66 research outputs found
Effects of Levodopa-Carbidopa Intestinal Gel Compared with Optimized Medical Treatment on Nonmotor Symptoms in Advanced Parkinson’s Disease: INSIGHTS Study
No full textBackground. Nonmotor symptoms (NMS) are common in advanced Parkinson's disease (APD) and reduce health-related quality of life. Objective. The aim of the study was to evaluate levodopa-carbidopa intestinal gel (LCIG) versus optimized medical treatment (OMT) on NMS in APD. Methods. INSIGHTS was a phase 3b, open-label, randomized, multicenter study in patients with APD (LCIG or OMT, 26 weeks) (NCT02549092). Primary outcomes assessed were total NMS (NMS scale (NMSS) and PD sleep scale (PDSS-2)). Key secondary outcomes included the Unified PD Rating Scale (UPDRS) Part II, Clinical Global Impression of Change (CGI-C), and PD Questionnaire-8 (PDQ-8). Additional secondary measures of Patient Global Impression of Change (PGIC), King's PD Pain Scale (KPPS), and Parkinson Anxiety Scale (PAS) also were evaluated. Finally, safety was assessed. Results. Out of 89 patients randomized, 87 were included in the analysis (LCIG, n = 43; OMT, n = 44). There were no significant differences in NMSS or PDSS-2 total score changes (baseline to Week 26) between LCIG and OMT; within-group changes were significant for NMSS (LCIG, p < 0.001; OMT, p=0.005) and PDSS-2 (LCIG, p < 0.001; OMT, p < 0.001). Between-group treatment differences were nominally significant for UPDRS Part II (p=0.006) and CGI-C (p < 0.001) at Week 26 in favor of LCIG; however, statistical significance could not be claimed in light of primary efficacy outcomes. PGIC (Week 26) and KPPS (Week 12) scores were nominally significantly reduced with LCIG versus OMT (p < 0.001; p < 0.05). There were no significant differences in PDQ-8 or PAS. Adverse events (AEs) were mostly mild to moderate; common serious AEs were pneumoperitoneum (n = 2) and stoma-site infection (n = 2) (LCIG). Conclusions. There were no significant differences between LCIG versus OMT in NMSS or PDSS-2; both LCIG and OMT groups significantly improved from baseline. AEs were consistent with the known safety profile
Can suitable candidates for levodopa/carbidopa intestinal gel therapy be identified using current evidence?
No full textAdvanced Parkinson's disease (APD) is characterized by increased functional disability, caused by motor complications, the presence of axial symptoms, and emergent disease- and drug-related non-motor symptoms. One of the advanced therapies available is intrajejunal infusion of levodopa/carbidopa intestinal gel (LCIG); however, patient selection for this treatment is sometimes difficult, particularly because of overlapping indications with other alternatives.In recent years, strong evidence has supported the use of LCIG in treating motor fluctuations associated with APD, and several clinical studies provide emerging evidence for additional benefits of LCIG treatment in certain patients. This article provides an overview of the published literature on the benefits, limitations, and drawbacks of LCIG in relation to PD symptoms, the psychosocial impact of the disease, and the quality of life of patients, with the aim of determining candidates for whom treatment with LCIG would be beneficial. According to current evidence, patients with APD (defined as inability to achieve optimal control of the disease with conventional oral treatment), a relatively well-preserved cognitive-behavioral status, and good family/caregiver would count as suitable candidates for LCIG treatment. Contraindications in the opinion of the authors are severe dementia and active psychosis. Keywords: Parkinson's disease, Intrajejunal infusion of levodopa/carbidopa intestinal gel, Duodopa, Motor symptoms, Non-motor symptoms, Quality of lif
Intestinal Levodopa/Carbidopa Infusion as a Therapeutic Option for Unresponsive Freezing of Gait after Deep Brain Stimulation in Parkinson's Disease
No full textBackground. Treatment of freezing of gait (FOG) is always challenging because of its unpredictable nature and multifactorial physiopathology. Intestinal levodopa infusion has been proposed in recent years as a valuable option for its improvement. FOG in Parkinson's disease (PD) can appear after deep brain stimulation in patients who never had gait symptoms. Objective. To study the effects of intestinal levodopa/carbidopa infusion in unresponsive-FOG that appears in PD patients treated with subthalamic nucleus deep brain stimulation. Methods. We retrospectively collected and analyzed demographic, clinical, and therapeutic data from five PD patients treated with subthalamic nucleus stimulation who developed unresponsive-FOG and received intestinal levodopa/carbidopa infusion as an alternative therapy. FOG was measured based on scores in item 14 of the Unified Parkinson's Disease Rating Scale before and after intestinal levodopa infusion. Results. Administration of intestinal levodopa caused improvement of FOG in the "ON" state in four patients (80%) by 2 or more points in item 14 of the Unified Parkinson's Disease Rating Scale. The improvement was maintained for at least 12 months. Conclusions. Intestinal levodopa infusion may be a valuable therapeutic option for unresponsive-FOG developed after subthalamic nucleus deep brain stimulation
Stereotaxic Administration of 1-Methyl-4-Phenylpyridinium Ion (MPP+) Decreases Striatal Fructose 2,6-Bisphosphate in Rats
No full textMapping iron content and white matter integrity in the anterior thalamic radiations across Huntington's disease stages
No full textHuntington’s disease (HD) is characterized by progressive neurodegeneration, often accompanied by disrupted iron regulation and altered white matter (WM) integrity. This study investigates iron content and microstructural changes in the anterior thalamic radiations (ATR) across different HD stages. Thirty-one gene carriers and twenty-four controls underwent neuropsychological assessment and 3 T-MRI scanning, including relaxometry and diffusion tensor imaging (DTI) sequences to assess iron content and WM microstructure. ATR changes were examined using average and along-the-tract analyses, with ANOVA and post-hoc Tukey tests to identify group differences and Spearman correlations to evaluate clinical associations. Machine-learning models were applied to assess the potential of MRI metrics as diagnostic biomarkers for HD, focusing on disease stage differentiation and presymptomatic detection. Premanifest individuals exhibited increased iron content and enhanced WM integrity bilaterally, while manifest patients maintained elevated left ATR iron levels alongside bilateral WM degeneration. Both ATRs contribute to the clinical manifestations of HD, including cognitive impairment and neuropsychiatric disturbances. Both along-the-tract relaxometry and DTI metrics emerged as promising biomarkers for distinguishing HD subgroups and identifying presymptomatic individuals. These findings highlight the interplay between iron dysregulation and WM disruption in HD, offering potential pathways for early diagnosis and targeted therapeutic strategies
Present and Future of Parkinson’s Disease in Spain: PARKINSON-2030 Delphi Project
No full textAbstract: Parkinson’s disease (PD) is a chronic progressive and irreversible disease and the second
most common neurodegenerative disease worldwide. In Spain, it affects around 120.000–150.000
individuals, and its prevalence is estimated to increase in the future. PD has a great impact on
patients’ and caregivers’ lives and also entails a substantial socioeconomic burden. The aim of
the present study was to examine the current situation and the 10-year PD forecast for Spain in
order to optimize and design future management strategies. This study was performed using the
modified Delphi method to try to obtain a consensus among a panel of movement disorders experts. According to the panel, future PD management will improve diagnostic capacity and follow-up, it
will include multidisciplinary teams, and innovative treatments will be developed. The expansion of
new technologies and studies on biomarkers will have an impact on future PD management, leading
to more accurate diagnoses, prognoses, and individualized therapies. However, the socio-economic
impact of the disease will continue to be significant by 2030, especially for patients in advanced
stages. This study highlighted the unmet needs in diagnosis and treatment and how crucial it is to
establish recommendations for future diagnostic and therapeutic management of PD
Correction: Huntington Disease Health Related Quality of Life, Function and Well Being: The Patient's Perspective
No full textIn this article the authors’ names Marta Blázquez Estrada and Pablo Mir were incorrectly written as María Blázquez Estrada and Pablo Mir Ribera. The original article has been corrected.Peer reviewe
IC–P–023: Patterns of gray matter atrophy in lewy body dementia in comparison with Parkinson disease with dementia
No full textHuntington Disease Health Related Quality of Life, Function and Well Being : The Patient's Perspective
No full textLimited information is available on patients' experience living with Huntington's disease (HD). The primary objective of this study was to assess the health-related quality of life and well being of patients with HD. A non-interventional, cross-sectional study was conducted in 17 hospitals-based movement disorders units in Spain. Patients aged ≥ 18 years, genetically HD diagnosed [with a diagnostic confidence level score of 4, and an Independence Scale (IS) score ≥ 70] were included. The primary variables were the Huntington's Disease Health-related Quality of Life (HDQLIFE) scores and results of the Satisfaction with Life Scale (SWLS). Secondary outcomes include the Unified HD Rating Scale (UHDRS), Beck Hopelessness Scale (BHS), Stigma Scale for Chronic Illness (SSCI-8), Beck Depression Inventory-Fast Screen (BDI-FS) and Problem Behaviours Assessment for HD short Version (PBA-S). A total of 102 patients were included. The mean age (SD) was 53.1 (12.1) years and 56% were male. Most of the patients (99.0%) showed motor symptoms (87.3%), behavioural and psychiatric disturbances (59.8%), or cognitive impairment (20.6%). HDQLIFE domain score means (SD) includes concern with death and dying 45.97 (9.60) end-of-life planning 37.91 (8.84), and meaning and purpose 44.74 (9.05). SWLS score mean was 24.25 (7.33). Depressive symptoms were found in 37.4% of patients and moderate-to-severe feelings of hopelessness in 32.9%. The prevalence of stigma was 55.9% (n = 57). HD impacted quality of life, with prevalent motor, psychiatric symptoms and cognitive impairment. Patient perspectives may provide complementary information to implement specific interventions. The online version contains supplementary material available at 10.1007/s40120-024-00655-0
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