Influence of structured treatment on gait parameters in rehabilitation patients with Parkinson's disease

Cilj: Glavni rehabilitacioni cilj u tretmanu bolesnika sa Parkinsonovom bolešću je da se unapredi, očuva i uspori propadanje funkcije hoda, održavanje bezbednog hoda za vreme različitih motornih i kognitivnih zadataka. Cilj ovog istraživanja je bio da ispita da li individualizovani strukturisani rehabilitacioni postupak, usmeren na različite patofiziološke mehanizme u osnovi poremećaja hoda obolelih od Parkinsonove bolesti, nezavisno poboljšava parametre hoda u poređenju sa optimalizovanom antiparkinsonom terapijom. Cilj je bio i da se utvrdi na koje specifične parametre hoda i na koji način deluje strukturisani rehabilitacioni tretman. Poseban cilj istraživanja je bio se ispita, da li repetitivna transkranijalna magnetna stimulacija suplementarne motorne areje moždane kore utiče na parametre hoda obolelih od Parkinsonove bolesti. Metodologija: Istraživanje, u formi otvorene prospektivne kliničke studije sprovedeno je na Klinici za neurologiju Kliničkog Centra Srbije u Beogradu. Istraživanjem su obuhvaćeni bolesnici sa Parkinsonovom bolešću (PB) koji su se ambulantno ili hospitalno lečili u periodu od 2010 do 2012 godine. U studiju su bila uključena 43 bolesnika sa PB, koji su bili randomizovani u dve studijske grupe metodom slučajnih brojeva: a) Grupa I, koja je bila podvrgnuta strukturisanom rehabilitacionom protokolu u trajanju od 21 dana, u režimu 6 terapijskih seansi nedeljno, ukupno 16 sati efektivnog vežbanja; b) Grupa II, koja je bila podvrgnuta tretmanu repetitivne transkranijalne magnetne stimulacije (rTMS) frekvencom od 10 Hz iznad suplementarne motorne areje (SMA) u trajanju od 10 dana ukupno 400 TMS pulseva tokom 20 minuta /dnevno. U našoj studiji sa dva protokola strukturisanim rehabilitacionim programom i rTMS, analiziranje efekata rTMS smo posmatrali odvojeno kako bismo dobili jasnije inicijalne rezultate. Dijagnoza PB postavljena na osnovu kriterijuma Britanske Banke mozgova i od strane neurologa specijalizovanog za bolesti nevoljnih pokreta. Na ispitanicima obe grupe su sprovedena identična testiranja. Sva testiranja kliničkih parametara bolesti, kao i testiranje hoda, sprovedena su tokom „ON“ perioda , u najvećem broju slučajeva 2 sata nakon uzimanja prve jutarnje doze L-dope...Aim: The main rehabilitation aim in rehabilitation of patients with Parkinson’s disease is advancing, keeping up and slowing down decline the gait function, keeping up walking safety during different motor and cognitive tasks. The aim of our study was to examine if individual structural rehabilitation treatment, directed to different patophisiology mechanisms in the base of gait disorder of patients with Parkinson’s disease (PD), indipendently making better the gait parameters in comparing to optimal antiparkinsonic therapy. The aim was to determine to which specific gait parameters and how structural rehabilitation treatment functioned. Specific aim og study was to examine, if repetitive transcranial magnetic stimulation (rTMS) of supplementary motor area of brain cortex influences to gait parameters to patients with Parkinson’s disease. Methodology: The examination in the form of open prospective clinical study was carried out at the Clinic for neurology at Clinical Center of Serbia in Belgrade. Researching were included the patients with Parkinson’s disease who were treated outpatiently or in hospital in the period from 2010-2012. Forty three participants with PD were included in two study groups with the method of randomly numbers: a) Group 1 was under the structural rehabilitation protocol lasting 21 days, under the regime of 6 seance therapies per week, all together 16 hours effective exercises; b) Group 2, was under rTMS treatment frequency of 10Hz above supplementary motor area (SMA) lasting 10 days, all together 400 TMS pulses during 20 minutes daily. In our study with two protocols given with structural rehabilitation programme and rTMS, analysing the effects of rTMS we watched separately in order to get better initial results.The diagnosis of PB was made on the base of UK Brain Bank Criteria for the diagnosis of Parkinson's disease and by the neurologist specialized for the movement disorders.The same testing was done to both groups of participants. All clinical tests, as well as gait testing, were done during “On“ period, mostly 2 hours after the first morning dose of L-Dopa. Patients from the group 1 were tested the first day before the beginning of given rehabilitation protocol, and after finishing rehabilitation protocol which lasted 21 days. Patients from the group 2 (rTMS) were tested 1. day, before biginning of protocol, after the finishing of protocol stimulation which lasted 10 and 21th day from the beginning of testing..

Homeostatic Modulation of Stimulation-Dependent Plasticity in Human Motor Cortex

Since recently, it is possible, using noninvasive cortical stimulation, such as the protocol of paired associative stimulation (PAS), to induce the plastic changes in the motor cortex, in humans that mimic Hebb's model of learning. Application of TMS conjugated with peripheral electrical stimulation at strictly coherent temporal manner lead to convergence of inputs in the sensory-motor cortex, with the consequent synaptic potentiation or weakening, if applied repetitively. However, when optimal interstimulus interval (ISI) for induction of LTP-like effects is applied as a single pair, Motor evoked potential (MEP) amplitude inhibition is observed, the paradigm known as short-latency afferent inhibition (SLAI). Aiming to resolve this paradox, PAS protocols were applied, with 200 repetitions of TMS pulses paired with median nerve electrical stimulation, at ISI equal to individual latencies of evoked response of somatosensory cortex (N-20) (PASLTP), and at ISI of N-20 shortened for 5 msec (PASLTD) protocols that mimic LTP-like changes in the human motor cortex. MEP amplitudes before, during and after interventions were measured as an indicator based on output signals originating from the motor system. Post-intervention MEP amplitudes following the TMS protocols of PASLTP and PASLTD were facilitated and depressed, respectively, contrary to MEP amplitudes during intervention. During PASLTP MEP amplitudes were significantly decreased in case of PASLTP, while in the case of PASLTD an upward trend was observed. In conclusions, a possible explanation for the seemingly paradoxical effect of PAS can be found in the mechanism of homeostatic modulation of plasticity. Those findings indicate the existence of complex relationships in the development of plasticity induced by stimulation, depending on the level of the previous motor cortex excitability

Genetic and epigenomic modifiers of diabetic neuropathy

Diabetic neuropathy (DN), the most common chronic and progressive complication of diabetes mellitus (DM), strongly affects patients’ quality of life. DN could be present as peripheral, autonomous or, clinically also relevant, uremic neuropathy. The etiopathogenesis of DN is multifactorial, and genetic components play a role both in its occurrence and clinical course. A number of gene polymorphisms in candidate genes have been assessed as susceptibility factors for DN, and most of them are linked to mechanisms such as reactive oxygen species production, neurovascular impairments and modified protein glycosylation, as well as immunomodulation and inflammation. Different epigenomic mechanisms such as DNA methylation, histone modifications and non-coding RNA action have been studied in DN, which also underline the importance of “metabolic memory” in DN appearance and progression. In this review, we summarize most of the relevant data in the field of genetics and epigenomics of DN, hoping they will become significant for diagnosis, therapy and prevention of DN

Lajm neuroborelioza

Lyme borreliosis (LB) is a multisystemic zoonotic disease which in humans can involve the skin, joints, heart and/or nervous system. In this study a total of 11 patients with clinical manifestations have been assessed at the Institute for Occupational Health. Evaluation of the patients was done in order to determine their working capability and further professional orientation. Patients were of different gender, age, education and profession. They fulfilled at least two of the three criteria: tick infestation data (epidemiological criteria), central and/or peripheral neurological symptoms (clinical criteria) and a positive serological finding. Diagnosis was done upon classical clinical criteria: electromyeloneurography (EMNG) analysis, neurological impairments, electroencephalography (EEG), computer tomography (CT) and/or magnetic resonance imaging (MRI). IgM and IgG antibodies against B. burgdorferi were determined by commercial ELISA kits. IgM antibodies were recorded in the serum of 4 (44.4%) and IgG in 6 (66.7%) patients. Electro-myeloneurography findings of the upper and lower limbs were positive in 5 (83.3%), electroencephalography in 4 (66.6%) of the 6 observed patients and CT was positive in 4 (36.4%) of the 5 observed patients. The study has established that in patients with neuroborreliosis (NB) the capability to carry out intellectual tasks, as well as responsible duties is impaired due to poor memory. Patients suffering from peripheral neuropathies are not fit to withstand longterm walks, weight lifting and carrying or any other form of physical stress.Lajm borelioza je multisistemsko oboljenje, iz grupe zoonoza koje kod ljudi može zahvatiti kožu, zglobove, srce i/ili nervni sistem. Istraživanjem je obuhvaćeno 11 bolesnika sa kliničkim manifestacijama neuroborelioze koji su ispitivani u Institutu za medicinu rada Srbije u cilju ocene radne sposobnosti i dalje profesionalne orijentacije. Ispitani su bolesnici različite starosti, pola, nivoa obrazovanja i različitih zanimanja koji su ispunili minimalno dva od tri kriterijuma i to: podatak o ubodu krpelja (epidemiološki kriterijum), ispoljavanje centralnih i/ili, perifernih neuroloških simptoma (klinički kriterijum) i pozitivan serološki nalaz. Dijagnoza neuroborelioze je postavljena na osnovu klasičnih kliničkih kriterijuma: neurološ kih ispada, analize elektro-mioneurografije (EMNG), elektroencefalografije (EEG), kompjuterske tomografije (CT) i/ili magnetne rezonance (MRI). Ispitivanje prisustva antitela IgM i IgG klase u krvnom serumu prema B. burgdorferi vršeno je komercijalnim ELISA testom. Antitela IgM klase registrovana su u serumu četiri (44,4%), dok su IgG antitela registrovana kod 6 (66,7%) ispitanih pacijenata. Nalaz elektro-mioneurografije gornjih i donjih ekstremiteta je bio pozitivan kod pet (83,3%), nalaz elektroencefalografije kod četiri (66,6%) od šest ispitanih pacijenata, dok je nalaz CT bio pozitivan kod 4 (36,4%) od pet ispitanih pacijenata. Sprovedenim ispitivanjem je utvrđeno da je kod bolesnika sa razvijenom neuroboreliozom smanjena sposobnost za bilo koju vrstu intelektualnog rada, kao i za poslove koji su povezani sa moralnom i materijalnom odgovornošću zbog problema sa pamćenjem. Kod bolesnika sa perifernim neuropatijama postoji nesposobnost za poslove koji uključuju dugotrajno stajanje i hodanje, dizanje i nošenje tereta, kao i bilo koju vrstu fizičkog rada

Influence of structured treatment on gait parameters in rehabilitation patients with Parkinson's disease

Cilj: Glavni rehabilitacioni cilj u tretmanu bolesnika sa Parkinsonovom bolešću je da se unapredi, očuva i uspori propadanje funkcije hoda, održavanje bezbednog hoda za vreme različitih motornih i kognitivnih zadataka. Cilj ovog istraživanja je bio da ispita da li individualizovani strukturisani rehabilitacioni postupak, usmeren na različite patofiziološke mehanizme u osnovi poremećaja hoda obolelih od Parkinsonove bolesti, nezavisno poboljšava parametre hoda u poređenju sa optimalizovanom antiparkinsonom terapijom. Cilj je bio i da se utvrdi na koje specifične parametre hoda i na koji način deluje strukturisani rehabilitacioni tretman. Poseban cilj istraživanja je bio se ispita, da li repetitivna transkranijalna magnetna stimulacija suplementarne motorne areje moždane kore utiče na parametre hoda obolelih od Parkinsonove bolesti. Metodologija: Istraživanje, u formi otvorene prospektivne kliničke studije sprovedeno je na Klinici za neurologiju Kliničkog Centra Srbije u Beogradu. Istraživanjem su obuhvaćeni bolesnici sa Parkinsonovom bolešću (PB) koji su se ambulantno ili hospitalno lečili u periodu od 2010 do 2012 godine. U studiju su bila uključena 43 bolesnika sa PB, koji su bili randomizovani u dve studijske grupe metodom slučajnih brojeva: a) Grupa I, koja je bila podvrgnuta strukturisanom rehabilitacionom protokolu u trajanju od 21 dana, u režimu 6 terapijskih seansi nedeljno, ukupno 16 sati efektivnog vežbanja; b) Grupa II, koja je bila podvrgnuta tretmanu repetitivne transkranijalne magnetne stimulacije (rTMS) frekvencom od 10 Hz iznad suplementarne motorne areje (SMA) u trajanju od 10 dana ukupno 400 TMS pulseva tokom 20 minuta /dnevno. U našoj studiji sa dva protokola strukturisanim rehabilitacionim programom i rTMS, analiziranje efekata rTMS smo posmatrali odvojeno kako bismo dobili jasnije inicijalne rezultate. Dijagnoza PB postavljena na osnovu kriterijuma Britanske Banke mozgova i od strane neurologa specijalizovanog za bolesti nevoljnih pokreta. Na ispitanicima obe grupe su sprovedena identična testiranja. Sva testiranja kliničkih parametara bolesti, kao i testiranje hoda, sprovedena su tokom „ON“ perioda , u najvećem broju slučajeva 2 sata nakon uzimanja prve jutarnje doze L-dope...Aim: The main rehabilitation aim in rehabilitation of patients with Parkinson’s disease is advancing, keeping up and slowing down decline the gait function, keeping up walking safety during different motor and cognitive tasks. The aim of our study was to examine if individual structural rehabilitation treatment, directed to different patophisiology mechanisms in the base of gait disorder of patients with Parkinson’s disease (PD), indipendently making better the gait parameters in comparing to optimal antiparkinsonic therapy. The aim was to determine to which specific gait parameters and how structural rehabilitation treatment functioned. Specific aim og study was to examine, if repetitive transcranial magnetic stimulation (rTMS) of supplementary motor area of brain cortex influences to gait parameters to patients with Parkinson’s disease. Methodology: The examination in the form of open prospective clinical study was carried out at the Clinic for neurology at Clinical Center of Serbia in Belgrade. Researching were included the patients with Parkinson’s disease who were treated outpatiently or in hospital in the period from 2010-2012. Forty three participants with PD were included in two study groups with the method of randomly numbers: a) Group 1 was under the structural rehabilitation protocol lasting 21 days, under the regime of 6 seance therapies per week, all together 16 hours effective exercises; b) Group 2, was under rTMS treatment frequency of 10Hz above supplementary motor area (SMA) lasting 10 days, all together 400 TMS pulses during 20 minutes daily. In our study with two protocols given with structural rehabilitation programme and rTMS, analysing the effects of rTMS we watched separately in order to get better initial results.The diagnosis of PB was made on the base of UK Brain Bank Criteria for the diagnosis of Parkinson's disease and by the neurologist specialized for the movement disorders.The same testing was done to both groups of participants. All clinical tests, as well as gait testing, were done during “On“ period, mostly 2 hours after the first morning dose of L-Dopa. Patients from the group 1 were tested the first day before the beginning of given rehabilitation protocol, and after finishing rehabilitation protocol which lasted 21 days. Patients from the group 2 (rTMS) were tested 1. day, before biginning of protocol, after the finishing of protocol stimulation which lasted 10 and 21th day from the beginning of testing..

Influence of structured treatment on gait parameters in rehabilitation patients with Parkinson's disease

Cilj: Glavni rehabilitacioni cilj u tretmanu bolesnika sa Parkinsonovom bolešću je da se unapredi, očuva i uspori propadanje funkcije hoda, održavanje bezbednog hoda za vreme različitih motornih i kognitivnih zadataka. Cilj ovog istraživanja je bio da ispita da li individualizovani strukturisani rehabilitacioni postupak, usmeren na različite patofiziološke mehanizme u osnovi poremećaja hoda obolelih od Parkinsonove bolesti, nezavisno poboljšava parametre hoda u poređenju sa optimalizovanom antiparkinsonom terapijom. Cilj je bio i da se utvrdi na koje specifične parametre hoda i na koji način deluje strukturisani rehabilitacioni tretman. Poseban cilj istraživanja je bio se ispita, da li repetitivna transkranijalna magnetna stimulacija suplementarne motorne areje moždane kore utiče na parametre hoda obolelih od Parkinsonove bolesti. Metodologija: Istraživanje, u formi otvorene prospektivne kliničke studije sprovedeno je na Klinici za neurologiju Kliničkog Centra Srbije u Beogradu. Istraživanjem su obuhvaćeni bolesnici sa Parkinsonovom bolešću (PB) koji su se ambulantno ili hospitalno lečili u periodu od 2010 do 2012 godine. U studiju su bila uključena 43 bolesnika sa PB, koji su bili randomizovani u dve studijske grupe metodom slučajnih brojeva: a) Grupa I, koja je bila podvrgnuta strukturisanom rehabilitacionom protokolu u trajanju od 21 dana, u režimu 6 terapijskih seansi nedeljno, ukupno 16 sati efektivnog vežbanja; b) Grupa II, koja je bila podvrgnuta tretmanu repetitivne transkranijalne magnetne stimulacije (rTMS) frekvencom od 10 Hz iznad suplementarne motorne areje (SMA) u trajanju od 10 dana ukupno 400 TMS pulseva tokom 20 minuta /dnevno. U našoj studiji sa dva protokola strukturisanim rehabilitacionim programom i rTMS, analiziranje efekata rTMS smo posmatrali odvojeno kako bismo dobili jasnije inicijalne rezultate. Dijagnoza PB postavljena na osnovu kriterijuma Britanske Banke mozgova i od strane neurologa specijalizovanog za bolesti nevoljnih pokreta. Na ispitanicima obe grupe su sprovedena identična testiranja. Sva testiranja kliničkih parametara bolesti, kao i testiranje hoda, sprovedena su tokom „ON“ perioda , u najvećem broju slučajeva 2 sata nakon uzimanja prve jutarnje doze L-dope...Aim: The main rehabilitation aim in rehabilitation of patients with Parkinson’s disease is advancing, keeping up and slowing down decline the gait function, keeping up walking safety during different motor and cognitive tasks. The aim of our study was to examine if individual structural rehabilitation treatment, directed to different patophisiology mechanisms in the base of gait disorder of patients with Parkinson’s disease (PD), indipendently making better the gait parameters in comparing to optimal antiparkinsonic therapy. The aim was to determine to which specific gait parameters and how structural rehabilitation treatment functioned. Specific aim og study was to examine, if repetitive transcranial magnetic stimulation (rTMS) of supplementary motor area of brain cortex influences to gait parameters to patients with Parkinson’s disease. Methodology: The examination in the form of open prospective clinical study was carried out at the Clinic for neurology at Clinical Center of Serbia in Belgrade. Researching were included the patients with Parkinson’s disease who were treated outpatiently or in hospital in the period from 2010-2012. Forty three participants with PD were included in two study groups with the method of randomly numbers: a) Group 1 was under the structural rehabilitation protocol lasting 21 days, under the regime of 6 seance therapies per week, all together 16 hours effective exercises; b) Group 2, was under rTMS treatment frequency of 10Hz above supplementary motor area (SMA) lasting 10 days, all together 400 TMS pulses during 20 minutes daily. In our study with two protocols given with structural rehabilitation programme and rTMS, analysing the effects of rTMS we watched separately in order to get better initial results.The diagnosis of PB was made on the base of UK Brain Bank Criteria for the diagnosis of Parkinson's disease and by the neurologist specialized for the movement disorders.The same testing was done to both groups of participants. All clinical tests, as well as gait testing, were done during “On“ period, mostly 2 hours after the first morning dose of L-Dopa. Patients from the group 1 were tested the first day before the beginning of given rehabilitation protocol, and after finishing rehabilitation protocol which lasted 21 days. Patients from the group 2 (rTMS) were tested 1. day, before biginning of protocol, after the finishing of protocol stimulation which lasted 10 and 21th day from the beginning of testing..

Gait in drug naive patients with de novo Parkinson's disease - altered but symmetric

Background: Motor symptoms in Parkinson's disease (PD) are typically asymmetrical. Early stage of PD is characterised with a predominantly unilateral appearance of tremor, rigidity and bradykinesia, with or without axial involvement. Also, studies have demonstrated gait asymmetry in de novo drug naive PD patients. Aim of this study was to investigate gait pattern, gait symmetry and gait variability in early phases of PD. Methods: The gait was measured in 40 de novo, drug naive PD patients and 43 healthy control subjects (HC) while performing a simple walking task. Calculated parameters were cycle time (CT), stride length (SL) and swing time (ST), and their coefficients of variation (CV). Results: Considering gait parameters, PD patients and HC differed in terms of all parameters, except for the CV of CT. Analysis of gait symmetry, comparison between the gait patterns of the left and the right leg in PD patients revealed no difference for any of the assessed parameters. The majority of the gait parameters did not differ between left and right legs of HC. Conclusions: It can be concluded that even gait was already altered in de novo drug naive PD patients, gait symmetry remained preserved. The SL was the most prominent parameter of altered gait in initial stages of PD patients, while the ST heralded postural asymmetry