Medical, surgical, and physical treatments for Parkinson's disease

The Lancet, Год журнала: 2024, Номер 403(10423), С. 305 - 324

Опубликована: Янв. 1, 2024

Язык: Английский

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Parkinson’s Disease

New England Journal of Medicine, Год журнала: 2024, Номер 391(5), С. 442 - 452

Опубликована: Июль 31, 2024

Parkinson's disease is a multisystem neurodegenerative disorder with motor and prominent, sometimes premonitory, nonmotor symptoms. Detection of gene variants may inform prognosis and, potentially, treatment.

Язык: Английский

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Tremor in Parkinson’s Disease: From Pathophysiology to Advanced Therapies

Tremor and Other Hyperkinetic Movements, Год журнала: 2022, Номер 12(1)

Опубликована: Янв. 1, 2022

Background: Tremor is one of the most prevalent symptoms in Parkinson's Disease (PD). The progression and management tremor PD can be challenging, as response to dopaminergic agents might relatively poor, particularly patients with tremor-dominant compared akinetic/rigid subtype. In this review, we aim highlight recent advances underlying pathogenesis treatment modalities for PD. Methods: A structured literature search through Embase was conducted using terms "Parkinson's Disease" AND "tremor" OR "etiology" "management" "drug resistance" "therapy" "rehabilitation" "surgery." After initial screening, eligible articles were selected a focus on published last 10 years. Discussion: pathophysiology remains complex incompletely understood. Neurodegeneration neurons retrorubral area, addition high-power neural oscillations cerebello-thalamo-cortical circuit basal ganglia, play major role. Levodopa first-line therapeutic option all motor symptoms, including tremor. dopamine agonists or anticholinergics lead further reduction. Botulinum toxin injection an effective alternative pharmacological-resistant who are not seeking advanced therapies. Deep brain stimulation well-established therapy owing its long-term efficacy, reversibility, effectiveness other fluctuations. Magnetic resonance-guided focused ultrasound promising modality, which has advantage being incisionless. Cortical peripheral electrical non-invasive innovatory techniques that have demonstrated good efficacy suppressing intractable

Язык: Английский

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Off-time Treatment Options for Parkinson’s Disease

Neurology and Therapy, Год журнала: 2023, Номер 12(2), С. 391 - 424

Опубликована: Янв. 12, 2023

Motor fluctuations (MF) are deemed by patients with Parkinson's disease (PD) as the most troublesome feature resulting from increasing impairment in responsiveness to dopaminergic drug treatments. MF characterized loss of a stable response levodopa over nychthemeron reappearance motor (and non-motor) parkinsonian clinical signs at various moments during day and night. They normally appear after few years treatment variable, though overall severity, course. The armamentarium first-line options has widened last decade new once-a-daily compounds, including catechol O-methyltransferase inhibitor – Opicapone-, two MAO-B inhibitors plus channel blocker Zonisamide Safinamide one amantadine extended-release formulation ADS5012. In addition apomorphine injection or oral dispersible tablets, which have been available for long time, on-demand therapies such sublingual inhaled formulations recently shown efficacy rescue Off-time treatment. When management becomes difficult spite oral/on-demand options, more complex should be considered, surgical, i.e. deep brain stimulation, device-aided pump systems delivering continuous subcutaneous intestinal formulation. Older less commonly used ablative techniques (radiofrequency pallidotomy) may also effective while there is still scarce data regarding reduction using lesional approach, magnetic resonance-guided focused ultrasound. choice between different advanced shared decision that consider physician opinion on contraindication/main target symptom, patients' preference, caregiver's availability together public health socio-economic environment. right/first add-on matter debate well proper time an therapy considered. this narrative review, we discuss all above cited aspects PD, their phenomenology, management, means pharmacological therapies, on-going trials future research perspectives.

Язык: Английский

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Sex and gender differences in Alzheimer’s disease, Parkinson’s disease, and Amyotrophic Lateral Sclerosis: A narrative review

Mechanisms of Ageing and Development, Год журнала: 2023, Номер 212, С. 111821 - 111821

Опубликована: Апрель 30, 2023

Язык: Английский

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Neurostimulation for Advanced Parkinson Disease and Quality of Life at 5 Years

JAMA Network Open, Год журнала: 2024, Номер 7(1), С. e2352177 - e2352177

Опубликована: Янв. 18, 2024

Importance Deep brain stimulation of the subthalamic nucleus (STN-DBS) improves quality life (QOL) in patients with advanced Parkinson disease (PD). However, controlled studies more than 3 years follow-up are lacking. Objective To investigate long-term effects STN-DBS on QOL compared standard-of-care medication (MED). Design, Setting, and Participants In this prospective, observational, quasi-experimental, longitudinal nonrandomized trial, 183 were screened for eligibility 167 enrolled from March 1, 2011, to May 31, 2017, at European university centers. Propensity score matching demographic clinical characteristics was applied 108 PD (62 group 46 MED group), resulting a well-balanced, matched subcohort 25 per group. Data analysis performed September 2022 January 2023. Exposure Treatment or MED. Main Outcomes Measures Assessments included Parkinson’s Disease Questionnaire 8 (PDQ-8), Unified Rating Scale–motor examination, Scales PD–activities daily living (ADL) motor complications, levodopa-equivalent dose. Within-group outcome changes, between-group differences, correlations change scores analyzed. Results The study population (mean [SD] age, 63.7 [8.3] years; 66 [61.1%] male). At 5-year follow-up, PDQ-8 ADL worsened only (PDQ-8 change, −10.9; 95% CI, −19.0 −2.7; P = .01; change: −2.0; −3.1 −0.8; .002), whereas both outcomes remained stable −4.3; −13.2 4.7; .34; −2.5 1.0; .38). Changes correlated moderately ( r s .40, .008). Furthermore, favorable complications (median difference between MED, −4.0 −1.0; .003), mobility (−1.0; −2.0 0; .03), dose reduction (−821.4; −1111.9 −530.8; < .001). Conclusions Relevance This provides evidence differences (stable) (worsened), mainly driven by effect (class IIb evidence). association changes ADL, but not impairment highlights relative importance DBS assessments. Trial Registration German ClinicalTrials Registry: DRKS00006735

Язык: Английский

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Sex difference in human diseases: mechanistic insights and clinical implications

Signal Transduction and Targeted Therapy, Год журнала: 2024, Номер 9(1)

Опубликована: Сен. 10, 2024

Abstract Sex characteristics exhibit significant disparities in various human diseases, including prevalent cardiovascular cancers, metabolic disorders, autoimmune and neurodegenerative diseases. Risk profiles pathological manifestations of these diseases notable variations between sexes. The underlying reasons for sex encompass multifactorial elements, such as physiology, genetics, environment. Recent studies have shown that body systems demonstrate sex-specific gene expression during critical developmental stages editing processes. These genes, differentially expressed based on different sex, may be regulated by androgen or estrogen-responsive thereby influencing the incidence presentation cardiovascular, oncological, metabolic, immune, neurological across However, despite existence differences patients with treatment guidelines predominantly rely male data due to underrepresentation women clinical trials. At present, there exists a substantial knowledge gap concerning mechanisms treatments diverse Therefore, this review aims elucidate advances examining epidemiological factors, pathogenesis, innovative progress accordance distinctive risk each disease provide new theoretical practical basis further optimizing individualized improving patient prognosis.

Язык: Английский

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Optimizing levodopa therapy, when and how? Perspectives on the importance of delivery and the potential for an early combination approach

Expert Review of Neurotherapeutics, Год журнала: 2023, Номер 23(1), С. 15 - 24

Опубликована: Янв. 2, 2023

Introduction There is currently a resurgence of levodopa as the initial treatment choice for most patients with Parkinson's disease, albeit at lower doses than previously used. The addition adjuvant treatments (including MAO-B inhibitors, COMT inhibitors and dopamine agonists) an established strategy to reduce motor complications that develop sustained therapy.Areas covered In this narrative review, authors discuss evidence underpinning current optimization strategies, during early disease once occur. To support discussion, performed broad PubMed search terms 'levodopa/L-dopa/L-Dopa, disease,' restricted clinical trials. now wealth improving delivery brain improves outcomes we how agents can be combined earlier in course leverage full potential strategy.Expert opinion Levodopa remains cornerstone antiparkinsonian therapy. Several promising advances formulation have been made include novel extended-release oral drugs well non-oral systems. However, has long suggested anti-parkinsonian medications may better used combination consequently will benefit from low several rather ever larger doses.

Язык: Английский

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New horizons in Parkinson’s disease in older populations

Age and Ageing, Год журнала: 2023, Номер 52(10)

Опубликована: Сен. 4, 2023

Parkinson's disease (PD) is the second most common neurodegenerative disorder after Alzheimer's disease. Ageing considered to be greatest risk factor for PD, with a complex interplay between genetics and environment. With population ageing, prevalence of PD expected escalate worldwide; thus, it utmost importance reduce burden PD. To date, there are no therapies cure disease, current treatment strategies focus on management symptoms. Older adults often have multiple chronic diseases geriatric syndromes, which further complicates Healthcare systems care models necessary address broad needs older patients largely unavailable. In this New Horizon article, we discuss various aspects from an ageing perspective, including management. We highlight recent advancements in new potential improve patient's quality life.

Язык: Английский

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Continuous Subcutaneous Foslevodopa‐Foscarbidopa in Parkinson's Disease: A Mini‐Review of Current Scope and Future Outlook

Movement Disorders Clinical Practice, Год журнала: 2024, Номер 11(10), С. 1188 - 1194

Опубликована: Июль 11, 2024

Abstract Background Parkinson's disease (PD) is a progressive neurodegenerative disorder characterized by motor and non‐motor symptoms, primarily because of the impairment dopaminergic neurons. Long‐term use levodopa, standard PD treatment, often results in fluctuating therapeutic effects dyskinesia, necessitating alternative therapies. Objectives This review aims to synthesize current insights clinical experiences with foslevodopa‐foscarbidopa, focusing on its pharmacokinetics, efficacy, safety profile, evaluate potential transforming therapy. Methods A systematic literature search was conducted up November 2023 using databases PubMed, Web Science, Cochrane Library. The yielded eight eligible articles, including pharmacological studies, case reports, observational controlled trials. No language restrictions were applied. Results Foslevodopa foscarbidopa, as prodrugs levodopa carbidopa, exhibited excellent chemical stability solubility, facilitating continuous subcutaneous infusion. Clinical trials demonstrated that these maintain stable levels, thereby addressing limitations oral Phase 1 3 studies indicated significant improvements function quality life advanced patients. However, higher incidence treatment‐emergent adverse events, mainly infusion site reactions, observed compared Conclusions Foslevodopa‐foscarbidopa emerges promising for offering sustained symptom control. Its efficacy managing fluctuations dyskinesia makes it viable option spectrum. Future research should focus long‐term safety, economic impact, broader accessibility. now commercially distributed many countries Europe Japan.

Язык: Английский

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