Impact of autonomic dysfunction on quality of life in Parkinson’s disease

The present study aims at investigating the impact of the most frequent autonomic symptoms in Parkinson’s disease (PD) on patients’ quality of life (QoL). Two hundred patients with Parkinson’s disease and autonomic symptoms were included, aged 45 to 76 years, distributed evenly by sex and Hoehn-Yahr stage of severity from I to IV. The most commonly reported symptoms, negatively influencing quality of life, were constipation (53%), urinary incontinence (41,5%), nicturia and hyperhydrosis (23% each). Ninety-eight patients (49%) graded their autonomic symptoms as mildly affecting QoL, 70 (35%) as moderate, and 32 (16%) as severe. Our results support the literature data about the frequency of autonomic disorders in PD and the distribution of symptoms affecting QoL. We found a clear tendency of increase of the frequency and intensity of dysautonomias with disease severity. This trend supports the predominant opinion that autonomic distur­bances in PD are mainly mild to moderate and become clinically significant usually in late stages. On the other hand, though mild to moderate in severity, they can appear even in the early stages of the disease. Widely uti­lized specific and generic questionnaires generally do not consider this subject, therefore the introduction of questions regarding the impact of autonomic symptoms in PD on quality of life is highly appropriate

Tc-99m MIBI SPECT in the differential diagnosis of non-neoplastic brain lesions associated with epilepsy

Although considered experimental or investigational, techne tium scintigraphy has been reported to be useful in the diagnosis of structural brain lesions. Many series have evaluated its efficacy in the differentiation of brain malignancies from radiation necrosis, vascularmal formations, stroke, trauma or cerebral abscess. Accordingly, we decided to assess the usefulness of Tc-99m MIBI SPECT for the final diagnosis of suspected non-neoplas tic brain lesions associated with epilepsy. Ten patients (6 males and 4 fe males; mean age, 46.4±9.8 years) with symptomatic epilepsy asso ciated with finally non-neoplastic diagnosis were included in the study. SPECT was per formed 20 and 120 min after administration of 740 MBq (20 mCi) Tc-99m MIBI. Transverse, sagittal, and coronal views were reconstructed, and MIBI up take index was calculated on SPECT imaging. All patients under went structural neuroimaging (CT and/or MRI) that supposed cystic lesion in five patients, vascular abnormality in four and hemorrhage in one. In all cases SPECT showed no radiotracer accumulation. A correlation between lack of MIBI up take and non-tumor origin of the lesions was noted. In conclusion, we suggest that Tc-99m MIBI SPECT may be a useful noninvasive tool for the precise diagnosis of non-neoplastic brain lesions.Scripta Scientifica Medica 2009; 41(2): 179-181

Use of levetiracetam in structural brain lesions associated with refractory seizures

BACKGROUND. Approximately 40% of all individuals with epilepsy have medically refractory or intractable seizures. Among the most common etiologies are Mesiotemporal and tuberous sclerosis, Sturge-Weber syndrome, cerebral tumors, arteriovenous malformations, developmental malformations, and sequel of cerebral infections, infarcts or trauma. Levetiracetam (LEV) is a second generation AED, indicated as adjunctive therapy in adults with partial seizures.OBJECTIVE. To assess the efficacy and safety of LEV add-on therapy in patients with structural brain lesions associated with medically refractory partial epilepsy.MATERIAL AND METHODS. Twelve patients (5 M and 7 F; aged 41.6 ±7.6 years) with tumor and non-neoplastic brain lesions associated with refractory seizures were included in the study. Diagnosis was based on the criteria of ILAE. All patients had an adjunctive therapy with LEV (1000-3000 mg/daily) for at least six months. Drug efficacy was assessed as change in seizure frequency. Safety was assessed as measurement of retention rate and reporting the drug related adverse effects. Neuroimaging, EEG, and clinical follow-up were performed before and after initiation of LEV add-on therapy. RESULTS. LEV add-on therapy reduced seizure frequency in 85 percent of patients and 46 percent became seizure free. Retention rate was 100 percent for patients treated with LEV. The most common side effect was transient somnolence, noted in 25 percent of patients.CONCLUSION. This study confirms the efficacy and safety of LEV as add-on therapy in patients with structural brain lesions. Due to its unique mechanisms of action, LEV presents a new therapeutic challenge even for patients with highly refractory partial epilepsy.BACKGROUND. Approximately 40% of all individuals with epilepsy have medically refractory or intracta­ble seizures. Among the most common etiologies are Mesiotemporal and tuberous sclerosis, Sturge-Weber syndrome, cerebral tumors, arteriovenous malformations, developmental malformations, and sequel of cere­bral infections, infarcts or trauma. Levetiracetam (LEV) is a second generation AED, indicated as adjunctive therapy in adults with partial seizures. OBJECTIVE. To assess the efficacy and safety of LEV add-on therapy in patients with structural brain lesions associated with medically refractory partial epilepsy. MATERIAL AND METHODS. Twelve patients (5 M and 7 F; aged 41.6 ±7.6 years) with tumor and non-neoplastic brain lesions associated with refractory seizures were included in the study. Diagnosis was based on the criteria of ILAE. All patients had an adjunctive therapy with LEV (1000-3000 mg/daily) for at least six months. Drug ef­ficacy was assessed as change in seizure frequency. Safety was assessed as measurement of retention rate and reporting the drug related adverse effects. Neuroimaging, EEG, and clinical follow-up were performed before and after initiation of LEV add-on therapy. RESULTS. LEV add-on therapy reduced seizure frequency in 85 percent of patients and 46 percent became seizure free. Retention rate was 100 percent for patients treated with LEV. The most common side effect was transient somnolence, noted in 25 percent of patients. CONCLUSION. This study confirms the efficacy and safety of LEV as add-on therapy in patients with struc­tural brain lesions. Due to its unique mechanisms of action, LEV presents a new therapeutic challenge even for patients with highly refractory partial epilepsy

Unilateral proptosis: a diagnostic clinical and neuroimaging challenge

INTRODUCTION: The differential diagnosis of unilateral proptosis includes tumors, infections often related with immunological process, trauma, vascular diseases or axial myopia.CASE REPORTS: We present two patients with unilateral proptosis. A 34-yeard old caucasian man with a 3-months history of proptosis of the left eye with diplopia and normal visual acuity; initial CT scan examination showed highly suggestive finding for orbital apex tumor or glioma of the optic nerve, but a second CT scan with complementary projections was performed and a highly swollen inferior rectus muscle simulating an orbital apex tumor was visible. A diagnosis of unilateral thyroid ophthalmopathy was made. A 56-year old caucasian woman with unilateral exophthalmus and medical history of Graves’ hyperthyroidism; previously Graves’ ophthalmopathy was suggested. Fundoscopy showed myopic fundus. The CT scan revealed normal extraocular muscles without swollen.CONCLUSION: These two cases of unilateral proptosis are described because of their clinical and radiological differential diagnosis. We suggest that the accurate diagnosis of a unilateral proptosis remains a big challenge to the neuroophthalmologist, endocrinologist, immunologist, neurosurgeon and radiologist

Diabetes mellitus in Parkinson`s disease patients

PURPOSE: Parkinson's disease (PD) is the second most common neurodegenerative disease affecting approximately 5 million people worldwide. Some studies have found out an association between PD and type 2 diabetes mellitus (DMT2). Their results suggest a common pathophysiologic pathway. Other authors fail to establish any link between these two diseases. The aim of the present study is to search for a potential association between DMT2 and PD.MATERIAL AND METHODS: We  investigated the medical records of 85 patients, 45 males and 40 females, aged 68.02±9.02 (range, 40-87) years and with disease duration of 4.98±..96 (range, 1-18) years. They were diagnosed as PD according to the United Kingdom Parkinson's Disease Society Brain Bank Diagnostic Criteria and hospitalized for a two-year period.RESULTS: We established a prevalence of DMT2 in PD patients of 18.8%. We discussed the potential relationships between these two disorders of great medical, social and economic impact. Insulin levels contribute to normal brain function.CONCLUSION: The history of DMT2 or the use of antidiabetic drugs might be a risk factor for PD.Scripta Scientifica Medica 2013; 45(1): 79-81.</p

A comparison of (18)F FDG-PET, morphological neuroimaging and EEG findings in epilepsy

Although, EEG is accepted as a gold standard only 50% of the patients are safely diagnosed. MRI demonstrates morphologic changes in approximately 80% of patients with epilepsy. Interictal 18F-FDG PET studies show focus-localizing sensitivity ranging from 80 to 85%. Accordingly, we studied the usefulness of interictal FDG PET for detecting epileptic foci compared to structural neuroimaging and EEG findings. A total of 18 patients (7 M and 11 F; mean age 37.8±18.4 years, range 16-77 years) with epilepsy were included in the study. Neurological, FDG-PET/CT, MRI, and EEG examinations were performed. Interictal PET/CT images were acquired starting at 60 min after the intravenous injection of 5.0 mCi of (18) F-fluorodeoxyglucose. Neuroimaging showed abnormal findings in 9 patients. 15 patients had a predominantly unilateral epileptiform focus on EEG. Focal hypometabolism was found in 13 cases. 4p presented with larger hypometabolic areas and 2 had normal brain metabolism despite the epileptic focus on EEG. In 3p the zones of hypermetabolism corresponded to the tumor location. Additional hypometabolic areas were observed in the surrounding regions, which were concordant with the neuroimaging findings of perifocal edema. Based on our own findings and literature review, we suggest that interictal FDG-PET may be an important tool to better understand the neurobiology of seizures and to better define the ictal onset in epilepsy

Optic disc melanocytoma associated with macular cyst

BACKGROUND: Optic disc melanocytoma (ODM) is a benign tumor, most often asymptomatic and stationary. However occasionally it can grow slowly, cause visual loss or extremely rarely undergoes into malignant melanoma. Here lies the importance of periodic ocular examination and reliable documentation.AIM: to report a rare case of growing ODM, associated with macular cyst with related visual loss, 25-years follow-up, and documentation by color photography, optical coherence tomography (OCT) and fluorescein angiography (FAG).METHODS: Full ophthalmic examination, fundus color photography, FAG and OCT.CASE REPORT: An asymptomatic 40-year-old Caucasian female with normal visual acuity at routine ocular examination had a pigmented elevated lesion on the left optic disc, occupying the inferotemporal half. The diagnosis of ODM was based on clinical assessment, FAG, fundus photographies, and observation was recommended. Ten years later she complained of gradually decreasing visual acuity in the left eye. Dilated ophthalmoscopy showed an evidence of slow growth of ODM and initial macular degeneration. After 25 years fundus color photography, FAG, and OCT documented mild progressive growth of ODM and macular cyst in the same eye.CONCLUSION: According to the literature, optic disc melanocytoma is generally recognized to be a stationary lesion with excellent prognosis and no treatment is usually necessary. In our case fundus color photography, FAG and OCT data reveal persisting ODM. Despite the progressive growth of ODM and moderate to significant visual loss, the malignant transformation is not proved. We suggest that loss of vision is related with macular lesion. To our knowledge we report a rare case of 25 years follow-up of growing ODM with visual loss, associated with macula degeneration/cyst.

Serum cholesterol and triglycerides in Parkinson`s disease and essential tremor

The role of lipid metabolism in the pathogenesis of Parkinson`s disease is still controversial. Most authors suggest that higher The role of lipid metabolism in the pathogenesis of Parkinson`s disease is still controversial. Most authors suggest that higher serum cholesterol may be associated with a lower risk of Parkinson`s disease. Debates exist as to whether essential tremor shares similar neuropathological mechanisms as Parkinson`s disease. We investigated serum total cholesterol and triglyceride levels in a clinical setting of Parkinson`s disease versus essential tremor patients. Two hundred and sixteen Parkinson`s disease patients (126 males), aged 68.04 years, with 4.58 years disease duration and 342 essential tremor patients (118 males), aged 69.39 years, with 5.3 years disease duration were included, hospitalized during a period of 7 years in First Clinic of Neurology, University St Marina Hospital, Varna, Bulgaria. We found insignificantly higher levels of serum total cholesterol and triglyceride in essential tremor patients. Results differ statistically only on gender level with increased cholesterol in males and triglycerides in females. Our findings may indicate divergent pathophysiological mechanisms underlying Parkinson`s disease and essential tremor. Further research may elucidate the role of lipid metabolism changes in both diseases.Biomed Rev 2015; 26: 43-46.Key words: serum total cholesterol, triglycerides, Parkinson`s disease, essential tremo

Treatment options in late Parkinson's disease: decimeter wave therapy

Late stage Parkinson's disease (PD) is characterized by significant worsening of symptoms, motor fluctuations and decrease of effectiveness of drug therapy. Decimeter wave therapy (DWT) is one option to enlarge treatment strategy in late PD. We studied the effect of DWT in 12 patients (7 males), aged 65,83± 4,02 years, with 6,42± 1,51 years disease duration. Seven were at Hoehn-Yahr stage III and remaining 5 at stage IV. Mean UPDRS total score sum was 39,25± 1,91, and mean UPDRS part III sum was 24,67± 2,1. DMW was performed according to a standard protocol with apparatus Volna - 2, 10 consecutive procedures, once daily. Evaluation of UPDRS total and part III was performed on baseline, on days 11, 31 and 61. On day 11 all patients showed decrease in their both UPDRS total and part III. We lowered the levodopa doses of 6 patients in Hoehn-Yahr stage III with greatest decrease of UPDRS. On days 31 and 61 UPDRS total and part III were still lower. Our results demonstrate substantial effect of DWT on motor symptoms in late PD patients. All patients showed improvement, assessed by UPDRS, as the effect still lasted for 2 months after the physical therapy, even slightly diminished on day 61, compared to day 11. According to our results and patients subjective satisfaction reported, we could propose DWT become a part of the treatment strategy in late PD patients

A Growing Journey From Neurotrophins To Metabotrophins In Cardiometabolic Diseases

Currently, obesity has been recognized as a prime risk in the development of car-diometabolic diseases (CMD) and neurodegenerative diseases (NDD). The patho-genesis and therapy of CMD are immensely complex at the cellular and molecular levels. This scenario raises the question of how such a complexity may be grappled in a more tangible manner. Since 2003, we have been thinking “what nobody has yet thought about that everybody sees”, namely, matabotrophic factors (MTF, metabotrophins). The latter include mainly (i) the neurotrophins nerve growth factor (NGF) and brain-derived neurotrophic factor (BDNF), and (ii) the adipomyo-kines adiponectin, irisin, BDNF, fibroblast growth factor-21 alike as adipose- and skeletal muscle-derived signaling proteins (these latter discussed in another review in the present volume of Adipobiology). Herein, we argue that obesity and related CMD and NDD, particularly Alzheimer’s disease, may be viewed as MTF-deficient diseases. Further studies on MTF signatures and ramifications in these diseases are required. These would provide greater insights on how we can make MTF work for the improvement of physiological and psychological quality of human life