocampus and hippocampus and right mid-cingulate gyrus. Increases in flow in left inferior frontal area, bilateral insula, dorsolateral prefrontal cortex, and cuneus were common to all DBS conditions. GP stimulation in PD may be associated with behavioral and cognitive effects. Distributed blood flow changes observed with pallidal DBS support a role for the pallidum in cognition and affective regulation. Copyright 2000 Academic Press.

2000/06
2000/08 09:00


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TITLE: Health-related quality of life in Parkinson's disease after pallidotomy and deep brain stimulation.
AUTHORS: Straits-Troster K; Fields JA; Wilkinson SB; Pahwa R; Lyons KE; Koller WC; Troster AI
AUTHOR AFFILIATION: Department of Veterans Affairs Medical Center, Kansas City, USA. troster@kansas-city.va.gov
SOURCE: Brain Cogn 2000 Apr;42(3):399-416
CITATION IDS: PMID: 10753487 UI: 20218809
ABSTRACT: This study explored the multidimensional outcome of three neurosurgical interventions for Parkinson's disease (PD): pallidotomy (N = 23), pallidal deep brain stimulation (DBS) (N = 9), and thalamic DBS (N = 7). All patients completed the Sickness Impact Profile (SIP) and the Beck Depression Inventory. Pallidotomy patients also completed the Profile of Mood States, the Beck Anxiety Inventory, and a disease-specific quality of life (QOL) measure, the Parkinson's Disease Questionnaire (PDQ-39). Three months after surgery, all neurosurgical groups showed significant improvements in mood and function, including physical, psychosocial, and overall functioning. Pallidal DBS and pallidotomy patients who completed additional QOL measures reported decreased anxiety and tension, increased vigor, improved mobility and ability to perform activities of daily living, and decreased perceived stigma. Psychosocial dysfunction scores from the SIP were related to depressed mood both at baseline (r = .42) and at followup (r = .45), but the physical dysfunction subscale was not related to mood at either time point, suggesting that disruption of social relationships due to PD may have more impact on affective distress than physical symptoms alone. Results suggest that neurosurgical interventions for PD improve disabling PD motor symptoms and also improve several domains of quality of life. Copyright 2000 Academic Press.

2000/06
2000/08 09:00

Mov Disord 1999 Sep;14(5):847-50
Efficacy of unilateral deep brain stimulation of the VIM nucleus of the thalamus for essential head tremor.
Koller WC, Lyons KE, Wilkinson SB, Pahwa R
Department of Neurology, University of Kansas Medical Center, Kansas City 66160-7314, USA.
Essential tremor is a common movement disorder. Deep brain stimulation of the VIM nucleus of the thalamus has been reported to be efficacious for reducing essential hand tremor. The effect of deep brain stimulation of the thalamus on essential head tremor has not been well studied. Therefore, we evaluated the effect of DBS of the thalamus in 38 patients with essential head tremor. Head tremor scores prior to surgery were compared with scores at 3, 6, and 12 months postimplant with stimulation "on" and "off." The 3-month evaluations were blinded for 24 patients and all others were open-label. There was a significant improvement in head tremor at all postimplant evaluations compared with baseline. Essential head tremor can be reduced with deep brain stimulation of the VIM nucleus of the thalamus and, pending the results of other controlled trials, should be considered as a treatment option for patients with disabling essential head tremor unresponsive to medication.
PMID: 10495050, UI: 99423241

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