Modification of Parkinsonism???Chronic Treatment with L-Dopa

Cotzias, George C.; Papvasiliou, P S; Gellene, Rosemary A.

doi:10.1097/00043764-196912000-00037

Cited by 169 publications

(235 citation statements)

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“…Levodopa, an effective therapy for the cardinal signs of PD, provides relief of dysphagia for only a minority of PD patients. Several anecdotal reports mention such symptomatic benefit [12,26,36,57], but only Bushmann et al [14] evaluated their dysphagic PD patients prior to and after levodopa treatment. Levodopa improved some aspects of pharyngeal function in 40% of their cohort, a result that might be partly attributed to improved lingual stage efficiency.…”

Section: Discussionmentioning

confidence: 99%

Pharyngo-Esophageal Dysphagia in Parkinson's Disease

1997

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The radiologic characteristics of pharyngoesophageal (PE) dysfunction in Parkinson's disease (PD) are not well established, partly because most previous studies have examined only small numbers of patients. We administered a dynamic videofluoroscopic swallowing function study to 71 patients with idiopathic PD. Using the Hoehn and Yahr disease severity scale, patients were subdivided into those with mild/moderate disease, subgroup I (n = 38), and advanced PD disease, subgroup II (n = 33). From pharyngeal ingestion to gastric emptying, bolus transport was normal in only 2 patients. The most common abnormalities occurring during pharyngeal ingestion included impaired motility, vallecular and pyriform sinus stasis, supraglottic and glottic aspiration, and deficient epiglottic positioning and range of motion. Esophageal abnormalities were multiple but most commonly included delayed transport, stasis, bolus redirection, and tertiary contractions. Typical aberrations of lower esophageal sphincter (LES) function included an open or delayed opening of the LES and gastro-esophageal reflux. A pathogenesis linking PE with the pathology of PD is proposed.

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Section: Discussionmentioning

confidence: 99%

Pharyngo-Esophageal Dysphagia in Parkinson's Disease

1997

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“…Tremor responds to drug treatment, but therapeutic effects are poorer in comparison with other cardinal symptoms of PD, such as rigidity and bradykinesia [9,57], and therapeutic effectiveness often diminishes over the years. Deep brain stimulation (DBS) of the ventral intermediate nucleus (VIM) has been shown to be efficacious in the treatment of intractable tremor [28], but it is no longer the treatment of choice for PD given the progression of the other cardinal symptoms [4,19,37,47].…”

Section: Introductionmentioning

confidence: 99%

Tremor reduction by subthalamic nucleus stimulation and medication in advanced Parkinson’s disease

et al. 2007

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Deep brain stimulation (DBS) of the subthalamic nucleus (STN) has proved to be effective for tremor in Parkinson's disease (PD). Most of the recent studies used only clinical data to analyse tremor reduction. The objective of our study was to quantify tremor reduction by STN DBS and antiparkinsonian medication in elderly PD patients using an objective measuring system. Amplitude and frequency of resting tremor and re-emergent resting tremor during postural tasks were analysed using an ultrasound-based measuring system and surface electromyography. In a prospective study design nine patients with advanced PD were examined preoperatively off and on medication, and twice postoperatively during four treatment conditions: off treatment, on STN DBS, on medication, and on STN DBS plus medication. While both STN DBS and medication reduced tremor amplitude, STN DBS alone and the combination of medication and STN DBS were significantly superior to pre- and postoperative medication. STN DBS but not medication increased tremor frequency, and off treatment tremor frequency was significantly reduced postoperatively compared to baseline. These findings demonstrate that STN DBS is highly effective in elderly patients with advanced PD and moderate preoperative tremor reduction by medication. Thus, with regard to the advanced impact on the other parkinsonian symptoms, STN DBS can replace thalamic stimulation in this cohort of patients. Nevertheless, medication was still effective postoperatively and may act synergistically. The significantly superior efficacy of STN DBS on tremor amplitude and its impact on tremor frequency in contrast to medication might be explained by the influence of STN DBS on additional neural circuits independent from dopaminergic neurotransmission.

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“…7 In contrast, the long-duration response (LDR) lasts from days to weeks. It is evident clinically as a gradual improvement when levodopa is begun [8][9][10] and as a gradual worsening following cessation of therapy. 7,[10][11][12][13] The LDR is the largest component of symptomatic improvement during the first year of chronic levodopa therapy.…”

Section: Discussionmentioning

confidence: 99%