440 results on '"Pacchetti, C."'
Search Results
252. Time dependent subthalamic local field potential changes after DBS surgery in Parkinson's disease.
- Author
-
Rosa M, Marceglia S, Servello D, Foffani G, Rossi L, Sassi M, Mrakic-Sposta S, Zangaglia R, Pacchetti C, Porta M, and Priori A
- Subjects
- Aged, Analysis of Variance, Biophysics, Electric Stimulation methods, Female, Humans, Magnetic Resonance Imaging methods, Male, Middle Aged, Spectrum Analysis methods, Statistics as Topic, Time Factors, Tomography, X-Ray Computed methods, Deep Brain Stimulation methods, Evoked Potentials physiology, Parkinson Disease physiopathology, Parkinson Disease therapy, Subthalamus physiology
- Abstract
Local field potentials (LFPs) recorded through electrodes implanted in patients with Parkinson's disease (PD) for deep brain stimulation (DBS) provided physiological information about the human basal ganglia. However, LFPs were always recorded 2-7 days after electrode implantation ("acute" condition). Because changes in the tissue surrounding the electrode occur after DBS surgery and could be relevant for LFPs, in this work we assessed whether impedance and LFP pattern are a function of the time interval between the electrode implant and the recordings. LFPs and impedances were recorded from 11 patients with PD immediately after (T-0h), 2 h after (T-2h), 2 days after (T-48h), and 1 month after (T-30d, "chronic" condition) surgery. Impedances at T-0h were significantly higher than at all the other time intervals (T-2h, p=0.0005; T-48h, p=0.0002; T-30d, p=0.003). Correlated with this change (p=0.005), the low-frequency band (2-7 Hz) decreased at all time intervals (p=0.0005). Conversely, the low- (8-20 Hz) and the high-beta (21-35 Hz) bands increased in time (low-beta, p=0.003; high beta, p=0.022), but did not change between T-48h and T-30d. Our results suggest that DBS electrode impedance and LFP pattern are a function of the time interval between electrode implant and LFP recordings. Impedance decrease could be related to changes in the electrode/tissue interface and in the low-frequency band. Conversely, beta band modulations could raise from the adaptation of the neural circuit. These findings confirm that results from LFP analysis in the acute condition can be extended to the chronic condition and that LFPs can be used in novel closed-loop DBS systems., (Copyright 2010 Elsevier Inc. All rights reserved.)
- Published
- 2010
- Full Text
- View/download PDF
253. Clinical experiences with levodopa methylester (melevodopa) in patients with Parkinson disease experiencing motor fluctuations: an open-label observational study.
- Author
-
Zangaglia R, Stocchi F, Sciarretta M, Antonini A, Mancini F, Guidi M, Martignoni E, and Pacchetti C
- Subjects
- Aged, Carbidopa adverse effects, Drug Combinations, Drug Therapy, Combination, Female, Humans, Levodopa adverse effects, Levodopa therapeutic use, Male, Patient Satisfaction, Time Factors, Carbidopa therapeutic use, Catechols therapeutic use, Dyskinesias drug therapy, Levodopa analogs & derivatives, Parkinson Disease drug therapy
- Abstract
Introduction: Slow gastric emptying decreasing levodopa (LD) bioavailability contributes to motor fluctuations in Parkinson disease (PD). Melevodopa (LD methylester), ensuring rapid duodenal absorption, has been proposed as rescue therapy for afternoon off periods., Objective: To assess daily motor fluctuations by multiple administrations of Sirio (Chiesi Farmaceutici SpA, Parma, Italy) (melevodopa/carbidopa) in PD patients., Patients and Methods: In this open-label naturalistic study, 75 PD patients (group A) completely switched standard LD (Sinemet or Madopar) with Sirio at an equivalent dosage (800-1000 mg/d). One hundred nineteen PD patients (group B) partially replaced their standard LD (Sinemet) with Sirio at an equivalent dosage (400-500 mg/d) while continuing Stalevo 100. In both groups, the observational period lasted 6 months. Assessments included an on/off diary, the Unified Parkinson's Disease Rating Scale (motor examination [UPDRS II] and activities of daily living [UPDRS III]), the dyskinesia scale, and an adverse event profile., Results: Group A showed a significant reduction of afternoon off hours at 6 months (P < 0.05). Forty-five patients (69%) reported a subjective early onset of on motor response. Twelve patients (18.5%) reported its shorter duration. The dyskinesia scale score remained unchanged. Ten patients (13.3%) discontinued melevodopa for gastric intolerance. Group B showed at 6 months a significant reduction of total hours of daily off periods (P < 0.05), particularly in the morning (P < 0.01) and afternoon (P < 0.05). Seventy subjects (59%) expressed positive judgment on quickness of onset of on motor response. The dyskinesia scale score was unchanged. No significant adverse events were reported., Conclusions: Switching PD patients with motor fluctuations to melevodopa, particularly in the presence of entacapone, could optimize critical periods of the day such as the morning delay on and afternoon off periods.
- Published
- 2010
- Full Text
- View/download PDF
254. Four-week trunk-specific rehabilitation treatment improves lateral trunk flexion in Parkinson's disease.
- Author
-
Bartolo M, Serrao M, Tassorelli C, Don R, Ranavolo A, Draicchio F, Pacchetti C, Buscone S, Perrotta A, Furnari A, Bramanti P, Padua L, Pierelli F, and Sandrini G
- Subjects
- Aged, Aged, 80 and over, Analysis of Variance, Biomechanical Phenomena, Female, Humans, Male, Mental Status Schedule, Middle Aged, Neurologic Examination methods, Reference Values, Severity of Illness Index, Torque, Functional Laterality physiology, Parkinson Disease physiopathology, Parkinson Disease rehabilitation, Postural Balance physiology, Posture physiology
- Abstract
People with Parkinson's disease (PD) often have a posture characterized by lateral trunk flexion poorly responsive to antiparkinsonian drugs. To examine the effects of a rehabilitation programme (daily individual 90-minute-sessions, 5-days-a-week for 4-consecutive weeks) on lateral trunk flexion and mobility, 22 PD patients with mild to severe lateral trunk flexion, and 22 PD patients without trunk flexion were studied. Patients were evaluated using the Unified Parkinson's Disease Rating Scale motor subscale (UPDRS-III) score, and the kinematic behavior of the trunk was recorded by means of an optoelectronic system to determine: a) trunk flexion, inclination and rotation values in the erect standing posture; b) ranges of trunk flexion and inclination during trunk movements. After the treatment, significant decreases in trunk flexion [24 degrees (4) vs. 14 degrees (3), P < 0.001] and inclination in the static condition [23 degrees (5) vs. 12 degrees (4), P < 0.001)] were observed, both of which were maintained at the 6-month follow up. During the trunk flexion task, a significantly increased range of trunk flexion [64 degrees (15) vs. 83 degrees (15), P < 0.001] was observed; similarly, during the lateral bending task, the range of trunk inclination was found to be significantly increased, both toward the side of the trunk deviation [29 degrees (8) vs. 42 degrees (13), P < 0.01] and toward the contralateral side [14 degrees (6) vs 29 degrees (11), P < 0.01]. No further significant changes were observed at the 6-month follow-up. Trunk flexion and inclination values in the upright standing posture correlated slightly with the UPDRS-III score. Our findings show that significant improvements in axial posture and trunk mobility can be obtained through the 4-week rehabilitation programme described, with a parallel improvement in clinical status., ((c) 2010 Movement Disorder Society.)
- Published
- 2010
- Full Text
- View/download PDF
255. The role of rehabilitation in deep brain stimulation of the subthalamic nucleus for Parkinson's disease: a pilot study.
- Author
-
Tassorelli C, Buscone S, Sandrini G, Pacchetti C, Furnari A, Zangaglia R, Bartolo M, Nappi G, and Martignoni E
- Subjects
- Cognition Disorders etiology, Cognition Disorders rehabilitation, Deglutition Disorders etiology, Deglutition Disorders rehabilitation, Exercise Therapy, Female, Humans, Male, Middle Aged, Movement Disorders etiology, Movement Disorders rehabilitation, Pain etiology, Pain rehabilitation, Pilot Projects, Postural Balance, Speech Disorders etiology, Speech Disorders rehabilitation, Deep Brain Stimulation adverse effects, Parkinson Disease rehabilitation, Parkinson Disease therapy, Subthalamic Nucleus physiology
- Abstract
Bilateral deep brain stimulation (DBS) of the subthalamic nucleus (STN) is an efficacious therapeutic option in the treatment of advanced Parkinson's disease (PD). The procedure may be however associated with functional impairment of different types and intensity. In this paper we describe the functional impairments detected in a group of 34 subjects with PD who were submitted to DBS. These patients belonged to a cohort of 75 consecutive PD patients who underwent the surgical procedure. The rehabilitation program included physiotherapy exercises for recovery/maintenance of the range of motion, active exercises, exercises for coordination and proprioception, and walking training based on the use of sensory cues, with daily sessions for a period of 4-8 weeks. The motor examination section of unified Parkinson's disease rating scale (UPDRS-ME) and the functional independence measure (FIM) scores showed a consistent and significant improvement in the patients' motor performances. The reported findings suggest that rehabilitation may play an important role in the correction of specific functional impairments caused by or associated with DBS in PD.
- Published
- 2009
- Full Text
- View/download PDF
256. Deep brain stimulation and cognitive functions in Parkinson's disease: A three-year controlled study.
- Author
-
Zangaglia R, Pacchetti C, Pasotti C, Mancini F, Servello D, Sinforiani E, Cristina S, Sassi M, and Nappi G
- Subjects
- Aged, Antiparkinson Agents pharmacology, Antiparkinson Agents therapeutic use, Cognition drug effects, Cognition Disorders etiology, Cognition Disorders therapy, Combined Modality Therapy, Disease Progression, Executive Function drug effects, Executive Function physiology, Female, Follow-Up Studies, Humans, Male, Middle Aged, Neuropsychological Tests, Parkinson Disease complications, Parkinson Disease drug therapy, Parkinson Disease psychology, Prospective Studies, Psychomotor Performance drug effects, Psychomotor Performance physiology, Speech Disorders etiology, Speech Disorders therapy, Cognition physiology, Deep Brain Stimulation, Parkinson Disease therapy, Subthalamic Nucleus physiology
- Abstract
There is debate over the cognitive and behavioral effects of deep brain stimulation (DBS) of the subthalamic nucleus (STN) in advanced Parkinson's disease (PD). To evaluate these effects, we performed a prospective, naturalistic controlled, 3-year follow-up study. A total of 65 PD patients were enrolled, of whom 32 underwent STN-DBS (PD-DBS) and 33, even though eligible for this treatment, declined surgery and chose other therapeutic procedures (PD-control). Motor and neuropsychological functions were assessed in all the subjects at baseline (T0) and 36 months (T36). The PD-DBS patients were also evaluated at 1, 6, 12, and 24 months after surgery (T1, T6, T12, and T24). At T1, compared with T0, the PD-DBS patients recorded worse logical executive function task and verbal fluency (FAS) scores, whereas their performance of memory tasks remained stable. At T12, their cognitive profile had returned within the pre-DBS range, thereafter remaining stable until T36. FAS scores at T36 were significantly worse in the PD-DBS compared with the PD-control patients. This is the first long-term naturalistic controlled study of cognitive functions in PD patients submitted to STN-DBS. Our results confirm previous reports of a worsening of verbal fluency after DBS, but show that STN-DBS seems to be relatively safe from a cognitive standpoint, as the short-term worsening of frontal-executive functions was found to be transient., (2009 Movement Disorder Society.)
- Published
- 2009
- Full Text
- View/download PDF
257. Hyperhomocysteinemia in levodopa-treated patients with Parkinson's disease dementia.
- Author
-
Zoccolella S, dell'Aquila C, Abruzzese G, Antonini A, Bonuccelli U, Canesi M, Cristina S, Marchese R, Pacchetti C, Zagaglia R, Logroscino G, Defazio G, Lamberti P, and Livrea P
- Subjects
- Aged, Analysis of Variance, Case-Control Studies, Chromatography, High Pressure Liquid methods, Cross-Sectional Studies, Female, Humans, Levodopa therapeutic use, Logistic Models, Male, Mental Status Schedule, Middle Aged, Neuropsychological Tests, Antiparkinson Agents adverse effects, Dementia blood, Dementia complications, Dementia drug therapy, Homocysteine blood, Hyperhomocysteinemia chemically induced, Levodopa adverse effects, Parkinson Disease blood, Parkinson Disease complications, Parkinson Disease drug therapy
- Abstract
Dementia is a frequent non-motor feature of Parkinson's disease (PD). Elevated plasma homocysteine (Hcy) levels have been associated with both cognitive impairment and dementia. Increased Hcy levels have been observed in levodopa-treated patients with PD. The objective of our study was to evaluate the association between plasma Hcy levels and dementia in PD. We performed a multicenter cross-sectional study on patients with PD with (PDD) and without (PDnD) dementia and age- and sex-matched healthy controls. We compared Hcy levels in patients with PDD and PDnD and healthy controls, and we performed logistic regression analysis to search for an association between the presence of dementia and increased Hcy levels in PD. Patients with PD (121), PDD (42), and PDnD (79), and age- and sex-matched controls (154) were enrolled. Hcy levels were higher in patients with PD compared to controls (17.5 micromol/L +/- 10.2 vs. 11 +/- 4.1; P < 0.00001). Among patients with PD, Hcy levels were higher in the PDD group compared to the PDnD group (20.7 micromol/L +/- 12.1 vs. 15.8 +/- 8.5; P = 0.002). In a multivariate logistic regression model, higher Hcy levels [Odds ratios comparing the top (>18.9 micromol/L) with the bottom tertile (<12.4 micromol/L): 3.68; 95% CI: 1.14-11.83] were significantly associated with dementia. These data support the association between elevated Hcy levels and the presence of dementia in PD., ((c) 2009 Movement Disorder Society.)
- Published
- 2009
- Full Text
- View/download PDF
258. Calcium homeostasis is dysregulated in parkinsonian patients with L-DOPA-induced dyskinesias.
- Author
-
Blandini F, Bazzini E, Marino F, Saporiti F, Armentero MT, Pacchetti C, Zangaglia R, Martignoni E, Lecchini S, Nappi G, and Cosentino M
- Subjects
- Aged, Carbonyl Cyanide p-Trifluoromethoxyphenylhydrazone pharmacology, Case-Control Studies, Cyclic AMP metabolism, Female, Humans, Ionophores pharmacology, Lactones pharmacology, Lymphocytes drug effects, Lymphocytes metabolism, Male, Middle Aged, Mitogens pharmacology, Parkinson Disease drug therapy, Phytohemagglutinins pharmacology, RNA, Messenger metabolism, Receptors, Dopamine D3 genetics, Receptors, Dopamine D3 metabolism, Receptors, Dopamine D5 genetics, Receptors, Dopamine D5 metabolism, Sesquiterpenes pharmacology, Akathisia, Drug-Induced etiology, Antiparkinson Agents adverse effects, Calcium metabolism, Homeostasis drug effects, Levodopa adverse effects, Parkinson Disease metabolism
- Abstract
Long-term treatment of Parkinson disease (PD) is frequently associated with l-3,4-dihydroxyphenylalanine (L-DOPA)-induced dyskinesias (LIDs). L-DOPA-induced dyskinesias are likely due to changes in the signal transduction pathways, at the striatal level, related to pulsatile stimulation of dopamine receptors. We investigated whether markers of this phenomenon can also be detected peripherally. We analyzed mRNA expression for D5 (D1-like) and D3 (D2-like) receptors and levels of second messengers, such as cAMP and free intracellular Ca2+ ([Ca2+]i), in peripheral blood lymphocytes of PD patients with (LID+) or without LIDs (LID-). Patients with PD showed depressed [Ca2+]i rise in response to mitogen-induced activation. The defect was more pronounced in LID+ (-33% with respect to healthy controls) than in LID- patients (-20%). Peripheral blood lymphocyte levels of cAMP were decreased in both LID+ (3.8 +/- 2.9 pmol/10 cells) and LID- patients (4.2 +/- 2.4 pmol/10(6) cells), with respect to controls (6 +/- 2.6 pmol/10(6) cells). No differences were found in dopamine receptor mRNA expression. Our results demonstrate that second messenger levels are altered in the peripheral blood lymphocytes of PD patients treated with dopaminergic agents and that patients with LIDs show further alterations in the regulation of [Ca2+]i homeostasis. This may represent a distinctive trait of patients prone to develop dyskinetic movements.
- Published
- 2009
- Full Text
- View/download PDF
259. Electrode displacement after intracerebral hematoma as a complication of a deep brain stimulation procedure.
- Author
-
Servello D, Sassi M, Bastianello S, Poloni GU, Mancini F, and Pacchetti C
- Abstract
Objectives: Deep brain stimulation (DBS) is nowadays considered a safe and effective procedure for various movement disorders in which conservative treatments have failed to show significant therapeutic results. One of the most common complications of definitive electrode positioning is intraparenchymal hemorrhage., Materials and Methods: Authors report the case of a 55-year-old female patient treated for Parkinson's disease in which intraparenchymal hemorrhage developed after DBS procedure, leading to significant (about 8 mm at the neuroradiological controls) displacement of an otherwise correctly positioned DBS electrode., Results: After conservative management, the hematoma spontaneously resolved. Late neuroradiological controls documented correct, symmetrically positioned electrodes, comparable to the immediate postoperative controls., Conclusions: Six months follow-up endpoint results of the DBS treatment were considered satisfying by an independent neurologist, with modest residual neurological deficits, demonstrating that re-positioning of the electrode was unnecessary in this rare complication.
- Published
- 2009
- Full Text
- View/download PDF
260. REM behavior disorder, hallucinations and cognitive impairment in Parkinson's disease: a two-year follow up.
- Author
-
Sinforiani E, Pacchetti C, Zangaglia R, Pasotti C, Manni R, and Nappi G
- Subjects
- Age Factors, Aged, Aged, 80 and over, Cognition Disorders diagnosis, Cognition Disorders epidemiology, Disease Progression, Female, Follow-Up Studies, Frontal Lobe physiopathology, Hallucinations epidemiology, Humans, Logic, Male, Memory Disorders epidemiology, Memory Disorders etiology, Middle Aged, Neuropsychological Tests, Parkinson Disease complications, Parkinson Disease epidemiology, Prognosis, Prospective Studies, REM Sleep Behavior Disorder epidemiology, Cognition Disorders etiology, Hallucinations etiology, Parkinson Disease psychology, REM Sleep Behavior Disorder etiology
- Abstract
In Parkinson's disease (PD) the presence of REM parasonnias as REM Behaviour Disorder (RBD) or vivid dreams/nightmares, is recognized as largely associated with hallucinations, even if the risk of the development of hallucinations seem not to depend on how long the REM parasomnias had been occurring. The aim of this study was to establish if RBDs occurring earlier than hallucinations in PD are predictive of cognitive impairment development. Three groups of PD patients: i) group 1, without RBD and without hallucinations; ii) group 2, with RBD but without hallucinations; iii) group 3, with RBD and hallucinations have been prospectively investigated at baseline and after two years throughout a clinical and neuropsychological evaluation. After two years, the group 1 continued to present normal neuropsychological tests and did not present either RBDs or hallucinations. In the group 2, the frontal impairment evidenced at baseline was confirmed; the onset of newly hallucinations was reported in a subgroup of 12 patients, who proved to be older, with a more severe executive impairment at baseline and with a more severe motor symptoms progression than those RBD patients who had not manifested hallucinations. The group 3, characterized at baseline by a more severe cognitive impairment presented, after two years, a cognitive worsening and a higher mortality rate. The longitudinal but at preliminary step investigation identified a PD subgroup of patients, in whom a common background disease profile, including the presence of RBD, could represent a "red flag" in developing further cognitive impairment., (Copyright 2008 Movement Disorder Society.)
- Published
- 2008
- Full Text
- View/download PDF
261. Macrogol for the treatment of constipation in Parkinson's disease. A randomized placebo-controlled study.
- Author
-
Zangaglia R, Martignoni E, Glorioso M, Ossola M, Riboldazzi G, Calandrella D, Brunetti G, and Pacchetti C
- Subjects
- Aged, Chi-Square Distribution, Constipation etiology, Double-Blind Method, Female, Humans, Male, Parkinson Disease complications, Severity of Illness Index, Time Factors, Constipation drug therapy, Polyethylene Glycols therapeutic use, Surface-Active Agents therapeutic use
- Abstract
Chronic constipation is the most frequent symptom of autonomic system involvement in Parkinson's disease (PD). Quite often the symptom is severe and impairs patients' quality of life. The objective of this study is to determine the efficacy and safety of an isosmotic macrogol solution for the treatment of constipation in PD patients, in a double-blind, placebo-controlled study. A total of 57 PD patients with constipation were randomly assigned to receive an isosmotic macrogol electrolyte solution (MC-ES; 29 patients) or placebo (28 patients) for 8 weeks. Treatment efficacy was defined as complete relief of the symptom or a marked improvement of two of the following indicators: stool frequency, straining, stool consistency, use of rectal laxatives as a rescue therapy. The responder rates were significantly higher in the MC-ES group both at the first (4 weeks; P < 0.0003) and at the final evaluation (8 weeks; P < 0.0012). The frequency of bowel movements (P < 0.002) and stool consistency (P < 0.006) were significantly changed in the MC-ES group compared to the placebo group. At the final evaluation, a rectal laxative was used by 2 (12.5%) patients on placebo, whereas no use was recorded in the MC-ES group. Responder rate for straining showed a favorable trend in patients treated with macrogol versus placebo. Unified Parkinson's Disease Rating Scale Part III and Parkinson's Disease Questionnaire (PDQ-39) did not show any significant modification in either group during the 8-week treatment period. The results of this placebo-controlled study show the efficacy of MC-ES in the treatment of constipation in PD. MC-ES was well-tolerated and did not affect the course of PD., (2006 Movement Disorder Society)
- Published
- 2007
- Full Text
- View/download PDF
262. Magnetic resonance spectroscopy in Parkinson's disease and parkinsonian syndromes.
- Author
-
Rango M, Arighi A, Biondetti P, Barberis B, Bonifati C, Blandini F, Pacchetti C, Martignoni E, Bresolin N, and Nappi G
- Subjects
- Animals, Humans, Magnetic Resonance Spectroscopy, Parkinson Disease metabolism, Parkinson Disease pathology, Parkinsonian Disorders metabolism, Parkinsonian Disorders pathology, Magnetic Resonance Imaging, Parkinson Disease diagnosis, Parkinsonian Disorders diagnosis
- Abstract
This paper looks at the use of magnetic resonance spectroscopy (MRS) for diagnostic and research purposes in Parkinson's disease and parkinsonian syndromes. The review considers both proton MRS (1H MRS) and phosphorus MRS (31 P MRS) studies. MRS is useful for diagnostic purposes, helping to differentiate Parkinson's disease from other parkinsonian syndromes. Even more usefully, MRS can be used for non invasive in vivo human research.
- Published
- 2007
263. Botulinum toxin and neuromotor rehabilitation: An integrated approach to idiopathic cervical dystonia.
- Author
-
Tassorelli C, Mancini F, Balloni L, Pacchetti C, Sandrini G, Nappi G, and Martignoni E
- Subjects
- Activities of Daily Living, Aged, Analysis of Variance, Cross-Over Studies, Double-Blind Method, Electromyography methods, Female, Humans, Injections, Intramuscular, Male, Middle Aged, Pain Measurement, Time Factors, Treatment Outcome, Botulinum Toxins, Type A therapeutic use, Neuromuscular Agents therapeutic use, Physical Therapy Specialty methods, Torticollis drug therapy, Torticollis rehabilitation
- Abstract
Currently, the best treatment option for idiopathic cervical dystonia (ICD) is injection of botulinum toxin (BTX) into the affected muscles, whereas rehabilitative approaches have given disappointing results. We evaluated whether the association of an ad hoc rehabilitative program may improve the clinical efficacy of BTX treatment in a single-center, cross-over, controlled study. Forty patients with ICD were randomly assigned to two different treatment groups: (1) BTX type A (BTX-A) plus a specific program of physical therapy (BTX-PT) or (2) BTX-A alone (BTX-0). Patients in the BTX-PT group showed a longer duration of the clinical benefit (118.8 vs. 99.1 days) and needed a lower dose of BTX at reinjection (284.5 vs. 325.5 units). In addition, they showed more marked reductions in their disability in activities of daily living (-9.7 vs. -4.85 points) and subjective pain (-13.35 vs. 6.95 points) scores. Association of BTX-A therapy with a specific program of physical therapy may improve ICD treatment outcome., (Copyright 2006 Movement Disorder Society.)
- Published
- 2006
- Full Text
- View/download PDF
264. Secondary cervical dystonia in iatrogenic hypoparathyroidism associated with extensive brain calcifications.
- Author
-
Mancini F, Zangaglia R, Cristina S, Tassorelli C, Uggetti C, Nappi G, and Pacchetti C
- Subjects
- Brain Diseases pathology, Calcinosis pathology, Female, Humans, Hypoparathyroidism pathology, Middle Aged, Brain Diseases etiology, Calcinosis etiology, Hypoparathyroidism complications, Iatrogenic Disease, Torticollis etiology
- Abstract
Cervical dystonia (CD) is usually idiopathic, without a known aetiology. Hypoparathyroidism, both primary and secondary, can be associated with brain calcifications and various clinical neurological features. Anecdotal evidence suggests that patients affected by hypoparathyroidism show a rapid-onset oral dyskinesia after use of neuroleptic drugs. We report the case of a 60-year-old woman with CD, iatrogenic hypoparathyroidism and extensive brain calcifications. On the basis of the clinical features and the localization of the brain calcifications we suppose that they may have played a role in the development of this CD. This case may prove to be, after a review of literature, the first report of CD secondary to iatrogenic hypoparathyroidism in a patient with extensive brain calcifications.
- Published
- 2006
265. REM sleep behavior disorder, hallucinations, and cognitive impairment in Parkinson's disease.
- Author
-
Sinforiani E, Zangaglia R, Manni R, Cristina S, Marchioni E, Nappi G, Mancini F, and Pacchetti C
- Subjects
- Aged, Female, Humans, Male, Mental Status Schedule, Middle Aged, Multivariate Analysis, Neuropsychological Tests, Cognition Disorders complications, Hallucinations complications, Parkinson Disease complications, REM Sleep Behavior Disorder complications
- Abstract
The objective of this study was to evaluate the relationship between REM sleep behavior disorder (RBD), hallucinations, and cognitive impairment in Parkinson's disease (PD). One hundred and ten PD patients, divided into three groups (without RBD or hallucinations; with RBD but no hallucinations; with RBD and hallucinations), were submitted to neuropsychological evaluation. The group without RBD and hallucinations showed normal neuropsychological tests when compared to normal controls. The group with hallucinations was characterized by a more severe cognitive impairment affecting both short- and long-term memory, logical abilities, and frontal functions, while the RBD-only group presented frontal impairment. The hypothesis that RBD in PD can be considered a risk factor not only of the hallucinations but also of more severe and diffuse cognitive abnormalities needs to be strengthened through a longitudinal evaluation., (Copyright 2005 Movement Disorder Society.)
- Published
- 2006
- Full Text
- View/download PDF
266. Relationship between hallucinations, delusions, and rapid eye movement sleep behavior disorder in Parkinson's disease.
- Author
-
Pacchetti C, Manni R, Zangaglia R, Mancini F, Marchioni E, Tassorelli C, Terzaghi M, Ossola M, Martignoni E, Moglia A, and Nappi G
- Subjects
- Aged, Analysis of Variance, Chi-Square Distribution, Demography, Female, Humans, Male, Mental Status Schedule statistics & numerical data, Middle Aged, Parkinson Disease therapy, Retrospective Studies, Delusions physiopathology, Hallucinations physiopathology, Parkinson Disease physiopathology, REM Sleep Behavior Disorder physiopathology, Sleep, REM physiology
- Abstract
Psychotic symptoms are the main and the most disabling "nonmotor" complications of Parkinson's disease (PD), the pathophysiology of which is poorly recognized. Polysomnographic studies have shown a relationship between visual hallucinations and rapid eye movement (REM) sleep. The objective of this study is to clarify the relationship between psychotic symptoms and REM sleep behavior disorder (RBD) in PD. In a Parkinson's disease outpatient unit, 289 consecutive subjects with idiopathic PD were administered (in the period from January to December 2002) a multiple-choice questionnaire and structured interview on sleep and mental disorders. RBD was diagnosed in accordance with the minimal diagnostic criteria of the International Classification of Sleep Disorders. Hallucinations and delusional disorders were diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders-IV criteria. The presence or absence of psychotic symptoms, of RBD, and of daytime sleepiness, as well as motor status, cognitive status, and mood were assessed. Approximately 32% (n = 92) of the subjects presented with psychotic disorders; 30% (n = 86) had experienced hallucinations; 2% (n = 6) had delusions without hallucinations. Sixty-two (72%) hallucinators reported nocturnal hallucinations. A total of 6.6% (n = 19) of the subjects complained of a delusional disorder. There were 26.6% (n = 77) of subjects who presented with RBD: 28 (36%) with onset before and 49 (63%) with onset after PD diagnosis. The presence of RBD was associated with an increased risk of manifesting hallucinations and delusions (odds ratio [OR], 2.73). Other independent clinical factors found to have an effect on psychotic disorders were cognitive impairment (OR, 3.92), disease duration (OR, 2.46), advanced age (OR, 2.34), and severity of motor symptoms (OR, 2.06). These results suggest that RBD is widely associated with psychosis in PD.
- Published
- 2005
- Full Text
- View/download PDF
267. A randomised, double-blind, dose-ranging study to evaluate efficacy and safety of three doses of botulinum toxin type A (Botox) for the treatment of spastic foot.
- Author
-
Mancini F, Sandrini G, Moglia A, Nappi G, and Pacchetti C
- Subjects
- Aged, Botulinum Toxins, Type A adverse effects, Disability Evaluation, Dose-Response Relationship, Drug, Double-Blind Method, Edema chemically induced, Female, Humans, Injections, Intramuscular methods, Male, Middle Aged, Muscle Spasticity etiology, Muscle Spasticity physiopathology, Muscle Tonus drug effects, Muscle Weakness chemically induced, Muscle, Skeletal drug effects, Muscle, Skeletal innervation, Muscle, Skeletal physiopathology, Neuromuscular Agents administration & dosage, Neuromuscular Agents adverse effects, Paresis etiology, Paresis physiopathology, Treatment Outcome, Botulinum Toxins, Type A administration & dosage, Foot physiopathology, Muscle Spasticity drug therapy, Paresis drug therapy, Stroke complications
- Abstract
Botulinum toxin A (BTX) injections have been used successfully in the treatment of post-stroke foot spasticity, but the optimal dose-response relationship for selected muscles has yet to be established. The aim of this study was to outline beneficial and unwanted effects of three different doses of BTX in the treatment of spastic foot. In this randomised, double-blind, dose-ranging study, 45 spastic feet were randomly allocated to one of three groups, each of which was treated with a different dosage of BTX. The doses were decided on the basis of suggestions in the literature. Outcome measures (Modified Ashworth Scale, Medical Research Council Scale, gait assessment, presence of Achilles tendon clonus, Visual Analogue Scales for Gait Function and Pain, Adverse Effects scale) were applied at baseline, 4 weeks and 4 months after treatment. All the groups showed significant scales scores improvements after treatment with BTX. Group II (mean BTX total dose: 322 U) and Group III (mean BTX total dose: 540 U) showed a greater and more prolonged response than Group I (mean BTX total dose: 167 U). Group III showed the highest rate of adverse effects 4 weeks post-treatment. BTX injections constitute a useful and safe method of improving post-stroke foot spasticity, associated pain, gait speed and function. In particular, the medium BTX dosages (320 UI spread over 2-5 muscles) were found to be both safe and effective in producing long-lasting improvement of spastic foot dysfunction.
- Published
- 2005
- Full Text
- View/download PDF
268. Binocular control of saccades in idiopathic Parkinson's disease.
- Author
-
Versino M, Zavanone C, Colnaghi S, Beltrami G, Pacchetti C, Zangaglia R, and Cosi V
- Subjects
- Adult, Aged, Fixation, Ocular, Functional Laterality, Humans, Middle Aged, Reference Values, Parkinson Disease therapy, Saccades physiology, Vision, Binocular physiology
- Abstract
We focused on the saccade disconjugate control in idiopathic Parkinson's disease patients. Our data showed that in IPD patients the saccade precision was differently impaired in the two eyes--namely, the disconjugate component was larger than in controls--more for the remembered than for the reflexive task.
- Published
- 2005
- Full Text
- View/download PDF
269. Medical healthcare use in Parkinson's disease: survey in a cohort of ambulatory patients in Italy.
- Author
-
Cosentino M, Martignoni E, Michielotto D, Calandrella D, Riboldazzi G, Pacchetti C, Frigo G, Nappi G, and Lecchini S
- Subjects
- Adult, Aged, Antiparkinson Agents therapeutic use, Comorbidity, Cross-Sectional Studies, Drug Prescriptions statistics & numerical data, Electric Stimulation Therapy, Female, Hospitalization statistics & numerical data, Humans, Italy, Levodopa therapeutic use, Male, Middle Aged, Neurology, Office Visits statistics & numerical data, Parkinson Disease drug therapy, Parkinson Disease physiopathology, Patient Care Team, Utilization Review, Health Services statistics & numerical data, Parkinson Disease therapy
- Abstract
Background: Parkinson's disease (PD) is a chronic neurodegenerative disease which at present has no cure, and it usually results in severe disability. The burden of PD increases as the illness progresses, resulting in the extensive utilisation of both health and community services. Knowledge of healthcare use patterns and of their determinants may greatly contribute to improve patient care, however few studies have examined this issue in PD. The present study was devised to describe the type of and reasons for medical healthcare resource use in persons with PD attending a Centre for PD and Movement Disorders, and to examine drug prescriptions issued on such occasions., Methods: The study was a retrospective, cross-sectional survey in a cohort of ambulatory patients with PD, conducted by means of standard interviews., Results: In the year before the study, 92 (70.8%) of 130 patients used medical healthcare resources: 1/5 of the patients was admitted to hospital, 1/5 to emergency room, 2/5 were visited by a non-neurology specialist, and 1/4 by the GP. Reasons were: nearly 20% programmed hospital admissions and visits, and more than 25% injuries and musculo-skeletal diseases. Other conditions typically occurring in PD (e.g. dementia, diabetes and cardio- and cerebro-vascular disease) were less frequently involved. On such occasions, drugs for PD were occasionally changed, however drug prescriptions for other indications were issued to more than 66% of the patients., Conclusion: Several physicians other than the neurologist may take care of PD patients on different occasions, thus emphasising the need for communication between the reference neurologist and other physicians who from time to time may visit the patient.
- Published
- 2005
- Full Text
- View/download PDF
270. Modifications of apoptosis-related protein levels in lymphocytes of patients with Parkinson's disease. The effect of dopaminergic treatment.
- Author
-
Blandini F, Cosentino M, Mangiagalli A, Marino F, Samuele A, Rasini E, Fancellu R, Tassorelli C, Pacchetti C, Martignoni E, Riboldazzi G, Calandrella D, Lecchini S, Frigo G, and Nappi G
- Subjects
- Aged, Apoptosis drug effects, Caspase 3, Cell Survival drug effects, Disease Progression, Dopamine Agonists pharmacology, Female, Humans, Levodopa pharmacology, Lymphocytes drug effects, Lymphocytes enzymology, Male, Middle Aged, Peripheral Nervous System drug effects, Peripheral Nervous System metabolism, Receptors, GABA-A drug effects, Receptors, GABA-A metabolism, Superoxide Dismutase metabolism, Antiparkinson Agents therapeutic use, Apoptosis physiology, Caspases metabolism, Dopamine Agents therapeutic use, Lymphocytes metabolism, Parkinson Disease drug therapy, Parkinson Disease metabolism, Proto-Oncogene Proteins c-bcl-2 biosynthesis
- Abstract
In this study, we investigated whether changes in the regulatory mechanisms of apoptosis and oxidative stress may be detected, peripherally, in patients with Parkinson's disease (PD). For this purpose, we measured caspase-3 activity, Bcl-2 concentrations, peripheral benzodiazepine receptor (PBR) expression and Cu/Zn superoxide dismutase (SOD) concentrations in lymphocytes of untreated PD patients, patients treated only with L-Dopa or with L-Dopa and dopamine agonists and healthy volunteers. Caspase-3 activity was significantly increased in all PD patient groups. Patients treated with L-Dopa and dopamine agonists showed the lowest values of Bcl-2, coupled with the highest density of PBRs, while increased levels of Cu/Zn SOD were found in the group under monotherapy with L-Dopa. We also found, in PD patients, clear, negative correlations between Bcl-2 levels and both duration and severity of the disease. Our findings point to the existence of changes in the regulatory mechanisms of apoptosis in PD patients -- observable outside the central nervous system -- which seem to be modulated by the pharmacological treatment with dopaminergic agents.
- Published
- 2004
- Full Text
- View/download PDF
271. Comorbid disorders and hospitalisation in Parkinson's disease: a prospective study.
- Author
-
Martignoni E, Godi L, Citterio A, Zangaglia R, Riboldazzi G, Calandrella D, Pacchetti C, and Nappi G
- Subjects
- Acute Disease, Aged, Comorbidity, Female, Humans, Italy epidemiology, Longitudinal Studies, Male, Middle Aged, Nervous System Diseases epidemiology, Prospective Studies, Risk Factors, Accidental Falls statistics & numerical data, Cardiovascular Diseases epidemiology, Hospitalization statistics & numerical data, Parkinson Disease epidemiology, Wounds and Injuries epidemiology
- Abstract
Parkinson's disease (PD) is often associated with other disorders, typical of the disease or of the age of PD patients, that can lead to hospitalisation, sometimes as emergencies. In this one-year prospective, longitudinal study, we investigated the comorbid events prompting the hospitalisation, or occurring during the planned hospitalisation, of an unselected group of 180 PD patients, admitted to 9 general hospitals in the course of the study. The most frequent acute comorbid events were trauma (30.5%), mostly due to falls, and vascular disorders (29.3%). Comorbidities were closely related to PD in 50% of cases. More than 50% of patients did not require (in addition to PD therapy) specific treatment for the acute comorbid event. Older age was associated with increased risk of complications. The setting up of multidisciplinary networks covering entire territories could help to improve the way in which we tackle the clinical and social problems generated by PD and its comorbidities.
- Published
- 2004
- Full Text
- View/download PDF
272. A questionnaire on sleep and mental disorders in Parkinson's disease (QSMDPD): development and application of a new screening tool.
- Author
-
Pacchetti C, Manni R, Zangaglia R, Glorioso M, Cristina S, Terzaghi M, Ossola M, Tassorelli C, Mancini F, and Nappi G
- Subjects
- Aged, Female, Humans, Incidence, Male, Mental Disorders epidemiology, Middle Aged, Sleep Wake Disorders epidemiology, Mass Screening methods, Mental Disorders etiology, Parkinson Disease complications, Parkinson Disease diagnosis, Sleep Wake Disorders etiology, Surveys and Questionnaires
- Abstract
Psychiatric, cognitive and sleep disorders are the most frequent and disabling non-motor complications of Parkinson's disease (PD). To improve the description of sleep and mental disorders in PD patients, we set out to develop a simple and reliable data collection tool (questionnaire) for the screening of large samples of PD patients. The first draft of the questionnaire was administered to a consecutive series of 120 PD patients from the outpatient department of our unit, who were instructed to fill it in with the help of their caregivers. Subsequent drafts of the questionnaire were evaluated together with the patients and their caregivers, until a final, satisfactory version was obtained. This final version was named the Questionnaire on Sleep and Mental Disorders in PD (QSMDPD). This questionnaire--we used the Italian version, named Questionario sui Disturbi del Sonno e Mentali nella Malattia di Parkinson, ODSMMP--consists of 119 questions with multiple-choice answers. The QSMDPD was mailed or handed to 400 PD patients followed at our unit's outpatient department. Three hundred and twenty (80%) were returned to us. A review of these completed questionnaires, conducted by a neurologist together with the patients, showed 90% of them (289) to be complete and to provide reliable data. This high compliance suggests that the QSMDPD is a promising tool for collecting data on sleep and mental disorders in large samples of PD patients. A short version will be administered as a follow-up tool.
- Published
- 2004
273. Dopamine agonists and sleepiness in PD: review of the literature and personal findings.
- Author
-
Manni R, Terzaghi M, Sartori I, Mancini F, and Pacchetti C
- Subjects
- Aged, Circadian Rhythm physiology, Disorders of Excessive Somnolence diagnosis, Female, Humans, Male, Parkinson Disease physiopathology, Prevalence, Sleep Stages physiology, Surveys and Questionnaires, Disorders of Excessive Somnolence drug therapy, Disorders of Excessive Somnolence epidemiology, Dopamine Agonists therapeutic use, Parkinson Disease drug therapy, Parkinson Disease epidemiology
- Abstract
Background and Purpose: This study is aimed at evaluating daytime sleepiness in a series of Parkinson's disease (PD) patients chronically treated with dopamine agonists (DAs) alone or in combination with L-Dopa., Patients and Methods: A preliminary series of 22 non-demented, adult PD patients (mean age 68.9, 13 men and 9 women) were evaluated by means of structured sleep interview, Epworth sleepiness scale (ESS) and 24-h ambulatory polysomnography (A-PSG)., Results: Sleep attacks (SAs) were reported by 32% of the patients, in three of them (43%) after DA treatment was initiated (alone or in addition to L-Dopa). In two patients, both with chronic use of ropinirole, we documented NREM SAs during a continuous ambulatory polysomnography (A-PSG) performed in the patients' real-life settings. The subjects experiencing SAs showed a higher degree of daytime sleep propensity than those without SA, having higher ESS scores and a higher proportion of microsleeps and intentional naps on A-PSG. Interestingly, we found that nocturnal total sleep time is higher in PD patients with SAs than in the others., Conclusions: All in all, our data indicate that SAs are an extreme manifestation of increased daytime sleepiness. The occurrence of SAs in our series of PD patients is unlikely to depend simply on the demands of homeostatic mechanisms.
- Published
- 2004
- Full Text
- View/download PDF
274. Cognitive rehabilitation in Parkinson's disease.
- Author
-
Sinforiani E, Banchieri L, Zucchella C, Pacchetti C, and Sandrini G
- Subjects
- Aged, Cognition Disorders diagnosis, Female, Humans, Male, Neuropsychological Tests, Severity of Illness Index, Therapy, Computer-Assisted instrumentation, Cognition Disorders complications, Cognition Disorders rehabilitation, Cognitive Behavioral Therapy methods, Parkinson Disease complications
- Abstract
A rehabilitation program of 6 weeks, including both motor and cognitive training, was applied to 20 patients affected by Parkinson's disease (PD) in the early stages, presenting with mild cognitive deficits, but no dementia. Cognitive rehabilitation has been performed by utilizing a software elaborated for neuropsychological training (TNP). At the end of the scheduled sessions, the patients showed a significant improvement at verbal fluency, logic memory and Raven's matrices tests, as compared to baseline. These results remained stable over the time. We hypothesize that rehabilitative training exerts its positive effects by reinforcing cognitive strategies, in particular, by enhancing frontal function, which are typically impaired in PD, and suggests that this instrument could be implemented in nonpharmacological treatment of this pathology.
- Published
- 2004
- Full Text
- View/download PDF
275. Long-term evaluation of the effect of quetiapine on hallucinations, delusions and motor function in advanced Parkinson disease.
- Author
-
Mancini F, Tassorelli C, Martignoni E, Moglia A, Nappi G, Cristina S, and Pacchetti C
- Subjects
- Aged, Antiparkinson Agents therapeutic use, Chi-Square Distribution, Cognition drug effects, Delusions etiology, Dopamine Agonists therapeutic use, Female, Hallucinations etiology, Humans, Male, Middle Aged, Parkinson Disease complications, Prospective Studies, Psychiatric Status Rating Scales, Quetiapine Fumarate, Severity of Illness Index, Statistics, Nonparametric, Time, Time Factors, Antipsychotic Agents therapeutic use, Delusions drug therapy, Dibenzothiazepines therapeutic use, Hallucinations drug therapy, Motor Activity drug effects, Parkinson Disease drug therapy
- Abstract
Objectives: Mental disorders (MDs) are disabling complications of Parkinson disease (PD). We set out to demonstrate the short- and long-term efficacy of quetiapine, an antipsychotic drug, in controlling hallucinations and delusions in parkinsonian patients without worsening their motor function. Since current guidelines recommend that dopaminergic drugs be decreased or even withdrawn altogether upon the appearance of MDs, we also sought to establish whether quetiapine enables a modification of this common course of action, and hence improve the management of pre-existing motor complications in affected subjects., Method: Thirty-five PD patients with disabling MDs were enrolled in this open-label study. Motor function, MDs and cognitive state were evaluated before starting quetiapine therapy and after 1, 3, and 12 months of treatment., Results: MDs significantly improved after 1, 3, and 12 months of quetiapine treatment. At the end of the study the mean daily dose of quetiapine (185 mg) did not produce significant changes in motor or cognitive function. Isolated hallucinations responded to low doses of quetiapine (110 mg daily), while delusions needed 265 mg daily. After 12 months, global dopaminergic therapy was reduced in 3 patients, modified (purely in terms of its components) in 17 patients, and increased in 15 patients., Conclusions: Quetiapine was effective in the treatment of hallucinations and delusions in PD. It did not worsen motor functions and allowed the dopaminergic treatment in PD patients affected by MDs to be managed safely.
- Published
- 2004
- Full Text
- View/download PDF
276. Sleep attacks in Parkinson's disease: a clinical and polysomnographic study.
- Author
-
Pacchetti C, Martignoni E, Terzaghi M, Zangaglia R, Mancini F, Nappi G, and Manni R
- Subjects
- Aged, Antiparkinson Agents therapeutic use, Disorders of Excessive Somnolence drug therapy, Humans, Male, Middle Aged, Parkinson Disease drug therapy, Sleep Stages physiology, Disorders of Excessive Somnolence etiology, Parkinson Disease complications, Polysomnography methods
- Abstract
The objective of the study was to evaluate daytime sleepiness, (the features of episodes of sudden sleep onset), i. e., so-called sleep attacks (SAs), in three male Parkinson's disease (PD) patients (mean age 66 years) on chronic therapy with ropirinole or pramipexole. A structured clinical interview, the Epworth Sleepiness Scale, and continuous 24-h ambulatory polysomnography were used to assess the features of SAs occurring in the patients in their normal home environments. The polysomnographic patterns characterizing SAs (sleep occurring against a background of wakefulness, and not preceded by a feeling of sleepiness or by other heralding symptoms) were analyzed. The results showed that SAs can be clearly documented through polysomnographic monitoring and really, but rarely, occur in PD. SAs seem to represent the extreme of the continuum of daytime sleepiness observed in PD patients.
- Published
- 2003
- Full Text
- View/download PDF
277. Modifications of plasma and platelet levels of L-DOPA and its direct metabolites during treatment with tolcapone or entacapone in patients with Parkinson's disease.
- Author
-
Blandini F, Nappi G, Fancellu R, Mangiagalli A, Samuele A, Riboldazzi G, Calandrella D, Pacchetti C, Bono G, and Martignoni E
- Subjects
- Age Factors, Age of Onset, Aged, Antiparkinson Agents pharmacology, Antiparkinson Agents therapeutic use, Benzophenones therapeutic use, Blood Platelets drug effects, Catechols therapeutic use, Dopamine blood, Dose-Response Relationship, Drug, Drug Administration Schedule, Female, Humans, Levodopa blood, Male, Middle Aged, Nitriles, Nitrophenols, Parkinson Disease blood, Retrospective Studies, Sex Characteristics, Tolcapone, Tyrosine blood, Up-Regulation drug effects, Up-Regulation physiology, Benzophenones pharmacology, Blood Platelets metabolism, Catechols pharmacology, Levodopa metabolism, Parkinson Disease drug therapy, Parkinson Disease metabolism, Tyrosine analogs & derivatives
- Abstract
We compared--retrospectively--the effects of a 3-month therapy with catechol- O-methyltransferase (COMT) inhibitors tolcapone (100 mg, t.i.d.) and entacapone (200 mg, t.i.d.), on L-DOPA metabolism in two groups of parkinsonian patients with motor fluctuations. Plasma and platelets concentrations of L-DOPA and its direct metabolites, dopamine and 3- O-methyldopa (3-OMD), were measured before starting treatment, after two weeks and at the end of treatment. Patients treated with tolcapone showed significant increases in plasma and platelet L-DOPA levels and marked reduction of plasma and platelet 3-OMD levels, both at short- and long-term. Entacapone did not modify L-DOPA levels, while inducing a less marked reduction of plasma and platelet 3-OMD concentrations, with respect to tolcapone, at both time points. Both drugs were similarly effective in increasing plasma and platelet levels of dopamine. These results confirm the different profiles of activity of the two drugs, with tolcapone proving more effective on both the intra- and extra-cellular levels of L-DOPA and 3-OMD.
- Published
- 2003
- Full Text
- View/download PDF
278. Differences in the EMG pattern of leg muscle activation during locomotion in Parkinson's disease.
- Author
-
Albani G, Sandrini G, Künig G, Martin-Soelch C, Mauro A, Pignatti R, Pacchetti C, Dietz V, and Leenders KL
- Subjects
- Adaptation, Physiological, Adult, Aged, Aged, 80 and over, Electromyography, Female, Humans, Hypokinesia physiopathology, Leg physiopathology, Male, Middle Aged, Pilot Projects, Gait physiology, Hypokinesia diagnosis, Locomotion physiology, Muscle, Skeletal physiopathology, Parkinson Disease physiopathology
- Abstract
In this pilot study, EMG patterns of leg muscle activation were studied in five parkinsonian patients with (B1) and five without (B2) freezing. Gastrocnemius medialis (GM) and tibialis anterior (TA) activity was analysed, by means of surface electromyography (EMG), during treadmill walking at two different belt speeds. Both groups showed reduced GM activity and an overactive TA at the lower speed compared with controls. Upon increasing the speed, the B2 patients showed a marked GM response (increment index 100%), while a moderate change was observed in the B1 group. Poor recruitment of the GM characterises parkinsonian gait in general; this pattern is much more marked in parkinsonian patients with freezing of gait, who show a loss of GM adaptation to variation of locomotion speed.
- Published
- 2003
279. Double-blind, placebo-controlled study to evaluate the efficacy and safety of botulinum toxin type A in the treatment of drooling in parkinsonism.
- Author
-
Mancini F, Zangaglia R, Cristina S, Sommaruga MG, Martignoni E, Nappi G, and Pacchetti C
- Subjects
- Aged, Botulinum Toxins, Type A administration & dosage, Botulinum Toxins, Type A adverse effects, Double-Blind Method, Female, Humans, Injections methods, Male, Middle Aged, Parkinson Disease drug therapy, Parkinson Disease physiopathology, Parotid Gland drug effects, Salivation drug effects, Severity of Illness Index, Sialorrhea etiology, Submandibular Gland drug effects, Treatment Outcome, Botulinum Toxins, Type A therapeutic use, Parkinson Disease complications, Sialorrhea drug therapy
- Abstract
Drooling is a frequent symptom in Parkinson's disease (PD), occurring in almost 75% of all patients. Although it is now well known that drooling in PD is the result of swallowing difficulties rather than excessive saliva production, few treatments have been developed to reduce it. Clinical studies suggest that botulinum toxin A (BTX) injections into salivary glands are effective in decreasing drooling in PD patients. In this double-blind, placebo-controlled study, 20 patients with parkinsonism (idiopathic PD or multiple system atrophy), were randomly assigned to receive 450 U of BTX (Dysport; Ipsen, Berkshire, UK) or 2 ml of placebo, injected into the parotids and submandibular glands under ultrasonographic guidance. Treatment efficacy and safety were assessed at baseline, 1 week and 3 months after BTX injections using clinical scales (Drooling Severity and Drooling Frequency scales) and side effects surveillance. After treatment, the average secretion of saliva in the BTX group was significantly lower than in the placebo group, as appraised by clinical measurements. No side effects were observed in either group. BTX injection into parotids and submandibular glands, under ultrasonographic guidance, is an effective and safe treatment for drooling in parkinsonism., (Copyright 2003 Movement Disorder Society)
- Published
- 2003
- Full Text
- View/download PDF
280. High-dose ropinirole in advanced Parkinson's disease with severe dyskinesias.
- Author
-
Cristina S, Zangaglia R, Mancini F, Martignoni E, Nappi G, and Pacchetti C
- Subjects
- Aged, Aged, 80 and over, Antiparkinson Agents administration & dosage, Antiparkinson Agents therapeutic use, Dopamine Agonists therapeutic use, Dose-Response Relationship, Drug, Dyskinesia, Drug-Induced etiology, Female, Humans, Indoles therapeutic use, Levodopa therapeutic use, Male, Middle Aged, Pilot Projects, Severity of Illness Index, Treatment Outcome, Antiparkinson Agents adverse effects, Dopamine Agonists administration & dosage, Dyskinesia, Drug-Induced drug therapy, Indoles administration & dosage, Levodopa adverse effects, Parkinson Disease drug therapy
- Abstract
Levodopa (LD) is the gold standard of therapy for Parkinson's disease, but it is commonly associated with motor fluctuations and dyskinesias. Dopamine agonists are often used as adjuncts to LD in an attempt to reduce these complications. In this open-label study the authors investigated the effects of high doses of adjunctive ropinirole in 36 patients with advanced Parkinson's disease and normal cognitive status. The daily dose of ropinirole was increased from 18.4 +/- 3.5 mg to 34.7 +/- 5.5 mg, generally in four separate doses. The daily LD dose was decreased from 734.1 +/- 254.8 mg to 502.8 +/- 228.4 mg. After 12 months 25 patients were still on high doses of ropinirole whereas 11 patients had, after either the emergence of side effects or a worsening of their clinical conditions, decreased or interrupted ropinirole. At 12 months, the daily doses of LD and ropinirole were 489 +/- 243 mg and 34.6 +/- 4.6 mg respectively. There was a significant reduction in the Dyskinesia Rating Scale scores during both ON and OFF periods, indicating a reduction in dyskinesias during ON periods and a reduction in dystonias during OFF periods (p < 0.001). Both the intensity and the hours spent during OFF periods were reduced significantly (p < 0.001). Even though these results need to be confirmed through extended controlled studies, the high-dose dopamine agonist strategy is safe for patients with advanced PD in whom a marked motor response to LD (even at very low doses) is associated with severe dyskinesias, and may be used as a means of delaying surgery or as an alternative to continuous apomorphine infusion.
- Published
- 2003
- Full Text
- View/download PDF
281. Hallucinations and sleep-wake cycle in PD: a 24-hour continuous polysomnographic study.
- Author
-
Manni R, Pacchetti C, Terzaghi M, Sartori I, Mancini F, and Nappi G
- Subjects
- Aged, Electroencephalography, Female, Humans, Male, Monitoring, Ambulatory, Parkinson Disease complications, Sleep, REM physiology, Hallucinations etiology, Parkinson Disease psychology, Polysomnography, Sleep physiology, Wakefulness physiology
- Abstract
Twenty-four-hour ambulatory polysomnography was performed in 20 patients with PD who were having visual hallucinations (12 men and 8 women, mean age 70 +/- 6 years). Visual hallucinations were clearly related to daytime NREM sleep or nocturnal REM sleep in 33% of the instances. The data reinforce the hypothesis that neural mechanisms implicated in generating sleep and, in particular, in dream imagery play a role in the occurrence of visual hallucinations in PD.
- Published
- 2002
- Full Text
- View/download PDF
282. Parkinson's disease and reproductive life events.
- Author
-
Martignoni E, Nappi RE, Citterio A, Calandrella D, Corengia E, Fignon A, Zangaglia R, Riboldazzi G, Pacchetti C, and Nappi G
- Subjects
- Adult, Aged, Aged, 80 and over, Breast Feeding, Case-Control Studies, Dysmenorrhea, Female, Humans, Italy epidemiology, Menarche, Menopause, Middle Aged, Parity, Premenstrual Syndrome, Surveys and Questionnaires, Parkinson Disease epidemiology, Reproductive History
- Abstract
Onset, progression and duration of Parkinson's disease (PD) seem to be similar in men and women but gender differences have been suggested concerning clinical aspects, such as more severe disease in men and more dyskinesia in women. Taking into account the multiple influences of sex hormones, estrogens in particular, on basal ganglia function, the present work compared the characteristics of reproductive events in PD subjects and in healthy women, with regard to onset and clinical aspects of the disease with respect to the milestones of reproductive life. A total of 150 PD women and 200 healthy women matched for age were interviewed about reproductive life and disease characteristics (if patients). As a group, the women with PD had menarche later than the controls, but in the normal range. Menopause was similar to the controls for time, type (natural) and onset (slow), but with less hormonal therapies. Women with PD had fewer children, while breast feeding and gynecological diseases were comparable to controls. The characteristics of menses were similar as far as dysmenorrhea and premenstrual syndrome (PMS). The women with PD onset before menopause had a longer disease duration, with a more frequent fluctuating stage, and longer treatment with both levodopa and dopamine agonists. They had more dysmenorrhea and PMS when compared with women with PD onset after menopause and controls.
- Published
- 2002
- Full Text
- View/download PDF
283. Reversible chorea and focal dystonia in vitamin B12 deficiency.
- Author
-
Pacchetti C, Cristina S, and Nappi G
- Subjects
- Aged, Anti-Dyskinesia Agents therapeutic use, Chorea drug therapy, Dystonic Disorders drug therapy, Humans, Male, Tiapamil Hydrochloride therapeutic use, Vitamin B Deficiency drug therapy, Chorea etiology, Dystonic Disorders etiology, Vitamin B 12 therapeutic use, Vitamin B Deficiency complications
- Published
- 2002
- Full Text
- View/download PDF
284. Not paralysis, but dystonia causes stridor in multiple system atrophy.
- Author
-
Merlo IM, Occhini A, Pacchetti C, and Alfonsi E
- Subjects
- Adult, Aged, Anti-Dyskinesia Agents therapeutic use, Botulinum Toxins therapeutic use, Diagnosis, Differential, Dystonia complications, Dystonia physiopathology, Electromyography, Female, Humans, Male, Middle Aged, Multiple System Atrophy complications, Multiple System Atrophy physiopathology, Paralysis physiopathology, Respiratory Sounds etiology, Respiratory Sounds physiopathology, Vocal Cords physiopathology, Dystonia diagnosis, Multiple System Atrophy diagnosis, Paralysis diagnosis, Respiratory Sounds diagnosis
- Abstract
Electromyography (EMG) was performed in 10 patients with multiple system atrophy, laryngeal or pharyngeal symptoms, or both. In patients with stridor, EMG during quiet breathing revealed persistent tonic activity in both abductor and adductor vocal cord muscles. In patients with dysphagia, the cricopharyngeal muscle showed persistent EMG activity throughout all phases of swallowing. Botulinum toxin injection into the adductor muscle determined subjective improvement and reduced tonic EMG activity. Therefore, the cause of stridor in multiple system atrophy is dystonia of the vocal cords.
- Published
- 2002
- Full Text
- View/download PDF
285. Plasma homocysteine and l-dopa metabolism in patients with Parkinson disease.
- Author
-
Blandini F, Fancellu R, Martignoni E, Mangiagalli A, Pacchetti C, Samuele A, and Nappi G
- Subjects
- Antiparkinson Agents metabolism, Antiparkinson Agents therapeutic use, Dihydroxyphenylalanine analogs & derivatives, Dihydroxyphenylalanine blood, Dopamine blood, Female, Humans, Levodopa metabolism, Levodopa therapeutic use, Male, Middle Aged, Parkinson Disease drug therapy, Parkinson Disease metabolism, Tyrosine analogs & derivatives, Antiparkinson Agents blood, Homocysteine blood, Levodopa blood, Parkinson Disease blood
- Published
- 2001
286. The position of the head in space: a kinematic analysis in patients with cervical dystonia treated with botulinum toxin.
- Author
-
Albani G, Bulgheroni MV, Mancini F, Mauro A, Fundarò C, Pacchetti C, Sandrini G, and Nappi G
- Subjects
- Adult, Biomechanical Phenomena, Female, Humans, Male, Middle Aged, Posture, Severity of Illness Index, Treatment Outcome, Anti-Dyskinesia Agents therapeutic use, Botulinum Toxins therapeutic use, Head, Torticollis drug therapy, Torticollis physiopathology
- Abstract
Many instruments have been employed in recent years in order to quantify the posture and motion of the head in normal and pathological subjects. Evaluations of this type present many difficulties related to the influence of individual and external factors and to the accuracy of the system used. In patients with cervical dystonia (CD) the only rating scales currently used are semi-quantitative and subjective. More precise information on disease severity and response to the treatment is needed. Posture and motion of the head were evaluated by means of ELITE motion analyser (BTS, Milan, Italy) in 6 patients with the left laterocollis form of CD undergoing treatment with botulinum toxin (BTX). The method emerged as very useful for the quantification of the therapeutic response (which was more marked in motion than in posture). We found an inverse relationship between the degree of motion improvement and the restriction of motion before treatment.
- Published
- 2001
287. COMT inhibition and safety.
- Author
-
Martignoni E, Blandini F, Pacchetti C, and Nappi G
- Subjects
- Antiparkinson Agents adverse effects, Clinical Trials, Phase III as Topic, Humans, Nitriles, Nitrophenols, Safety, Tolcapone, Antiparkinson Agents therapeutic use, Benzophenones adverse effects, Benzophenones therapeutic use, Catechol O-Methyltransferase Inhibitors, Catechols adverse effects, Catechols therapeutic use, Enzyme Inhibitors adverse effects, Enzyme Inhibitors therapeutic use
- Published
- 2001
288. Botulinum toxin treatment for functional disability induced by essential tremor.
- Author
-
Pacchetti C, Mancini F, Bulgheroni M, Zangaglia R, Cristina S, Sandrini G, and Nappi G
- Subjects
- Aged, Arm innervation, Arm physiopathology, Botulinum Toxins, Type A adverse effects, Disability Evaluation, Electromyography, Essential Tremor physiopathology, Female, Humans, Male, Middle Aged, Muscle, Skeletal drug effects, Muscle, Skeletal physiopathology, Neuromuscular Agents adverse effects, Patient Satisfaction, Recovery of Function physiology, Surveys and Questionnaires, Treatment Outcome, Botulinum Toxins, Type A administration & dosage, Essential Tremor drug therapy, Neuromuscular Agents administration & dosage, Recovery of Function drug effects
- Abstract
This study aimed to improve botulinum toxin's (BTX) efficacy and to reduce its unwanted effects in the treatment of functional disability due to essential tremor (ET) of the hand. Twenty patients with disabling ET, not responding to conventional pharmacological therapy, were enrolled in this open-label study. Activities of daily living self-questionnaire (ADLS) and severity tremor scale (STS) were used to establish patients' functional disability and tremor severity. Accelerometry and surface electromyography were used to identify the arm muscles with tremorogenic activity during impaired positions. Global rating was used to measure treatment efficacy and unwanted effects. BTX type A was injected into the muscles principally responsible for impaired positions. After BTX treatment, there was a significant reduction in both severity and functional rating scales scores (ADLS and STS) and of tremor amplitude as measured with accelerometry and EMG. Adverse effects were limited to a slight third finger extension weakness in 15% of patients. BTX injections are effective and safe in reducing disability due to ET, if based on the criterion of functional selection.
- Published
- 2000
- Full Text
- View/download PDF
289. Active music therapy in Parkinson's disease: an integrative method for motor and emotional rehabilitation.
- Author
-
Pacchetti C, Mancini F, Aglieri R, Fundarò C, Martignoni E, and Nappi G
- Subjects
- Female, Humans, Hypokinesia therapy, Male, Middle Aged, Physical Therapy Modalities methods, Prospective Studies, Quality of Life, Single-Blind Method, Surveys and Questionnaires, Treatment Outcome, Mood Disorders therapy, Movement Disorders therapy, Music Therapy methods, Parkinson Disease therapy
- Abstract
Background: Modern management of Parkinson's disease (PD) aims to obtain symptom control, to reduce clinical disability, and to improve quality of life. Music acts as a specific stimulus to obtain motor and emotional responses by combining movement and stimulation of different sensory pathways. We explored the efficacy of active music therapy (MT) on motor and emotional functions in patients with PD., Methods: This prospective, randomized, controlled, single-blinded study lasted 3 months. It consisted of weekly sessions of MT and physical therapy (PT). Thirty-two patients with PD, all stable responders to levodopa and in Hoehn and Yahr stage 2 or 3, were randomly assigned to two groups of 16 patients each. We assessed severity of PD with the Unified Parkinson's Disease Rating Scale, emotional functions with the Happiness Measure, and quality of life using the Parkinson's Disease Quality of Life Questionnaire. MT sessions consisted of choral singing, voice exercise, rhythmic and free body movements, and active music involving collective invention. PT sessions included a series of passive stretching exercises, specific motor tasks, and strategies to improve balance and gait., Results: MT had a significant overall effect on bradykinesia as measured by the Unified Parkinson's Disease Rating Scale (p < .034). Post-MT session findings were consistent with motor improvement, especially in bradykinesia items (p < .0001). Over time, changes on the Happiness Measure confirmed a beneficial effect of MT on emotional functions (p < .0001). Improvements in activities of daily living and in quality of life were also documented in the MT group (p < .0001). PT improved rigidity (p < .0001)., Conclusions: MT is effective on motor, affective, and behavioral functions. We propose active MT as a new method for inclusion in PD rehabilitation programs.
- Published
- 2000
- Full Text
- View/download PDF
290. Peripheral markers of oxidative stress in Parkinson's disease. The role of L-DOPA.
- Author
-
Martignoni E, Blandini F, Godi L, Desideri S, Pacchetti C, Mancini F, and Nappi G
- Subjects
- Biomarkers, Blood Platelets drug effects, Blood Platelets metabolism, Dopamine blood, Female, Humans, Hydroxybenzoates blood, Hydroxyl Radical, In Vitro Techniques, Linear Models, Male, Middle Aged, Parkinson Disease physiopathology, Sodium Salicylate pharmacology, Superoxide Dismutase blood, Tyrosine analogs & derivatives, Tyrosine blood, Antiparkinson Agents therapeutic use, Gentisates, Levodopa therapeutic use, Oxidative Stress physiology, Parkinson Disease drug therapy
- Abstract
Oxidative stress plays a central role in the pathogenesis of Parkinson's disease (PD). L-DOPA, the gold standard in PD therapy, may paradoxically contribute to the progression of the disease because of its pro-oxidant properties. The issue, however, is controversial. In this study, we evaluated peripheral markers of oxidative stress in normal subjects, untreated PD patients and PD patients treated only with L-DOPA. We also measured platelet and plasma levels of L-DOPA, 3-O-methyldopa (the long-lasting metabolite of the drug), and dopamine. We found that isolated platelets of treated PD patients form higher amounts of 2,3-dihydroxybenzoate, an index of hydroxyl radical generation, than platelets of controls or untreated patients. In treated patients, platelet levels of 2,3-dihydroxybenzoate were positively correlated with platelet levels of L-DOPA, 3-O-methyldopa, and with the score of disease severity. Disease severity was correlated with platelet and plasma levels of L-DOPA, as well as with the daily intake of the drug. No significant differences in platelet levels of cytosolic and mitochondrial isoforms of the antioxidant enzyme superoxide dismutase were found between PD patients, either treated or untreated, and controls. Our findings lend further support to the hypothesis that L-DOPA might promote free radical formation in PD patients.
- Published
- 1999
- Full Text
- View/download PDF
291. Active music therapy and Parkinson's disease: methods.
- Author
-
Pacchetti C, Aglieri R, Mancini F, Martignoni E, and Nappi G
- Subjects
- Aged, Emotions, Female, Humans, Male, Middle Aged, Parkinson Disease psychology, Prospective Studies, Quality of Life, Surveys and Questionnaires, Music Therapy methods, Parkinson Disease therapy
- Abstract
Music therapy (MT) is an unconventional, multisensorial therapy poorly assessed in medical care but widely used to different ends in a variety of settings. MT has two branches: active and passive. In active MT the utilisation of instruments is structured to correspond to all sensory organs so as to obtain suitable motor and emotional responses. We conducted a prospective study to evaluate the effects of MT in the neurorehabilitation of patients with Parkinson's Disease (PD), a common degenerative disorder involving movement and emotional impairment. Sixteen PD patients took part in 13 weekly sessions of MT each lasting 2 hours. At the beginning and at the end of the session, every 2 weeks, the patients were evaluated by a neurologist, who assessed PD severity with UPDRS, emotional functions with Happiness Measures (HM) and quality of life using the Parkinson's Disease Quality of Life Questionnaire (PDQL). After every session a significant improvement in motor function, particularly in relation to hypokinesia, was observed both in the overall and in the pre-post session evaluations. HM, UPDRS-ADL and PDQL changes confirmed an improving effect of MT on emotional functions, activities of daily living and quality of life. In conclusion, active MT, operating at a multisensorial level, stimulates motor, affective and behavioural functions. Finally, we propose active MT as new method to include in PD rehabilitation programmes. This article describes the methods adopted during MT sessions with PD patients.
- Published
- 1998
292. Simultaneous determination of L-dopa and 3-O-methyldopa in human platelets and plasma using high-performance liquid chromatography with electrochemical detection.
- Author
-
Blandini F, Martignoni E, Pacchetti C, Desideri S, Rivellini D, and Nappi G
- Subjects
- Adult, Aged, Antiparkinson Agents therapeutic use, Chromatography, High Pressure Liquid, Electrochemistry, Female, Humans, Levodopa therapeutic use, Male, Middle Aged, Parkinson Disease blood, Parkinson Disease drug therapy, Tyrosine blood, Tyrosine therapeutic use, Antiparkinson Agents blood, Blood Platelets chemistry, Levodopa blood, Tyrosine analogs & derivatives
- Abstract
Various high-performance liquid chromatographic (HPLC) methods for the determination of plasma levels of L-dopa and of its metabolite, 3-O-methyldopa (3-OMD), have been previously described. In this study, we report a modification of these methods, that enables the assay of these two compounds in platelets and plasma obtained from the same sample of whole blood. Reversed-phase (RP) HPLC with electrochemical (coulometric) detection was used. The within-run and between-run coefficients of variations, for the two compounds, were less than 10%, in both platelets and plasma; the detection limits for platelet levels of L-dopa and 3-OMD were 2 and 6 ng/10(9) platelets, respectively. In plasma, the detection limits for L-dopa and 3-OMD were 1 and 3 ng/ml, respectively. The method is rapid and simple. When applied to a population of patients with Parkinson's disease under treatment with L-dopa, this method revealed detectable levels of L-dopa and 3-OMD in the platelets of all patients. The application of this technique may provide new insights into the pharmacokinetics of L-dopa in patients with Parkinson's disease.
- Published
- 1997
- Full Text
- View/download PDF
293. Is seborrhea a sign of autonomic impairment in Parkinson's disease?
- Author
-
Martignoni E, Godi L, Pacchetti C, Berardesca E, Vignoli GP, Albani G, Mancini F, and Nappi G
- Subjects
- Aged, Antiparkinson Agents adverse effects, Antiparkinson Agents therapeutic use, Female, Humans, Levodopa adverse effects, Levodopa therapeutic use, Lipids chemistry, Male, Middle Aged, Parkinson Disease drug therapy, Sex Characteristics, Skin chemistry, Autonomic Nervous System physiopathology, Dermatitis, Seborrheic etiology, Parkinson Disease complications, Parkinson Disease physiopathology
- Abstract
An increase of sebum excretion rate (SER) is frequently observed in patients suffering from Parkinson's disease (PD). Some authors attribute it to the hyperactivity of the parasympathetic system, while others consider the possible action of androgens or of MSH-hormone. The aim of our study was to verify and quantify SER in 70 parkinsonian patients and compare it with SER in 60 normal subjects. We found higher values of SER in male subjects, both in normal and in parkinsonian patients. The highest rate of excretion was observed in parkinsonian males, in agreement with the possible main role of androgens or testosterone in sebum excretion, while the phenomenon did not appear to be related to abnormalities of the autonomic nervous system. The association of PD and sex hormones might therefore be crucial for the developing of seborrhea.
- Published
- 1997
- Full Text
- View/download PDF
294. Pituitary-adrenal responses to dexamethasone and CRH administration in patients with untreated Parkinson's disease.
- Author
-
Martignoni E, Costa A, Nappi RE, Pacchetti C, Godi L, and Nappi G
- Subjects
- Aged, Female, Humans, Male, Middle Aged, Parkinson Disease physiopathology, Anti-Inflammatory Agents administration & dosage, Corticotropin-Releasing Hormone administration & dosage, Dexamethasone administration & dosage, Parkinson Disease drug therapy, Pituitary-Adrenal System drug effects
- Published
- 1997
- Full Text
- View/download PDF
295. Lisuride and bromocryptine in L-Dopa stable-responder parkinsonian patients: a comparative, double-blind evaluation of cardiopressor and neurochemical effects.
- Author
-
Micieli G, Martignoni E, Cavallini A, Pacchetti C, Rossi F, Horowski R, and Nappi G
- Subjects
- Aged, Blood Pressure drug effects, Double-Blind Method, Female, Food-Drug Interactions, Heart Rate drug effects, Humans, Male, Middle Aged, Parkinson Disease physiopathology, Tilt-Table Test, Antiparkinson Agents therapeutic use, Brain Chemistry drug effects, Bromocriptine therapeutic use, Hemodynamics drug effects, Levodopa therapeutic use, Lisuride therapeutic use, Parkinson Disease drug therapy
- Abstract
In this study, we compared the haemodynamic and biochemical effects of bromocryptine to those of lisuride, in L-Dopa stable responder parkinsonian (PD) patients. Nineteen PD patients were admitted to the study. A double-blind, parallel group, randomized study was performed. Patients were randomly chosen to receive lisuride or bromoryptine. Both drugs were administered in increasing dosages until a maximum of either 0.6 mg lisuride or 7.5 mg bromocryptine was reached. The following tests were carried out: periprandial study, tilt table test and cardiovascular tests (sustained handgrip test, deep-breathing, lying-to-standing and Valsalva manoeuvre). During the tests, systolic and diastolic blood pressure and heart rate were monitored with an automatic sphyngomanometer. Blood samples for catecholamine assay were taken during tilt table test. In basal conditions 70% of the randomly chosen men in the bromocryptine group showed significant orthostatic hypotension (OH), while only one subject in the lisuride group demonstrated comparable OH values. The deepest derangement of orthostatic regulation was observed in the lisuride group but it should not be attributed to the greater hypotensive effects of this drug. Infact, the cardiopressor effects of bromocryptine may well be "masked" by the alteration detected in baseline conditions. Only bromocryptine significantly reduced supine and orthostatic NE plasma levels on the 14th day of therapy. Neither bromocryptine nor lisuride significantly altered periprandial blood pressure values. In conclusion, this study demonstrates that lisuride and bromocryptine are well tolerated as far as the analysis of the development of hypotensive effects is concerned. Further, more sophisticated study, with other agents that block the peripheral and/or central effects of dopamine-agonists in PD patients should be conducted in order better to define the precise role of these types of agents and the potential cardiopressor risks in these subjects.
- Published
- 1996
296. "Off" painful dystonia in Parkinson's disease treated with botulinum toxin.
- Author
-
Pacchetti C, Albani G, Martignoni E, Godi L, Alfonsi E, and Nappi G
- Subjects
- Aged, Botulinum Toxins adverse effects, Dystonia drug therapy, Dystonia physiopathology, Electromyography drug effects, Female, Foot innervation, Humans, Injections, Intramuscular, Levodopa administration & dosage, Male, Middle Aged, Muscle Contraction drug effects, Muscle Contraction physiology, Neurologic Examination drug effects, Pain physiopathology, Parkinson Disease physiopathology, Walking, Botulinum Toxins administration & dosage, Dystonia chemically induced, Levodopa adverse effects, Pain drug therapy, Parkinson Disease drug therapy
- Abstract
The "off" painful dystonia (OPD), usually concerning the feet, is a type of abnormal involuntary movement, induced by the chronic use of levodopa. It is mostly observed in the advanced stage of Parkinson's disease (PD), particularly in the early morning, in the evening, and late at night. Indeed, some patients have experienced OPD also during "on" periods when dystonic posture of the foot alternates with dyskinesia. The pain probably is due to sustained muscle contraction, which causes prolonged muscle spasm, as in primary dystonia or torticollis. Dopaminergic drugs like bromocriptine, pergolide, and especially apomorphine (s.c. infusions, or bolus), can dramatically improve the OPD. Anticholinergics baclofen and lithium are alos used in the management of OPD with some benefit. On the other hand, clinical experience shows that in many cases, these therapeutic procedures are not always enough to produce the expected results. Thirty PD patients (22 men and eight women) with OPD of the foot were treated with botulinum toxin (Botox, Btx) using electromyograms to guide injections. Dystonia was evaluated using a quantitative rating scale. The selection of the muscles for Btx treatment was carried out on the basis of foot posture. We injected Btx into tibialis posterior, tibialis anterior, gastrocnemius, flexor digitorum longus, and extensores hallucis longus with a median dose 40 IU for each muscle, distributed in two sites. In all patients, the pain improved within 10 days, whereas in 21 patients, the pain disappeared completely for 4 months (range, 3-7 months); a concomitant improvement in intensity of the dystonic spasm was also observed. No side effects were reported. Seven patients with associated "on" foot dystonia described an improvement of foot posture on walking. In conclusion, in this uncontrolled study, the use of Btx in OPD seemed a promising tool to improve pain linked to foot dystonia; however, because of the well-known underlying dopaminergic defect in OPD, the Btx therapy should be considered only if the dopaminergic treatment established for the management of OPD has failed.
- Published
- 1995
- Full Text
- View/download PDF
297. Terguride in stable Parkinson's disease.
- Author
-
Martignoni E, Pacchetti C, Aufdembrinke B, Godi L, Albani G, Mancini F, and Nappi G
- Subjects
- Aged, Dopamine Agonists administration & dosage, Dose-Response Relationship, Drug, Double-Blind Method, Female, Humans, Levodopa metabolism, Levodopa therapeutic use, Lisuride administration & dosage, Lisuride pharmacology, Lisuride therapeutic use, Male, Middle Aged, Placebos, Dopamine Agonists therapeutic use, Lisuride analogs & derivatives, Parkinson Disease drug therapy
- Abstract
Terguride (TER) (2 mg/day) was compared with a placebo in 41 stable Parkinson's disease (PD) patients, so as to test its efficacy as an add-on treatment to spare levodopa (LD). After the 4th week of add-on treatment, LD was reduced by about 25%. The number of "stable" patients (--those with an increase of no more than 20% of the basal Columbia University Rating Scale (CURS) score--remaining after LD reduction was used to compare the two add-on treatments. Most patients, remained "stable" in spite of LD reduction, and no significant differences between the therapies were discovered; the CURS score decreased over time only in the TER group. Hence, TER was shown to be a drug that has DA-ergic properties but with minimal antiparkinsonian efficacy.
- Published
- 1995
298. A crossover, controlled study comparing pergolide with bromocriptine as an adjunct to levodopa for the treatment of Parkinson's disease.
- Author
-
Pezzoli G, Martignoni E, Pacchetti C, Angeleri V, Lamberti P, Muratorio A, Bonuccelli U, De Mari M, Foschi N, and Cossutta E
- Subjects
- Aged, Cross-Over Studies, Dose-Response Relationship, Drug, Drug Therapy, Combination, Humans, Middle Aged, Bromocriptine therapeutic use, Levodopa therapeutic use, Parkinson Disease drug therapy, Pergolide therapeutic use
- Abstract
A single-blind, crossover study was carried out to compare the efficacy and safety of pergolide against that of bromocriptine in 57 patients with Parkinson's disease who showed a declining response to levodopa therapy. Patients were randomly assigned to receive either bromocriptine followed by pergolide, or pergolide followed by bromocriptine. Both drugs were administered for 12 weeks. Patients were assessed by a clinician blinded to treatment assignment using the New York University Parkinson's Disease Scale. The average daily dose of pergolide was 2.3 +/- 0.8 mg and of bromocriptine 24.2 +/- 8.4 mg. Addition of pergolide or bromocriptine resulted in a significant improvement in total scores when compared with the previous treatment of levodopa alone (pergolide, p = 0.0001; bromocriptine, p = 0.0005). Pergolide was more effective than bromocriptine in daily living scores (p = 0.02) and motor scores (p = 0.038). No differences in the incidence of dyskinesias, dystonias, or psychosis were observed between groups. Fewer adverse events were recorded in the pergolide group, and most patients and physicians preferred pergolide to bromocriptine. Pergolide as adjunctive therapy to levodopa was more effective than bromocriptine in this short-term trial.
- Published
- 1995
- Full Text
- View/download PDF
299. Autonomic disorders in Parkinson's disease.
- Author
-
Martignoni E, Pacchetti C, Godi L, Micieli G, and Nappi G
- Subjects
- Autonomic Nervous System Diseases epidemiology, Basal Ganglia Diseases epidemiology, Basal Ganglia Diseases etiology, Cardiovascular Diseases epidemiology, Cardiovascular Diseases etiology, Disease Progression, Gastrointestinal Diseases epidemiology, Gastrointestinal Diseases etiology, Humans, Incidence, Urologic Diseases epidemiology, Urologic Diseases etiology, Autonomic Nervous System Diseases etiology, Parkinson Disease complications
- Abstract
Patients with idiopathic Parkinson's disease (IPD) often show signs and symptoms of autonomic involvement, related to the disease itself or to its progression. The more frequently disturbances reported are connected with loss of extrapyramidal motor control, i.e. dysphagia, gastric emptying and the most common constipation. They concern about 73% of the patients. A high frequency of urinary symptoms, ranging from 37% to 71%, is also reported in IPD, in particular detrusor hyperreflexia causing urgency, frequency of micturing or urgency incontinence. Another autonomic groups of symptoms are related to the failure of cardiopressor adaptability which involve 15% of the subjects and are more typical of late onset cases or forms bordering with the Multiple System Atrophy, finally resulting in orthostatic hypotension (OH).
- Published
- 1995
300. Pergolide compared with bromocriptine in Parkinson's disease: a multicenter, crossover, controlled study.
- Author
-
Pezzoli G, Martignoni E, Pacchetti C, Angeleri VA, Lamberti P, Muratorio A, Bonuccelli U, De Mari M, Foschi N, and Cossutta E
- Subjects
- Aged, Bromocriptine adverse effects, Cross-Over Studies, Disability Evaluation, Dose-Response Relationship, Drug, Drug Therapy, Combination, Humans, Infant, Levodopa adverse effects, Levodopa therapeutic use, Male, Middle Aged, Neurologic Examination drug effects, Pergolide adverse effects, Single-Blind Method, Treatment Outcome, Bromocriptine therapeutic use, Parkinson Disease drug therapy, Pergolide therapeutic use
- Abstract
We compared the efficacy and safety of pergolide and bromocriptine in 57 patients with Parkinson's disease (PD) with a declining response to levodopa therapy in a single-blind, crossover study. Patients were placed randomly on the sequence bromocriptine-pergolide (12 + 12 weeks) or vice versa. Regular evaluations using the New York University Parkinson's Disease Scale were performed by a clinician blinded to treatment assignment. Patients' and clinicians' impressions also were recorded. The average daily dose of pergolide was 2.3 +/0- 0.8 mg, and that of bromocriptine was 24.2 +/- 8.4 mg. Significantly greater efficacy was demonstrated by both drugs as adjunctive therapy to levodopa compared with previous treatment of levodopa alone (pergolide, p = 0.0001; bromocriptine, p = 0.0005; Wilcoxon t test). Pergolide was more effective than bromocriptine in daily living scores (p = 0.020) and motor scores (p = 0.038). No difference in dyskinesias, dystonias, and psychosis was observed. Adverse events were more frequent in bromocriptine-treated patients. Most patients and physicians preferred pergolide to bromocriptine. Pergolide as adjunctive therapy to levodopa was more effective than bromocriptine in this short-term trial.
- Published
- 1994
- Full Text
- View/download PDF
Catalog
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.