Alvászavarok Parkinson-kórban: megjelenés, kivizsgálás, terápiás lehetőségek

Absztrakt Bevezetés: A neurológiai betegségek egyik legnagyobb csoportját a különféle eredetű mozgászavarok alkotják. Ezek közé tartozik a Parkinson-kór, amely a motoros-mozgató rendszert érintő tünetek, panaszok alapján ismerhető fel. A fentiek mellett azonban számos egyéb kísérő jelenséggel is számolni kell, amelyeket úgynevezett nem motoros tüneteknek nevezünk. Ezek közül több meg is előzi az ismert, klasszikus motoros tünetek megjelenését. Célkitűzés: Jelen összefoglaló a Parkinson-kórban megjelenő különböző alvászavarokat, azok felismerési és kezelési lehetőségeit ismerteti. Módszer: A szerzők áttekintették a PubMed-ben található, 2015. januárig megjelent, Parkison-kór és alvászavarok összefüggéseit vizsgáló közleményeket. Eredmények: A nem motoros tünetek egyik kategóriája az alvászavarok, amelyek között megtaláljuk az aluszékonysághoz vezető állapotokat, az insomniát vagy a parasomniák közé sorolt REM-magatartászavar-betegséget. Az alvászavarok kialakulásában a neurodegeneratív folyamat következményeként létrejövő agytörzsi és egyéb területek károsodása mellett (amelyek szerepet játszanak az alvás–ébrenlét ciklus szabályozásában) egyéb, jól befolyásolható faktorok (alvási apnoe betegség, nyugtalan láb szindróma stb.) is szerepet játszanak. Következtetések: A nem motoros panaszok felismerése és megfelelő kezelése a Parkinson-kórban szenvedő betegeknél az életminőséget jelentősen javítja. Orv. Hetil., 2015, 156(27), 1091–1099

The Parkinson's Disease Composite Scale Is Adequately Responsive to Acute Levodopa Challenge

Background: The Parkinson's Disease Composite Scale (PDCS) is a recently developed easy-to-use tool enabling a timely but comprehensive assessment of Parkinson's disease (PD)-related symptoms. Although the PDCS has been extensively validated, its responsiveness to acute levodopa challenge has not been demonstrated yet. Objective: To investigate the correlation between changes in the motor examination part of the Movement Disorder Society-sponsored Unified Parkinson's Disease Rating Scale (MDS-UPDRS) and the PDCS motor scores during acute levodopa challenge and calculate a cutoff range on the PDCS indicating clinically relevant improvement. Methods: A consecutive series of 100 patients with parkinsonism were assessed using the motor examination sections of the MDS-UPDRS and the PDCS at least 12 hours after the last levodopa dose and after the administration of a single dose of a suprathreshold immediate formulation of levodopa/benserazide reaching the "best ON." Results. There was a high correlation between changes in the MDS-UPDRS and the PDCS motor scores (Spearman's rho = 0.73, p < 0.001). Receiver operating characteristic analysis revealed that a 14.6%-18.5% improvement in the PDCS motor scores corresponds to a 20-30% improvement in the MDS-UPDRS motor examination. Conclusions: The PDCS can reliably and adequately respond to an acute levodopa challenge. Any improvements in PDCS motor scores exceeding the 14.6-18.5% threshold could represent a clinically relevant response to levodopa.This study was supported by the Hungarian Brain Research Program (2017-1.2.1-NKP-2017-00002) and NKFIH (EFOP-3.6.2-16-2017-00008, SNN125143, and ÚNKP-17-4-I.-PTE-311) (government-based funds). Our research was partly financed by the Higher Education Institutional Excellence Program of the Ministry of Human Capacities in Hungary, within the framework of the 5th thematic program of the University of Pécs, Hungary (20765/3/2018/FEKUSTRAT). The authors would like to thank Éva Balázs and Katalin Takács, our Parkinson’s nurses, for their assistance in study-related examinations.S

Mozgó atomok és molekulák erősen csatolt sugárzási terekben, rezonátorokban = Moving atoms and molecules in strongly-couped radiation fields, in cavities

A fény-anyag kölcsönhatást mikroszkópikus szinten, az erős csatolás tartományában vizsgáltuk. Jelentős előrehaladást értünk el a sugárzási tér atomok mozgására kifejtett hatásának és a mozgás visszahatásának megértésében. Új módszereket dolgoztunk ki atomok és molekulák mozgásának kontrollált manipulálására, a részecskék termikus mozgásának csillapítására (``rezonátoros hűtés''), és atomok stabil csapdázására a hullámhossz töredékének megfelelő térfogatban. Kidolgoztuk a korábban felállított szemiklasszikus modell kvantummechanikai általánosítását. Egyszerű rendszerek teljesen kvantumos leírását szolgáltató, a Monte-Carlo hullámfüggvény módszeren alapuló numerikus kódot egy kényelmesen kezelhető, szabadon letölthető programcsomagba foglaltuk. A kutatómunka másik fő vonala az erősen csatolt rezonátormódus által közvetített atom-atom kölcsönhatásból származó kollektív hatások vizsgálatát célozta meg. Részletesen felderítettük két atom mozgásában fellépő korrelációt. Átlagtérelmélet segítségével leírtuk a sokatomos rendszer fázisátalakulásait, és a meghatároztuk a rendszer teljes fázisdiagrammját. A csatolt atom rezonátor rendszer egyik lehetséges alkalmazása a kvantuminformáció kezelésében van. Új sémákat dolgoztunk ki több-bites, univerzális kvantumkapuk megvalósítására. Eredményeinket 25 cikkben közöltük, ebből 4 cikk a Physical Review Letters-ben jelent meg. | The strong coupling regime of the light-matter interaction has been studied at a microscopic level. We have considerably progressed in the understanding of the radiation field forces exerted on the motion of atoms, and the back-action of the motion on the field. We have developed new methods for the controlled manipulation of atoms and molecules, for the damping of the thermal motion (``cavity cooling''), and for the stable trapping of particles in a tiny volume corresponding to the fraction of the optical wavelength. We have worked out the quantum mechanical generalization of the semiclassical model, set up previously. The numerical code, providing for the fully quantum description of simple systems based on the Monte-Carlo Wavefunction Method has been created and put in an easy-to-use, documented program package. The other main research direction addressed the collective effects arising from the atom-atom interaction mediated by the commonly strongly coupled resonator mode. We have revealed in detail the correlated motion of two atoms. By means of mean-field theory we have described the phase transitions of the many atom system, and determined its full phase diagram. One possible application of the coupled atom and cavity system lies in the processing of quantum information. We have developed new schemes for the realization of universal, multi-qubits quantum gates. Our results have been published in 25 papers, including four papers in the Physical Review Letters

The possible role of the insula in the epilepsy and the gambling disorder of Fyodor Dostoyevsky

Background The retrospective diagnosis of Fyodor Mikhailovich Dostoyevsky’s (1821–1881) neurological and psychiatric disease proves to be particularly interesting. Recent neurobiological data suggest a solution to the questions regarding the writer’s retrospective diagnosis, claiming the insular cortex to be the origin of the rare ecstatic seizures. Regarding Dostoyevsky’s pathological gambling, this hypothesis is consistent with another finding from recent neuroscience, namely that the malfunction of the insula could be an important underlying pathology in gambling disorder. Case study Literary and scientific overview (1928–2015) on the subjects of Dostoyevsky’s epilepsy and gambling disorder. Discussion and conclusion Taking Dostoyevsky’s neurological (ecstatic seizures) and psychiatric (pathological gambling) disease and the crossroads into consideration, these two disciplines make regarding the underlying pathology, we would like to suggest a speculative theory that these two disorders have a common insular pathomechanism, namely, the malfunctioning of the risk prediction–risk prediction error coding system. Furthermore, based on Dostoyevsky’s case, regarding gambling disorder in general, we would like to hypothesize that the three common gambling-related cognitive distortions (near-miss effect, gambler’s fallacy, and the illusion of control) can be all attributed to the impairment of the anterior insular risk prediction–risk prediction error coding system

Minimal Clinically Important Differences for Burke-Fahn-Marsden Dystonia Rating Scale and 36-Item Short-Form Health Survey

Although an increasing number of trials are reported on the treatment of generalized or segmental isolated dystonia, the minimal clinically important difference thresholds for the most frequently reported outcome measures are still undetermined.To estimate the minimal clinically important difference for the Burke-Fahn-Marsden Dystonia Rating Scale and the 36-Item Short-Form Health Survey in generalized or segmental dystonia.A total of 898 paired examinations of 198 consecutive patients, aged >18 years, with idiopathic and inherited (torsin family 1 member A positive) segmental and generalized isolated dystonia were analyzed. To calculate the minimal clinically important difference thresholds, both anchor- and distribution-based methods were used simultaneously.Any improvement >16.6% or worsening larger than 21.5% on the Burke-Fahn-Marsden Dystonia Rating Scale indicates a minimal, yet clinically relevant, change. Threshold values for the Burke-Fahn-Marsden Dystonia Disability Scale were 0.5 points for both decline and improvement. Cut-off scores for the Physical Component Summary, the Mental Component Summary, and the Global (Total or Overall) Score of the 36-Item Short-Form Health Survey were 5.5 and 5.5, 6.5 and 7.5, and 7.5 and 8.5 points for clinically meaningful improvement and deterioration, respectively.The minimal clinically important difference represents the smallest change in an outcome measure that is meaningful to patients. Our estimates for the Burke-Fahn-Marsden Dystonia Rating Scale and the 36-Item Short-Form Health Survey may allow more reliable judgment of the clinical relevance of different treatments for segmental and generalized isolated dystonia. © 2020 The Authors. Movement Disorders published by Wiley Periodicals, Inc. on behalf of International Parkinson and Movement Disorder Society

Prevalence Of Anxiety Among Hungarian Subjects With Parkinson's Disease

Although anxiety is one of the most frequent symptoms of Parkinson’s disease (PD), only a few clinical tools can efficiently and reliably detect its presence. The aim of the present study was to validate the Hungarian patient-rated version of Parkinson Anxiety Scale (PAS). A total of 190 PD patients were enrolled into the clinimetric validation phase of the study and another 590 participated in the cross-sectional screening phase. The presence of anxiety disorder was diagnosed based on the Diagnostic and Statistical Manual of Mental Disorders criteria. The cutoff value for PAS which best discriminated the presence of anxiety from the absence was 12.5 points (sensitivity of 88.6%, specificity of 79.9). The area under the curve was 0.847 whereas the ROC analysis yielded the statistical significance level (p<0.001). The optimal threshold values for mild (Hoehn and Yahr Stage, HYS 1 and 2), moderate (HYS 3), and severe (HYS 4 and 5) disease stages were 10.5, 12.5, and 13.5 points, respectively. Based on the general threshold anxiety occurred in 35.8% of the patients (persistent anxiety: 29.2%, episodic anxiety: 20.7%, and avoidant anxiety disorder: 16.8%). We demonstrate that the PAS is a valid, highly reliable, and sensitive tool for assessing anxiety