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Mar 2019 DOI 10.14302/issn.2470-5020.jnrt-19-2630
Patients suffering treatment resistant Parkinson´s disease (PD) are potential candidates for deep brain stimulation (DBS). Commonly most implanted electrodes have a cylindrical shape with quadripolar electrode contacts and generate a symmetrical stimulation field around the lead. To reduce side effects through activation of neighboring fibers a new electrode design with segmented contacts was developed and enables a better adaption of the field of stimulation as well as a multi-target stimulation to improve therapeutic benefits. We report about a 51-year-old male patient with a 15-year history of treatment-refractory PD, who was implanted with bilateral segmented electrodes in the subthalamic nucleus (STN) with St. Jude Medical Infinity™ DBS System (Abbott/St. Jude Medical, Saint Paul, Minnesota, USA). Despite a clear mood-enhancing effect, stimulation with ring electrodes caused motor side effects including rigor and speech disorder. With segmented electrodes an effective and gentle stimulation was achieved. The stimulation of the anterior segments in the central position of the electrode in the STN showed no side-effects and allowed a reduction of initial symptoms in an low stimulation amplitude. Despite precise preoperatively planning and intraoperative trial stimulation, side effects of STN stimulation are very common. The application of segmented electrodes permits more options to reduce side effects rather than using ring electrodes. Studies with larger sample sizes are needed to establish the optional DBS electrode.
Jan 2019 DOI 10.14302/issn.2641-5526.jmid-18-2529
Discrimination of case-control status based on gene expression differences has potential to identify novel pathways relevant to neurodegenerative diseases including Parkinson’s disease (PD). In this paper we applied two different novel algorithms to predict dysregulated pathways of gene expression across several different regions of the brain in PD and controls. The Fisher’s ratio sampler uses the Fisher’s ratio of the most discriminatory genes as prior probability distribution to sample the genetic networks and their likelihood (accuracy) was established via Leave-One-Out-Cross Validation (LOOCV). The holdout sampler finds the minimum-scale signatures corresponding to different random holdouts, establishing their likelihood using the validation dataset in each holdout. Phenotype prediction problems have by genesis a very high underdetermined character. We used both approaches to sample different lists of genes that optimally discriminate PD from controls and subsequently used gene ontology to identify pathways affected by disease. Both algorithms identified common pathways of Insulin signaling, FOXA1 Transcription Factor Network, HIF-1 Signaling, p53 Signaling and Chromatin Regulation/Acetylation. This analysis provides new therapeutic targets to treat PD.
Oct 2016 DOI 10.14302/issn.2470-5020.jnrt-16-1240
Background: Impulse Control Disorders (ICDs) are characterized as pathologicalbehavioral patterns of excess impulsivity which may result as part of the non-motor complications of Parkinson’s disease (PD). These significantly affect the patient’s overall quality of life and have impact on their care givers, as well. Currently, the prevalence of ICDs among adult Filipino patients with Parkinson’s disease is unknown and less reported. Objectives: The study is intended to determine the prevalence of ICDs and its severityamong adult Filipino patients with idiopathic Parkinson’s disease seen at Jose R. Reyes Memorial Medical Center. Specifically, this study will identify risk factors and the clinical correlates to these patients. Methods: Adult Filipino patients diagnosed withidiopathic Parkinson’s diseasewhowere seen at the outpatient department from March 2015 – September 2015 are screened for the study. The Modified Hoehn and Yahr staging was utilized to determine the stage of PD. With approval from the author, the Questionnaire for Impulsive-Compulsive Disorders in Parkinson’s Disease-Rating Scale (QUIP-RS) was used for detecting the presence of ICDs and corresponding severity. Results: We were able to examine 66 patients (31 males and 35 females) withidiopathic Parkinson disease. Majority of the patients manifested with Tremor Dominant (50%) subtype, followed by Early Disease Onset (34.8%), and Non-Tremor Dominant (15.2%). Sixteen (16) out of 66 patients (24.2%) have ICD symptoms with the following incidence rates: hobbyism/ punding 56.25%, compulsive eating 50%, hypersexuality 18.75%, compulsive shopping 18.75, Dopamine dysregulation syndrome 18.75%, and gambling 12.5%. Overall average QUIP-RS score is 5.42. There is significant association of PD duration with occurrence of ICD symptoms; the longer the PD duration, the higher risk of having ICD symptoms (x2 20.41; p = 0.026). Patients with higher mean modified Hoehn and Yahr stage (2.66±0.94), t 2.735, df 64, p 0.008, have much higher incidence of ICD symptoms. Conclusion: Filipino patients with idiopathic Parkinson disease who are majority onlevodopa + carbidopa therapy may develop impluse control disorders (ICDs). Other contributory factors in development of ICDs include longer duration of PD and higher mean Modified Hoehn and Yahr stage.
May 2016 DOI 10.14302/issn.2470-5020.jnrt-15-908
Objective: We aimed to investigate homocysteine levels and carotid intima-media thickness (CIMT) in Parkinson’s Disease (PD), to determine relationship of these parameters and as well as to determine whether CIMT in patients with PD was associated to age, disease duration, age of disease onset, stage, the Unified Parkinson Disease rating scale (UPDRS), the drugs used in therapy. Methods: The study population consisted of 55 PD patients (37 male) and 25 healty subjects. The severity of neurological impairment was assessed with UPDRS and the Hoehn-Yahr scale. CIMT and homocysteine levels were measured. Anti-parkinsonian treatments were recorded and the total daily dose of levodopa was calculated for each patient. Results: Homocysteine levels were significantly higher in the patient group compared to the control group (p=0.002). A positive correlation was found between CIMT and homocysteine (r=0.29 p=0.03), but no a relationship between CIMT and UPDRS scores, disease duration, age of disease onset, and stage. Mean levodopa dosage did not predict CIMT 0.6 mm (AUC: 0.546, 95%CI 0.372-0.720, p=0.59). Homocysteine 14 µmol/l predicted CIMT 0.6 mm with 64% sensitivity and 69% specificity (AUC: 0.654, 95%CI 0.488-0.819, p=0.07). Dıscussion: This study revealed that homocysteine levels in levodopa + dopa decarboxylase enzyme inhibitor (DDEI) group were increased which was correlated with a mild increasement of CMIT. This might indicate to the importance of clinical and radiological follow up of PD patients who are under treatment of levodopa + DDEI. Conclusion: Our Findings May Suggest The Role Of CIMT As A Meaningful Clinical Marker For Follow-Up Of Patients With PD