Sleep Disorders in Parkinson’s Disease

Sleep disorders in Parkinson’s disease (PD) are common. They can develop due to many factors. PD symptoms like rigidity or tremor, some PD medications, restless legs syndrome, depression, nocturia, and degenerative changes in the brainstem can cause sleep disorders in PD. Sleep disorders in PD may occur during the day or at night. Sleep disorders can occur before or during the disease. Sleep disorders can impair patients’ quality of life and worsen their symptoms. For this reason, it is very important to recognize these disorders and treat them appropriately. This chapter discusses the clinical features, diagnosis, comorbidities, management, and pathogenesis of sleep disorders in PD under the literature light. At the same time, it describes the most appropriate treatment considerations

Microelectrode Recording for Deep Brain Stimulation of the Subthalamic Nucleus in Patients with Advanced Parkinson's Disease:Advantage or Loss of Time?

AIM: To investigate the effect of using microelectrode recording (MER) on the length of time required to carry out a deep brain stimulation (DBS) procedure of the subthalamic nucleus in patients with Parkinson's disease (PD). MATERIAL and METHODS: The time required to include MER in the DBS operation was calculated for the first and second sides in 24 patients with PD. The number of microelectrodes used on each trajectory for the first and second sides, and the percentage of permanent electrodes implanted on each trajectory for the first and second sides, were quantified. RESULTS: The average times taken to use MER were 23.4 +/- 6.2 minutes, 17.4 +/- 6.5 minutes, and 41.2 +/- 6.3 minutes for the first side, second side and total procedure, respectively. In 75% of patients, the permanent electrode was implanted at the planned target site for the first side, and in 61% of patients for the second side. CONCLUSION: MER extends the time required to carry out the DBS procedure. However, during surgery, it provides real-time information on the electrodes' neurophysiological locations and helps the surgical team choose an alternative target if the planned target does not produce satisfying results

Effect of clinical autonomic dysfunction on cognitive functions in Parkinson’s disease

Objective: Parkinson’s disease (PD) is a chronic progressive neurodegenerative disorder characterized by tremor, rigidity, bradykinesia, and postural instability. PD also involves nonmotor manifestations such as autonomic failure, cognitive disorders, and sleep disorders. These clinical characteristics are not identical in severity, frequency, and onset time in all PD patients. We assessed whether there is a negative effect on cognition of clinical autonomic dysfunction in PD patients. Methods: This prospective study includes 37 PD patients with autonomic failure. From each patient, a questionnaire (SCOPA-AUT) including symptoms associated with clinical autonomic dysfunction such as constipation, urinary incontinence, orthostatic hypotension, and hyperhydrosis was obtained and the patient’s clinical condition was rated on the Hoehn and Yahr (H-Y) scale in the ON-medication state. The patients’ cognitive function was assessed by the Mini-Mental State Examination (MMSE), Blessed score, Frontal Assessment Battery (FAB), and Digid Span Test (DST) (forward, reverse). Cognitive test scores were compared with SCOPA-OUT scores. Results: Mean age was 66,5±11.2 years. There was no correlation between cognitive test scores and SCOPA -OUT scores (p>0.05). However, H-Y scores were negatively correlated with the DSTf, DSTr, FAB, and MMSE scores (p50.005, r:-0.451; p50.025, r: -0.367; p50.040, r: -0.340; p50.044, r5-0.333, respectively). Conclusions: According to our results, clinical autonomic dysfunction did not seem to ha ve an effect on cognition. In addition, severity of cognitive dysfunction showed a strong negative correlation with the stage of disease

Left ventricular non-compaction in children and adolescents: Clinical features, treatment and follow-up

Background: Left ventricular non-compaction (LVNC) is a specific cardiomyopathy that occurs following a disruption of endomyocardial morphogenesis. This study presents clinical findings, diagnostic features, treatment and follow-up of pediatric patients diagnosed with LVNC. Methods: Patients with LVNC who were followed from January 2006 to March 2010 were included in this study. Diagnosis was made with the use of characteristic findings of magnetic resonance imaging and echocardiography. Holter electrocardiography and metabolic screening tests were also performed in all patients. Results: A total of 24 patients were studied (18 male, six female). Patient age at diagnosis was 50 ± 60 months (eight days to 15 years). Average follow-up period was 22 ± 12 months (four months to four years). Findings at diagnosis were as follows: eight (33%) patients had heart failure, five (20%) had rhythm abnormalities, five (20%) had cardiomegaly, two had murmurs, two had cyanosis, and two presented with fatigue. Ten (41%) patients had been followed previously with other diagnoses. In 21 (87.5%) patients, electrocardiographic abnormalities were noted, especially left ventricular hypertrophy and ST-T changes. Patients had an average ejection fraction of 46% (18-73%) and three of them had additional congenital heart disease (patent ductus arteriosus, aortopulmonary window and complex cyanotic heart disease). Scanning for metabolic diseases revealed fatty acid oxidation disorder in one patient, and mitochondrial disease in another. During follow-up, a permanent pacemaker was implanted in a patient with severe bradycardia and ventricular dysfunction, and three patients died. Conclusion: LVNC can be diagnosed at any age from newborn to adolescent and has a variable clinical course. Closer study of patients with cardiomegaly and heart failure can reduce delays in diagnosis of LVNC. (Cardiol J 2011; 18, 2: 176-184

Evaluation of coronary artery abnormalities in Williams syndrome patients using myocardial perfusion scintigraphy and CT angiography

Background: Sudden death risk in Williams syndrome (WS) patients has been shown to be 25–100 times higher than in the general population. This study aims to detect coronary artery anomalies and myocardial perfusion defects in WS patients using noninvasive diagnostic methods. Methods: This study features 38 patients diagnosed with WS. In addition to physical examination, electrocardiography, and echocardiography, computed tomography (CT) angiography and rest/dipyridamole stress technetium-99m sestamibi (99mTc-sestamibi) single photon emission computed tomography (SPECT) myocardial perfusion scintigraphy (MPS) were performed. Results: Twenty-one (55%) patients were male; 17 (45%) were female. The average patient age was 12 ± 5 years (2.5–26 years); the average follow-up period was 7.2 ± 4.2 years (6 months–18 years). Cardiovascular abnormalities were found in 89% of patients, the most common one being supravalvar aortic stenosis (SVAS). CT angiography revealed coronary anomalies in 10 (26%) patients, the most common ones being ectasia of the left main coronary artery and proximal right coronary artery as well as myocardial bridging. SVAS was present in 80% of patients with coronary artery anomalies. 99mTc-sestamibi SPECT MPS revealed findings possibly consistent with myocardial ischemia in 29% of patients, and ischemia in 7 out of 10 patients (70%) with coronary anomalies shown on CT angiography (p = 0.03). Conclusions: Coronary artery abnormalities are relatively common in WS patients and are often accompanied by SVAS. CT angiography and dipyridamole 99mTc-sestamibi SPECT MPS seem to be less invasive methods of detecting coronary artery anomalies and myocardial perfusion defects in WS patients

International nosocomial infection control consortium (INICC) report, data summary of 36 countries, for 2004-2009

The results of a surveillance study conducted by the International Nosocomial Infection Control Consortium (INICC) from January 2004 through December 2009 in 422 intensive care units (ICUs) of 36 countries in Latin America, Asia, Africa, and Europe are reported. During the 6-year study period, using Centers for Disease Control and Prevention (CDC) National Healthcare Safety Network (NHSN; formerly the National Nosocomial Infection Surveillance system [NNIS]) definitions for device-associated health care-associated infections, we gathered prospective data from 313,008 patients hospitalized in the consortium's ICUs for an aggregate of 2,194,897 ICU bed-days. Despite the fact that the use of devices in the developing countries' ICUs was remarkably similar to that reported in US ICUs in the CDC's NHSN, rates of device-associated nosocomial infection were significantly higher in the ICUs of the INICC hospitals; the pooled rate of central line-associated bloodstream infection in the INICC ICUs of 6.8 per 1,000 central line-days was more than 3-fold higher than the 2.0 per 1,000 central line-days reported in comparable US ICUs. The overall rate of ventilator-associated pneumonia also was far higher (15.8 vs 3.3 per 1,000 ventilator-days), as was the rate of catheter-associated urinary tract infection (6.3 vs. 3.3 per 1,000 catheter-days). Notably, the frequencies of resistance of Pseudomonas aeruginosa isolates to imipenem (47.2% vs 23.0%), Klebsiella pneumoniae isolates to ceftazidime (76.3% vs 27.1%), Escherichia coli isolates to ceftazidime (66.7% vs 8.1%), Staphylococcus aureus isolates to methicillin (84.4% vs 56.8%), were also higher in the consortium's ICUs, and the crude unadjusted excess mortalities of device-related infections ranged from 7.3% (for catheter-associated urinary tract infection) to 15.2% (for ventilator-associated pneumonia). Copyright © 2012 by the Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved

Effect of Age and Disease Duration on the Levodopa Response in Patients with Advanced Parkinson's Disease for Deep Brain Stimulation of the Subthalamic Nucleus

BACKGROUND: Deep brain stimulation (DBS) has become a preferred option for the treatment of motor symptoms in patients with advanced Parkinson’s disease (PD). A good levodopa response (LR) is considered the most important criterion in determining the suitability of a patient for DBS. However, the effect of age and disease duration (DD) on the LR is still a subject of discussion. OBJECTIVE: Here, we investigated the effect of age and DD on the preoperative LR in PD patients to be selected for DBS. METHODS: From August 2011 to May 2015, 54 consecutive patients (29 men and 25 women) with advanced PD were evaluated for DBS of the STN and included in this retrospective study. RESULTS: Thirty-seven patients were found suitable for DBS of the STN and 29 of them underwent bilateral surgery. We found no significant correlation between DD and the LR. However, there was a significant negative correlation between the patients’ age and the LR. CONCLUSION: The results indicate that the patients’ age, rather than DD, has a negative effect on the LR. The study, therefore, indicates that PD patients with an advanced age and with a poor LR are not good candidates for DBS of the STN

P-Wave Changes Associated with Chiari Network in the Right Atrium

The Chiari network (CN) is a mobile, net-like structure occasionally present in the right atrium, near the opening of the inferior vena cava and coronary sinus. While typically asymptomatic, it may contribute to thromboembolism or right atrial pathologies. Here, we hypothesized that existing differences in P-wave morphology on electrocardiograms (ECG) may be associated with atrial conduction changes. Seventy-one children with a CN were recruited and matched to 60 healthy controls. P-wave duration, P-wave amplitude, P dispersion (Pd), QRS, PR, QT, and QTc (calculated with Bazett formula) intervals were measured and compared. Between the control and the patient groups, the mean P-wave duration was 78.1 ms and 88.7 ms, P amplitude was 1.3 mm and 1.1 mm, and Pd was 18.9 and 35.5 ms, respectively. These differences were statistically significant across all measurements (p < 0.05). Atrial conduction may be affected in patients with CN, and these patients may then develop atrial arrhythmia