1/18. The effect of pregnancy in Parkinson's disease.pregnancy in patients with Parkinson's disease (PD) is a rare occurrence. Previous reports based on retrospective analysis suggest that pregnancy may have a deleterious effect on PD. We describe the effects of pregnancy on the symptomatology of a 33-year-old woman with PD using quantitative neurologic and quality-of-life scales prepartum, intrapartum, and postpartum. During her pregnancy, she was only treated with carbidopa/levodopa. The pregnancy resulted in a normal full-term vaginal delivery of a healthy infant. Significant worsening of this patient's motor symptoms occurred during pregnancy without return to baseline at 15 months postpartum. pregnancy may exacerbate PD and may have a long-term negative impact on the course of the illness. This report may assist physicians in the counseling of patients with young-onset PD who wish to consider pregnancy.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/18. The use of alternative therapies by patients with Parkinson's disease.OBJECTIVE: To determine the prevalence and spectrum of use of alternative therapy (AT) by patients with PD and to determine whether use of AT correlates with demographic, social, or disease-specific characteristics. methods: The authors administered a structured questionnaire, by interview, regarding the use of AT to 201 patients with PD. Demographic, social, and disease-specific characteristics were recorded for all patients. RESULTS: Eighty-one patients (40%) used at least one AT. vitamins and herbs, massage, and acupuncture were most common. Users of AT were younger (p = 0.0021) and had a younger age at onset of PD (p = 0.0011) than nonusers of AT. There was no correlation with sex or race. patients who used AT had a higher income (p = 0.038) and education level (p = 0.006) than did nonusers of AT. There was no association between the use of AT and the Hoehn and Yahr score, duration of PD, duration of treatment with levodopa, surgery for PD, and presence of fluctuations. CONCLUSIONS: The use of AT is common in patients with PD. The age at onset of PD is the most potent predictor of AT use. There is no association between the use of AT and the severity of PD. The widespread and largely unexamined use of AT for PD requires more attention. This should be directed at testing their safety and efficacy and improving physician and patient knowledge about the potential benefits, costs, limitations, and risks of AT.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/18. Lewy body dementia: case report and discussion.BACKGROUND: Lewy body dementia is a common but frequently underdiagnosed cause of dementia often mistaken for the more familiar entity of alzheimer disease. Clinically the distinction is important, because it can have profound implications for management. methods: The medical literature was searched using the keywords "lewy bodies," "Lewy body dementia," "Alzheimer dementia," and "parkinsonian disorders." A case of Lewy body dementia is described. RESULTS: An elderly man had long-standing diagnoses of alzheimer disease and parkinson disease. After he was evaluated thoroughly, the diagnosis was revised to Lewy body dementia, leading to changes in treatment that were associated with dramatic improvement in the patient's mental status. Evidence from the literature suggests that Lewy body dementia can be diagnosed in primary care settings based on clinical criteria. The physician should be alert to this diagnosis, and special attention should be paid to dementia patients who exhibit parkinsonism, hallucinations, fluctuating cognition, or prominent visuosperceptual deficits. CONCLUSIONS: The diagnosis of Lewy body dementia has important implications. It is associated with a high incidence of neuroleptic sensitivity, necessitating great caution in the use of these common antipsychotic agents. Early studies indicate cholinesterase inhibitors can be beneficial for treating the hallucinations and behavior disturbances that afflict these patients and might also improve cognition.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/18. Olfactory and visual hallucinations in Parkinson's disease.Management of hallucinations in patients with parkinson disease is a challenge for both the physician and the patient. They occur in more than 30% of patients and they present mostly as visual hallucinations but other forms such as auditory and tactile hallucinations have been reported. We have reported an interesting patient with olfactory hallucinations and visual hallucinations. To our knowledge, olfactory hallucinations have been rarely described in patients with Parkinson's disease and might be added to the late complications of Parkinson's disease.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/18. Permanent neurological deficit related to magnetic resonance imaging in a patient with implanted deep brain stimulation electrodes for Parkinson's disease: case report.OBJECTIVE AND IMPORTANCE: deep brain stimulation (DBS) is an accepted treatment for patients with Parkinson's disease refractory to medication. The efficacy of this therapy has led to increasing numbers of patients receiving DBS implants. Importantly, physicians caring for patients with implantable neurostimulators must be aware of treatment guidelines for these patients, including the use of therapeutic ultrasound, diathermy, and imaging studies such as magnetic resonance imaging (MRI). CLINICAL PRESENTATION: We describe a case of serious, permanent neurological injury secondary to a radiofrequency lesion produced by heating of a DBS electrode associated with MRI of the lumbar spine in a patient with Parkinson's disease. INTERVENTION: MRI may be performed safely in patients with DBS devices only by following the specific guidelines of the manufacturer. The generalization of these conditions to other neurostimulation system positioning schemes, other scanners, and other imaging scenarios can lead to significant patient injuries. CONCLUSION: To prevent catastrophic incidents, the manufacturer's guidelines should be followed carefully because they are known to result in the safe performance of MRI examinations of patients with neurostimulation systems used for DBS.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/18. neuroleptic malignant syndrome in Parkinson's disease after withdrawal or alteration of dopaminergic therapy.neuroleptic malignant syndrome is characterized by altered consciousness, fever, extrapyramidal signs, autonomic instability, elevated creatine kinase level, and leukocytosis. Although originally described in patients receiving neuroleptic drugs, this syndrome may also occur in patients with Parkinson's disease during withdrawal or reduction of levodopa therapy or other dopaminergic drug therapy. We have encountered three cases of neuroleptic malignant syndrome related to withdrawal of levodopa therapy. These cases illustrate the variety of circumstances in which alteration of therapy with dopaminergic drugs can cause this syndrome and the relative unfamiliarity of the neuroleptic malignant syndrome-levodopa relationship among physicians who do not treat large numbers of patients with Parkinson's disease. An understanding of the role of brain dopamine in the pathogenesis of neuroleptic malignant syndrome and an appreciation of the great variety of drugs whose manipulation can result in this potentially fatal syndrome will aid its proper and timely recognition, especially when the offending pharmacologic manipulation does not involve neuroleptic drugs.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/18. Hypomania as an adverse effect of subthalamic nucleus stimulation: report of two cases.Mania following subthalamic nucleus (STN) deep brain stimulation (DBS) is well described and obvious to both the patient and their physician. The authors describe two patients who developed hypomania following STN-DBS but were unaware of their mood disturbance. Two Parkinson's patients with no previous mood disorders received bilateral STN electrodes. Both experienced dramatic improvement in their motor function and neither complained of any side effects. Their families reported detrimental hypomanic behaviour. Readjusting the stimulation parameters resolved the hypomania with continued motor benefits. The authors draw attention to potential adverse effects of STN-DBS that might be neglected by patients.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
8/18. Approach to diagnosis of parkinson disease.OBJECTIVE: To review the clinical features of parkinson disease (PD) and other causes of motor parkinsonism with an emphasis on diagnosis in elderly patients. SOURCES OF INFORMATION medline: and Google Scholar were searched for original research articles describing clinical diagnosis of parkinsonism. consensus statements and articles summarizing diagnostic criteria for parkinsonian syndromes were also reviewed. Most evidence was levels II or III. MAIN MESSAGE: diagnosis of PD is made clinically and can be challenging. In older patients, PD can present with general functional decline and nonspecific symptoms. Clinical criteria for diagnosing PD and the TRAP mnemonic can be helpful. A 2-week trial of levodopa-carbidopa treatment can be considered. Specific signs and a minimal response to levodopa treatment suggest other causes of parkinsonism. Clinical features of other causes of parkinsonism are reviewed in the article. CONCLUSION: Parkinsonism and PD are common in older patients. family physicians should consider parkinsonism in the differential diagnosis of patients who have falls and exhibit general functional decline.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
9/18. Postmortem analysis of adrenal-medulla-to-caudate autograft in a patient with Parkinson's disease.A 53-year-old physician who had a 10-year history of progressive idiopathic parkinsonism survived for 4 months after an autologous adrenal-medulla-to-right-caudate autograft but he received little clinical benefit. A small number of chromaffin cells in the graft site survived; they expressed neurofilament proteins and chromogranin a, but scant tyrosine hydroxylase. The striatum on both sides showed almost complete loss of [3H]mazindol binding to dopamine-uptake sites; the density of dopamine receptors was decreased adjacent to the transplant but increased rostral to the transplant. These results demonstrate that autografted chromaffin cells can survive for 4 months after transplantation and that related changes in dopamine receptors can be quantified.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
10/18. Bilateral vocal cord paralysis due to laryngeal carcinoma in Parkinson's disease.A laryngeal carcinoma presenting as severe dyspnea and stridor due to bilateral vocal cord paralysis was found in a 66-year-old man who had been suffering from Parkinson's disease (PD) for twenty years. Although laryngeal carcinoma is a common cause of bilateral vocal cord paralysis, patients with PD have been suspected to have a low cancer incidence, and this may be the first case report. therapeutics have extended the survival of patients with PD, and the possibility of developing vocal cord paralysis. Thus, it is important for the physician to be aware that this condition may be caused by carcinoma even in PD cases.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
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