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Deep Brain Stimulation (DBS) is the surgical procedure of choice in advanced patients with Parkinson’s disease (PD) complicated by motor fluctuations. The subthalamic nucleus (STN) and the globus pallidus internal (GPi) are the two most common targets used to treat PD. Anyway the most source of information about the efficacy of this procedure came from STN DBS. Only recently the comparison between GPi and STN DBS in advanced PD had shown in 24months follow-up study similar improvement in motor score; GPi DBS also improved depression while in STN patients it worsened, finally the reduction of dopaminergic therapy was higher in STN DBS patients [1]. Experiences of simultaneous stimulation of both STN and GPi are inconclusive and limited in literature [2,3]. The long term follow-up at 4, 8 and recently at 9years after STN DBS shows that while the improvement of levodopa induced motor complications are maintained, freezing, postural instability, falling, speech difficulties and cognitive impairment emerge as the major source of disability [4–6]. Nevertheless the information emerging from latter studies, some patients manifest a motor disease progression need increasing dopaminergic doses after many years of STN DBS. In some of these cases continuous infusion of Duodopa is reported as possible therapeutic strategy [7]. We describe three patients (Table) with severe functional impairment after 8year with STN DBS in whom GPi implant has been done as “rescue therapy”. [Copyright &y& Elsevier]

Mild Cognitive Impairment (MCI), is an intermediate stage between normal cognitive function and dementia, is common in Parkinson disease (PD) and its presence might be a risk factor for progression to dementia. The prevalence and profiles of PD-MCI are variable. The aim of this study is to evaluate the relationship between types of PD-MCI and clinical variables of disease in PD patients. Methods: We enrolled 300 PD patients consecutively referring to the surgery of Parkinson’s disease and movement disorders of IRCCS “National Institute of Neurology C. Mondino” Foundation of Pavia, Italy from March 2009 to December 2010 and underwent neuropsychological assessment. Of these 100 are PD without cognitive impairment, 145 PD-MCI and 55 PD whit dementia. Patients without cognitive impairment and patients with dementia are excluded. PD-MCI are included. Subjects were classified as having MCI if their age and education corrected z score on one or more cognitive domains was at least 1.5 standard deviations below the mean of normative data. Results: In our population the most frequent is MCI non amnesic single domain (naMCI-SD): with logical-executive deficit (43% ), and with visuo-spatial deficit (25 %). The second most frequent MCI is non amnesic multiple domain (naMCI-MD19%). The MCI amnesic single domain (aMCI-SD) in 6% and multiple domain (aMCI-MD) in 7% of patients. The five groups are the same age, education, age of onset and disease severity (UPDRS and HY). The significant differences are a longer disease’s duration in aMCI-MD respect to naMCI-SD, meaning the parallelism between motor and cognitive worsening. Besides in this group hallucinations, anamnestic RBD and confusional episodes are most frequent. Conclusions: Our study naMCI-SD is most frequent (LE>VSP) while memory impairment may emerge later. The aMCI-MD in fact, is most frequent associated whit hallucinations, RBD, confusional episodes; could be a prelude to dementia. [Copyright &y& Elsevier]

Background: Nocturnal stridor and respiratory abnormalities are important features of multiple system atrophy (MSA) with relevance to patient survival, and they are detected and evaluated mainly through video-polysomnography (video-PSG). Diurnal laryngoscopy seems to yield abnormal findings only in the presence of significant vocal cord (VC) dysfunction.Aim: To assess whether specific electrophysiological patterns of diurnal EMG of VC muscles may indicate nocturnal stridor or respiratory dysfunctions in MSA patients.Materials and Methods: Seventeen patients with probable MSA were examined. A full-night video-PSG to collect standard breathing parameters (apnea/hypopnea index, mean HbSAO2, oxygen desaturation index, total sleep time with HbSaO2 below 90%) was performed in all the patients. Laryngoscopy and EMG investigation of adductor (thyroarytenoid-TA) and abductor (posterior cricoarytenoid-PCA) muscles of the VCs were also performed.Results: Both the laryngeal EMG abnormalities (based on MUAP analysis and kinesiologic EMG investigation of VC muscles) and the laryngoscopic alterations correlated with video-PSG respiratory abnormalities. Specific patterns of EMG findings were consistently found in MSA subjects with nocturnal stridor detected at PSG. In particular, the following EMG findings were related to the severity of breathing abnormalities and the presence of stridor on video-PSG: neurogenic pattern on MUAP analysis of the PCA, paradoxical activation of the TA during inspiration and tonic EMG activity of the TA during quiet breathing.Conclusions: Electromyographic/kinesiologic investigation of VC muscles during wakefulness provides additional information on the pathophysiology of the respiratory abnormalities in MSA patients that could be useful for guiding the choice of the best appropriate treatment and care. [ABSTRACT FROM AUTHOR]

Abstract: Background: Recent reports suggest increased frequency of peripheral neuropathy (PN) in Parkinson's disease (PD) patients on levodopa compared with age-matched controls particularly during continuous levodopa delivery by intestinal infusion (CLDII). The aim of this study is to compare frequency, clinical features, and outcome of PN in PD patients undergoing different therapeutic regimens. Methods: Three groups of consecutive PD patients, 50 on intestinal levodopa (CLDII), 50 on oral levodopa (O-LD) and 50 on other dopaminergic treatment (ODT), were enrolled in this study to assess frequency of PN using clinical and neurophysiological parameters. A biochemical study of all PN patients was performed. Results: Frequency of PN of no evident cause was 28% in CLDII, 20% in O-LD, and 6% in ODT patients. Clinically, 71% of CLDII patients and all O-LD and ODT PN patients displayed a subacute sensory PN. In contrast, 29% of CLDII patients presented acute motor PN. Levodopa daily dose, vitamin B12 (VB12) and homocysteine (hcy) levels differed significantly in patients with PN compared to patients without PN. Conclusions: Our findings support the relationship between levodopa and PN and confirm that an imbalance in VB12/hcy may be a key pathogenic factor. We suggest two different, possibly overlapping mechanisms of PN in patients on CDLII: axonal degeneration due to vitamin deficiency and inflammatory damage. Whether inflammatory damage is triggered by vitamin deficiency and/or by modifications in the intestinal micro-environment should be further explored. Proper vitamin supplementation may prevent peripheral damage in most cases. [Copyright &y& Elsevier]

Abstract: Alteration of key regulatory kinases may cause aberrant protein phosphorylation and aggregation in Alzheimer''s disease (AD) and Parkinson''s disease (PD). In this study, we investigated expression and phosphorylation status of glycogen synthase kinase 3 (GSK-3), protein kinase B (Akt) and tau protein in peripheral blood lymphocytes of 20 AD, 25 PD patients and 20 healthy controls. GSK-3 was increased in AD and PD patients. In these latter, GSK-3 levels were positively correlated with daily l-Dopa intake. Phosphorylated Akt expression was augmented in both groups; total Akt levels were increased only in AD patients and were positively correlated with disease duration and severity. Total and phosphorylated tau were increased only in AD, with phospho-tau levels being positively correlated with levels of total tau, Akt, and disease duration. No correlations between protein levels and clinical variables were found in PD patients. Investigation of peripheral changes in the expression of specific kinases may, therefore, lead to the development of innovative biomarkers of neurodegeneration, particularly for AD. [Copyright &y& Elsevier]