54 research outputs found
Trastornos del sueño en la enfermedad de Parkinson y otros trastornos del movimiento
Neurodegenerative processes with movement
disorders is predominant features show a high
incidence of sleep alterations at some point in their
evolution. The degeneration of structures responsible
for maintaining the sleep-wakefulness cycles and the
architecture of sleep could be at their root. Other
factors like the drugs employed in the treatment of
motor problems, the limitations to movement, etc.,
aggravate the problem. Although, at present, there is
no medical therapy able to restore the defects
derived from the degeneration of the key structures of
sleep, an individual analysis of the coadyuvant factors
in each patient could help to improve these problems.
In this article we describe the main sleep disorders in
Parkinsonâs disease and other degenerative diseases
such as multi-system atrophies or progressive
supranuclear paralysis
RevisiĂłn crĂtica de la estimulaciĂłn subtalĂĄmica en la enfermedad de Parkinson
The authors critically review subthalamic nucleus (STN) stimulation for Parkinson's disease (PD) at long follow-up (3-5 years). Subthalamic stimulation induce a significant improvement during the "off" medication in the assessment motor score UPDRS (Unified Parkinson Disease Rating Scale) 3-5 years after surgery. Results show that the benefits obtained in tremor, rigidity, bradykinesia, dyskinesias induced by medication and levodopa reduction are significantly maintained during long term. The improvement in other clinical signs as gait and postural stability at long follow-up are not maintained comparing with the benefits obtained one year after surgery. A high percentage of patients show a cognitive disturbance during the follow-up period that may be correlated with the disease progression. The conclusion is that bilateral STN stimulation is an effective treatment for PD patients at long term but it should be considered earlier in the course of P
Functional correlates of response inhibition in impulse control disorders in Parkinsonâs disease
Impulse control disorder is a prevalent side-effect of Parkinsonâs disease (PD) medication, with a strong negative
impact on the quality of life of those affected. Although impulsivity has classically been associated with response
inhibition deficits, previous evidence from PD patients with impulse control disorder (ICD) has not revealed
behavioral dysfunction in response inhibition. In this study, 18 PD patients with ICD, 17 PD patients without this
complication, and 15 healthy controls performed a version of the conditional Stop Signal Task during functional
magnetic resonance imaging. Whole-brain contrasts, regions of interest, and functional connectivity analyses
were conducted. Our aim was to investigate the neural underpinnings of two aspects of response inhibition:
proactive inhibition, inhibition that has been prepared beforehand, and restrained inhibition, inhibition of an
invalid inhibitory tendency. We observed that, in respect to the other two groups, PD patients with ICD exhibited
hyperactivation of the stopping network bilaterally while performing proactive inhibition. When engaged in
restrained inhibition, they showed hyperactivation of the left inferior frontal gyrus, an area linked to action
monitoring. Restrained inhibition also resulted in changes to the functional co-activation between inhibitory
regions and left inferior parietal cortex and right supramarginal gyrus. Our findings indicate that PD patients
with ICD completed the inhibition task correctly, showing altered engagement of inhibitory and attentional
areas. During proactive inhibition they showed bilateral hyperactivation of two inhibitory regions, while during
restrained inhibition they showed additional involvement of attentional areas responsible for alerting and
orientin
Terapia celular âneuro-restauradoraâ en la enfermedad de Parkinson: un debate pendiente
Existe en la actualidad un gran entusiasmo sobre las perspectivas derivadas de la denominada terapia
celular en la enfermedad de Parkinson. Este entusiasmo ha sobrepasado la esfera de la comunidad médica,
llegando hasta el pĂșblico general, y se ha venido alimentando de un considerable debate Ă©tico y polĂtico,
hurtĂĄndose en todo momento la necesidad de un anĂĄlisis realmente cientĂfico sobre las cualidades y limitaciones reales del tratamiento con cĂ©lulas madre en las enfermedades neurodegenerativas. La enfermedad de Parkinson con frecuencia se observa desde una perspectiva simplista, como una mera neurodegeneraciĂłn de la vĂa dopaminĂ©rgica nigroestriada, punto de vista bajo el que se colocan diferentes diseños tendentes a reemplazar la falta de dopamina en el estriado, mediante el empleo de distintos tipos de terapia celular. En este sentido, es necesario señalar por un lado la naturaleza multisistĂ©mica y generalizada de la enfermedad, y por otro lado el carĂĄcter progresivo del proceso neurodegenerativo de la enfermedad de Parkinson. Bajo este enfoque, pretender que el mero reemplazo de la dopamina estriatal mediante terapia celular sustitutiva, pueda corregir el carĂĄcter generalizado y progresivo de la enfermedad es una aspiraciĂłn quimĂ©rica, que Ășnicamente contribuye a generar expectativas infundadas en el pĂșblico general. Este artĂculo pretende argumentar desde un punto de vista puramente cientĂfico las dudas sobre las expectativas creadas con estos nuevos diseños terapĂ©uticos.At present there is great enthusiasm over the perspectives deriving from so-called cell therapy in
Parkinsonâs disease. This enthusiasm has spread beyond the ambit of the medical community, reaching
the general public, and has been fuelled by a considerable ethical and political debate, sidestepping
the need for a really scientific analysis of the real qualities and limitations of treatment with stem-cells in
neurodegenerative diseases. Parkinsonâs disease is frequently observed from a simplistic perspective, as a
mere neurodegeneration of the nigrostriatal dopaminergic pathway. This viewpoint encompasses
different designs that tend to replace the lack of dopamine in the striatum through the use of different
types of cell therapy. In this respect, it is important to indicate, on the one hand, the multisystemic and
generalised nature of the disease and, on the other, the progressive character of the neurodegenerative
process of Parkinsonâs disease. With this approach, to claim that the mere replacement of striatal dopamine
through replacement cell therapy can correct the generalised and progressive character of the disease is
a fanciful aspiration, which can only contribute to generating unfounded expectations in the general
public. This article attempts to set out from a purely scientific point of view the doubts over the
expectations created by these new therapeutic designs
Functional bold MRI: advantages of the 3 T vs. the 1.5 T
We quantitatively evaluate the benefits of a higher field strength for functional
brain MRI (fMRI) based on the blood oxygenation level-dependent contrast. The 3-T
fMRI shows a higher sensitivity for the motor and somatosensory stimulation and
more specific localization in the grey substance. The 3-T fMRI detects additional
areas of activation with the motor paradigm
Using Kinect to classify Parkinson's disease stages related to severity of gait impairment
Background: Parkinsonâs Disease (PD) is a chronic neurodegenerative disease associated with motor problems such
as gait impairment. Different systems based on 3D cameras, accelerometers or gyroscopes have been used in related
works in order to study gait disturbances in PD. Kinect has also been used to build these kinds of systems, but
contradictory results have been reported: some works conclude that Kinect does not provide an accurate method of
measuring gait kinematics variables, but others, on the contrary, report good accuracy results.
Methods: In this work, we have built a Kinect-based system that can distinguish between different PD stages, and
have performed a clinical study with 30 patients suffering from PD belonging to three groups: early PD patients
without axial impairment, more evolved PD patients with higher gait impairment but without Freezing of Gait (FoG),
and patients with advanced PD and FoG. Those patients were recorded by two Kinect devices when they were
walking in a hospital corridor. The datasets obtained from the Kinect were preprocessed, 115 features identified, some
methods were applied to select the relevant features (correlation based feature selection, information gain, and
consistency subset evaluation), and different classification methods (decision trees, Bayesian networks, neural
networks and K-nearest neighbours classifiers) were evaluated with the goal of finding the most accurate method for
PD stage classification.
Results: The classifier that provided the best results is a particular case of a Bayesian Network classifier (similar to a
NaĂŻve Bayesian classifier) built from a set of 7 relevant features selected by the correlation-based on feature selection
method. The accuracy obtained for that classifier using 10-fold cross validation is 93.40%. The relevant features are
related to left shin angles, left humerus angles, frontal and lateral bents, left forearm angles and the number of steps
during spin.
Conclusions: In this paper, it is shown that using Kinect is adequate to build a inexpensive and comfortable system
that classifies PD into three different stages related to FoG. Compared to the results of previous works, the obtained
accuracy (93.40%) can be considered high. The relevant features for the classifier are: a) movement and position of the
left arm, b) trunk position for slightly displaced walking sequences, and c) left shin angle, for straight walking
sequences. However, we have obtained a better accuracy (96.23%) for a classifier that only uses features extracted
from slightly displaced walking steps and spin walking steps. Finally, the obtained set of relevant features may lead to
new rehabilitation therapies for PD patients with gait problems
Involvement of the subthalamic nucleus in impulse control disorders associated with Parkinsonâs disease
Behavioural abnormalities such as impulse control disorders may develop when patients with Parkinsonâs disease receive
dopaminergic therapy, although they can be controlled by deep brain stimulation of the subthalamic nucleus. We have recorded
local field potentials in the subthalamic nucleus of 28 patients with surgically implanted subthalamic electrodes. According to
the predominant clinical features of each patient, their Parkinsonâs disease was associated with impulse control disorders
(n = 10), dyskinesias (n = 9) or no dopaminergic mediated motor or behavioural complications (n = 9). Recordings were obtained
during the OFF and ON dopaminergic states and the power spectrum of the subthalamic activity as well as the subthalamocortical
coherence were analysed using Fourier transform-based techniques. The position of each electrode contact was determined
in the postoperative magnetic resonance image to define the topography of the oscillatory activity recorded in each
patient. In the OFF state, the three groups of patients had similar oscillatory activity. By contrast, in the ON state, the patients
with impulse control disorders displayed theta-alpha (4â10 Hz) activity (mean peak: 6.71 Hz) that was generated 2â8mm below
the intercommissural line. Similarly, the patients with dyskinesia showed theta-alpha activity that peaked at a higher frequency
(mean: 8.38 Hz) and was generated 0â2mm below the intercommissural line. No such activity was detected in patients that
displayed no dopaminergic side effects. Cortico-subthalamic coherence was more frequent in the impulsive patients in the
4â7.5 Hz range in scalp electrodes placed on the frontal regions anterior to the primary motor cortex, while in patients with
dyskinesia it was in the 7.5â10 Hz range in the leads overlying the primary motor and supplementary motor area. Thus,
dopaminergic side effects in Parkinsonâs disease are associated with oscillatory activity in the theta-alpha band, but at different
frequencies and with different topography for the motor (dyskinesias) and behavioural (abnormal impulsivity) manifestations.
These findings suggest that the activity recorded in parkinsonian patients with impulse control disorders stems from the
associative-limbic area (ventral subthalamic area), which is coherent with premotor frontal cortical activity. Conversely, in
patients with L-dopa-induced dyskinesias such activity is recorded in the motor area (dorsal subthalamic area) and it is coherent
with cortical motor activity. Consequently, the subthalamic nucleus appears to be implicated in the motor and behavioural
complications associated with dopaminergic drugs in Parkinsonâs disease, specifically engaging different anatomo-functional
territories
The impact of silent vascular brain burden in cognitive impairment in Parkinson's disease
White matter hyperintensities (WMHs) detected by magnetic
resonance imaging (MRI) of the brain are associated with dementia and cognitive
impairment in the general population and in Alzheimer's disease. Their effect in
cognitive decline and dementia associated with Parkinson's disease (PD) is still
unclear. METHODS: We studied the relationship between WMHs and cognitive state in
111 patients with PD classified as cognitively normal (n = 39), with a mild
cognitive impairment (MCI) (n = 46) or dementia (n = 26), in a cross-sectional
and follow-up study. Cognitive state was evaluated with a comprehensive
neuropsychological battery, and WMHs were identified in FLAIR and T2-weighted
MRI. The burden of WMHs was rated using the Scheltens scale. RESULTS: No
differences in WMHs were found between the three groups in the cross-sectional
study. A negative correlation was observed between semantic fluency and the
subscore for WMHs in the frontal lobe. Of the 36 non-demented patients
re-evaluated after a mean follow-up of 30 months, three patients converted into
MCI and 5 into dementia. Progression of periventricular WMHs was associated with
an increased conversion to dementia. A marginal association between the increase
in total WMHs burden and worsening in the Mini Mental State Examination was
encountered. CONCLUSIONS: White matter hyperintensities do not influence the
cognitive status of patients with PD. Frontal WMHs have a negative impact on
semantic fluency. Brain vascular burden may have an effect on cognitive
impairment in patients with PD as WMHs increase overtime might increase the risk
of conversion to dementia. This finding needs further confirmation in larger
prospective studies
Slow oscillatory activity and levodopa-induced dyskinesias in Parkinsonâs disease
The pathophysiology of levodopa-induced dyskinesias (LID) in Parkinsonâs disease is not well understood.
We have recorded local field potentials (LFP) from macroelectrodes implanted in the subthalamic nucleus
(STN) of 14 patients with Parkinsonâs disease following surgical treatment with deep brain stimulation. Patients
were studied in the âOffâ medication state and in the âOnâ motor state after administration of levodopaâ
carbidopa (po) or apomorphine (sc) that elicited dyskinesias in 11 patients. The logarithm of the power
spectrum of the LFP in selected frequency bands (4â10, 11â30 and 60â80 Hz) was compared between the
âOffâ and âOnâ medication states. A peak in the 11â30 Hz band was recorded in the âOffâ medication state
and reduced by 45.2% (P < 0.001) in the âOnâ state. The âOnâ was also associated with an increment of 77. 6%
(P < 0.001) in the 4â10 Hz band in all patients who showed dyskinesias and of 17.8% (P < 0.001) in the 60â80 Hz
band in the majority of patients. When dyskinesias were only present in one limb (n = 2), the 4â10 Hz peak was
only recorded in the contralateralSTN. These findings suggest that the 4â10 Hz oscillation is associated with the
expression of LID in Parkinsonâs disease
- âŠ