Chronic pain and pain processing in Parkinson’s disease

Pain is experienced by the vast majority of patients living with Parkinson’s disease. It is most often of nociceptive origin, but may also be ascribed to neuropathic (radicular or central) or miscellaneous sources. The recently validated King’s Parkinson’s Disease Pain Scale is based on 7 domains including musculoskeletal pain, chronic body pain (central or visceral), fluctuation-related pain, nocturnal pain, oro-facial pain, pain with discolouration/oedema/swelling, and radicular pain. The basal ganglia integrate incoming nociceptive information and contribute to coordinated motor responses in pain avoidance and nocifensive behaviors. In Parkinson’s disease, nigral and extra-nigral pathology, involving cortical areas, brainstem nuclei, and spinal cord, may contribute to abnormal central nociceptive processing in patients experiencing pain or not. The dopamine deficit lowers multimodal pain thresholds that are amenable to correction following levodopa dosing. Functional brain imaging with positron emission tomography following administration of H215O revealed abnormalities in the sensory discriminative processing of pain (insula/SII), as well as in the affective motivational processing of pain (anterior cingulate cortex, prefrontal cortex). Pain management is dependent on efforts invested in diagnostic accuracy to distinguish nociceptive from neuropathic pain. Treatment requires an integrated approach including strategies to lessen levodopa-related response fluctuations, in addition to other pharmacological and non-pharmacological options such as deep brain stimulation and rehabilitation

Emerging analgesic drugs for Parkinson's disease

Introduction: Pain affects between 40 and 85% of Parkinson's disease (PD) patients. It is a frequently disabling and overlooked feature, which can significantly reduce health-related quality of life. Unfortunately, there are no universally recommended treatments for this condition. Areas covered: Evidence about the efficacy and safety of available analgesic treatments is summarized in this review. Potential targets for upcoming therapies are then discussed in light of what is currently known about the physiopathology of pain in PD. Protocols for efficacy and safety assessment of novel analgesic therapies are discussed. Finally, critical aspects of study protocol design such as patient selection or outcomes to be evaluated are discussed. Expert opinion: Preliminary results indicate that duloxetine, cranial electrotherapy stimulation, rotigotine, subthalamic or pallidum nuclei stimulation or lesion or levodopa could be effective for treating pain in PD. Similarly, some case reports indicate that repetitive transcranial magnetic stimulation (rTMS) or apomorphine could be effective for relieving painful off-period dystonia. Clinical trials with rTMS or oxycodone/naloxone prolonged-release tablets for neuropathic pain or botulinum toxin for off-period dystonia are underway. Success of clinical trials about analgesic strategies in PD will depend on the selection of the right PD population to be treated, according to the type of pain, and the proper selection of study outcomes and follow-up of international recommendations.Fil: Perez Lloret, Santiago. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Centre National de la Recherche Scientifique; Francia. Université Toulouse III Paul Sabatier; Francia. Fundación para la Lucha Contra las Enfermedades Neurológicas de la Infancia. Instituto de Investigaciones Neurológicas "Raúl Carrea"; ArgentinaFil: Rey, María Verónica. Centre National de la Recherche Scientifique; Francia. Université Toulouse III Paul Sabatier; Francia. Fundación para la Lucha Contra las Enfermedades Neurológicas de la Infancia. Instituto de Investigaciones Neurológicas "Raúl Carrea"; ArgentinaFil: Dellapina, Estelle. Université Toulouse III Paul Sabatier; FranciaFil: Pellaprat, Jean. Université Toulouse III Paul Sabatier; FranciaFil: Brefel Courbon, Christine. Centre National de la Recherche Scientifique; Francia. Université Toulouse III Paul Sabatier; FranciaFil: Rascol, Olivier. Centre National de la Recherche Scientifique; Francia. Université Toulouse III Paul Sabatier; Franci

Prevalence and pharmacological factors associated with impulse-control disorder symptoms in patients with parkinson disease

BACKGROUND: Impulse-control disorders (ICDs) occur in patients with Parkinson disease (PD), especially in younger patients on dopamine therapies. OBJECTIVE: To assess the prevalence of ICD symptoms and its pharmacological correlations in a sample of French patients with PD and without PD (poststroke). METHODS: Outpatients with PD and without PD (poststroke) were screened for compulsive behaviors related to hypersexuality, compulsive shopping, pathological gambling, or compulsive eating by means of the Questionnaire for Impulse-Control Disorders-short version. Full medical history and Unified Parkinson's Disease Rating Scale scores were also recorded. Dose of dopamine agonists were converted to defined daily doses (DDDs), according to the World Health Organization Anatomical Therapeutic Chemical classification system classification system. RESULTS: Two hundred three patients with PD and 52 patients without PD were recruited (mean ± SD age, 67 ± 1 vs 69 ± 2, P= 0.4; males: 62% vs 55% P= 0.2). Symptoms of ICDs were reported by 0% of poststroke patients and 25% of the patients with PD (P < 0.001). Hypersexuality was reported by 10% of the patients with PD, compulsive shopping by 6%, pathological gambling by 3%, and compulsive eating by 14%. A logistic regression analysis found that age younger than 68 years (odds ratio [OR], 3.3; 95% confidence interval, 1.6-6.6) and exposure to dopamine agonists (OR, 20.3; 95% confidence interval, 2.7-65.0) or monoaminooxidase-B inhibitor (OR, 3.7; 95% confidence interval, 1.1-12.6) were significant factors associated with increased ICD frequency. Patients with ICD symptoms were exposed to higher dopamine doses than those without them (1.6 ± 0.1 vs 1.0 ± 0.1 daily-defined doses; P < 0.001). A dose-response pharmacodynamic model disclosed a significant nonlinear dose-response relationship between dopamine agonists and frequency of ICD symptoms (P < 0.01). CONCLUSIONS: Impulse-control disorder symptoms were more frequent in the patients with PD than in the poststroke patients with PD. Impulse-control disorder symptoms were related to younger age and exposure to monoaminooxidase-B inhibitors, and showed a nonlinear dose-response relationship with dopamine agonists.Fil: Perez Lloret, Santiago. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Inserm; FranciaFil: Rey, María Verónica. Inserm; FranciaFil: Fabre, Nelly. No especifíca;Fil: Ory, Fabienne. No especifíca;Fil: Spampinato, Umberto. No especifíca;Fil: Brefel Courbon, Christine. No especifíca;Fil: Montastruc, Jean Louis. No especifíca;Fil: Rascol, Olivier. Inserm; Franci

Leucine-Rich Glioma-Inactivated 1 Encephalitis: Broadening the Sphere

Background: Leucine-rich glioma-inactivated 1 (LGI1) encephalitis is a rare entity. Its typical features are seizures, faciobrachial dystonic seizures (FBDS), cognitive impairment, and personality changes. Case report: We report the case of a 66-year-old man with an unusual presentation, consisting of two types of FBDS, one starting in the foot and the other consisting of asynchronous myoclonic and dystonic jerks of the face triggered by noise and chin stimulation. The patient displayed no personality changes or cognitive impairment. Discussion: LGI1 encephalitis is a heterogeneous disease. Many different forms of FBDS may be observed, and these seizures can be the only symptom. This type of encephalitis should be suspected in presenting very frequent episodic events with dystonic features, regardless of the part of the body affected

Médicaments et cognition chez le sujet âgé

De nombreux médicaments peuvent modifier les fonctions cognitives chez le sujet âgé. Les médicaments atropiniques ainsi que les psychotropes peuvent provoquer ou exacerber des troubles cognitifs chez le sujet âgé et majorer le risque de survenue de démence. En prévention, chez le sujet non dément, les médicaments antihypertenseurs pourraient améliorer les fonctions cognitives à court terme et diminuer le risque de démence à long terme. Par contre, les essais cliniques évaluant les statines et les anti-inflammatoires non stéroïdiens n’ont pas démontré d’effet cognitif significatif

Étude physiopathologique de la douleur dans la maladie de Parkinson (approches pharmacologique, en neuroimagerie et évaluation des effets de la stimulation cérébrale profonde du noyau sous-thalamique)

TOULOUSE3-BU Sciences (315552104) / SudocSudocFranceF

Prise en charge thérapeutique des patients diabétiques en France : Apport de la Banque Nationale de Pharmacovigilance

Objectif : L'objectif de cette étude était de vérifier si les données de la Banque Nationale de Pharmacovigilance (BNPV) pouvaient être utilisées dans le cadre de la caractérisation de la prise en charge des patients diabétiques en France. Matériels et méthode : À partir des données de la BNPV (2002-2005), nous avons identifiéles patients diabétiques, par leur exposition à des médicaments hypoglycémiants. Cette sélection nous a permis de décrire les caractéristiques démographiques et l'utilisation de médicaments dans cette population : médicaments utilisés dans la prise en charge du diabète ainsi que les autres classes thérapeutiques. Afin de valider les résultats obtenus, nous avons comparé les caractéristiques de cette population à un échantillon de patients diabétiques identifiés à partir des données de remboursement de l'Assurance Maladie en Midi-Pyrénées et Provence Alpes Côte d'Azur au cours de l'année 2005. Résultats : La prévalence du diabète estimée était de 2,7 % dans la BNPV et de 3,2 % dans les bases de remboursement de l'Assurance Maladie. Les expositions aux médicaments hypoglycémiants et aux médicaments associés ainsi que les caractéristiques démographiques sont comparables. Conclusion : Ces données suggèrent que la Banque Nationale de Pharmacovigilance peut, sous certaines conditions, être utilisée en l'absence d'autres sources d'information pour analyser les modes d'utilisation des médicaments en France

LRP10 in α-synucleinopathies

International audienceIn The Lancet Neurology, Marialuisa Quadri and colleagues1 reported that rare, potentially pathogenic variants in LRP10 can cause autosomal dominant Parkinson's disease and dementia with Lewy bodies. To assess the causality of LRP10 in our French cohorts, we used data mining in the exomes of 21 families (61 individuals) with autosomal dominant Parkinson's disease, four families (nine individuals) with dementia with Lewy bodies, and 66 individuals with sporadic Parkinson's disease (appendix). Mutations in parkinsonism-associated genes2 were excluded by exome sequencing and multiplex ligation-dependent probe amplification

How to diagnose parkinsonian central pain?

International audienc