The Hypothalamus in Parkinsonʼs Disease

Langston, J. W.; Forno, L. S.

doi:10.1097/00005072-197605000-00109

Cited by 7 publications

(9 citation statements)

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“…For instance, hypothalamic involvement has been described in PD. 4,5 Fluctuating psychiatric symptoms are frequently reported in PD. 6 Two thirds of patients receiving chronic levodopa treatment experience mood fluctuations.…”

Section: Discussionmentioning

confidence: 99%

The Clinical Profile of Nonmotor Fluctuations in Parkinson's Disease Patients

Günal

Nurichalichi

Tuncer

et al. 2002

Can. j. neurol. sci.

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All patients with Parkinson's disease (PD) experience motor fluctuations, usually related to chronic levodopa therapy during the course of the disease. These fluctuations constitute the greatest problem for the long-term management of these patients. 1 It is estimated that each year approximately 10% of all patients treated with levodopa will develop motor fluctuations, so that 50% will be affected after five years of sustained levodopa therapy.2 Recently, nonmotor fluctuations have been described, such as sensory, autonomic and psychiatric, in addition to motor fluctuations. 3 The aims of this study were firstly to determine nonmotor symptoms and secondly to ABSTRACT: Objective: Recently described nonmotor fluctuations may cause disability in Parkinson's disease patients. These fluctuations are generally grouped as sensory, autonomic and psychiatric. The clinical spectrum and frequency of these fluctuating symptoms are not well-described. Methods: We studied the relationship of nonmotor fluctuations with motor symptoms and determined the influence of age at disease onset, duration of disease, dosage and duration of levodopa treatment in the appearance of nonmotor fluctuations. R e s u l t s : Statistical analysis showed a relationship of disease-related parameters with sensory and autonomic fluctuations but psychiatric fluctuations were only found to be associated with the duration of levodopa usage. The nonmotor fluctuations included in the study were observed during "on" periods as well as "off" periods. Conclusion: Nonmotor fluctuations had variable presentations. Moreover, their co-appearance with different types of motor fluctuations may be linked to the effect of other neurotransmitter systems acting synchronously with dopamine. Risk factors for sensory and autonomic fluctuations in patients with Parkinson's disease were early age of disease onset, longer duration and higher dose of levodopa use. Psychiatric fluctuations were only associated with higher doses of levodopa. RÉSUMÉ: Le profil clinique des fluctuations non motrices chez les patients atteints de la maladie deParkinson. Objectif: Les fluctuations non motrices décrites récemment peuvent être invalidantes chez les parkinsoniens. Ces fluctuations sont généralement sensitives, neurovégétatives ou psychiatriques. Le spectre clinique et la fréquence de ces symptômes fluctuants n'ont pas été décrits avec précision. Méthodes: Nous avons étudié la relation entre les fluctuations non motrices et les symptômes moteurs et nous avons déterminé l'influence de l'âge de début de la maladie, la durée de la maladie, le dosage et la durée du traitement par la lévodopa par rapport à l'apparition des fluctuations non motrices. Résultats: L'analyse statistique a montré une relation entre les paramètres reliés à la maladie et les fluctuations sensitives etneurovégétatives. Cependant les fluctuations psychiatriques n'ont été associées qu'à la durée de l'utilisation de la lévodopa. Les fluctuations non motrices incluses dans l'étude étaient observées tant pendant les p...

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Section: Discussionmentioning

confidence: 99%

The Clinical Profile of Nonmotor Fluctuations in Parkinson's Disease Patients

Günal

Nurichalichi

Tuncer

et al. 2002

Can. j. neurol. sci.

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“…The specific pathological features of idiopathic Parkinson's disease, as seen in this case, include neuronal loss in the substantia nigra and hypothalamus (Langston & Forno, 1978). The effect of withdrawal of levodopa in Parkinson's disease would leave these areas substantially depleted or devoid of dopaminergic drive.…”

Section: Discussionmentioning

confidence: 82%

Levodopa withdrawal syndrome identical to neuroleptic malignant syndrome

Gibb

Griffith

1986

Postgraduate Medical Journal

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Summary A 60 year old woman with idiopathic Parkinson's disease had been prescribed thioridazine for schizophrenia. Five months after this was stopped, Sinemet also considered of dubious therapeutic value, was withdrawn. One week later she developed features of the neuroleptic malignant syndrome (NMS) accompanied by myoglobinuric renal failure. Post-mortem examination confirmed Lewy body degeneration in the substantia nigra. It is proposed that NMS may be caused by levodopa withdrawal in Parkinson's disease, and that it is withdrawal of dopaminergic drive that causes the syndrome.

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“…In addition, studies by Hirano and Zimmerman (1962) have demonstrated a proclivity for hypothalamic involvement in PD patients with dementia. With respect to the latter, this could also help explain the autonomic disturbances seen in PD patients (Langston & Forno, 1978). The importance of the hypothalamus in PD is further established by the reported influences of alpha-MSH (from medio-basal hypothalamus, and indirectly through the arcuate nucleus) on striatal dopamine activity (Torre et al, 1984;Verseteg et al, 1986).…”

Section: Hypothalmic-mediated Immune Mechanisms and Their Relevance Tmentioning

confidence: 97%

“…Attention has recently been focused on the role of the hypothalamus in aging (Barden et al, 1983), in Alzheimer's disease (Hirano & Zimmerman, 1962), and in PD (Langston & Forno, 1978). In addition, studies by Hirano and Zimmerman (1962) have demonstrated a proclivity for hypothalamic involvement in PD patients with dementia.…”

Section: Hypothalmic-mediated Immune Mechanisms and Their Relevance Tmentioning

confidence: 99%