Management Of Parkinson's Disease Research Articles

Parkinsonism--drug treatment: Part I.

The purpose of this two-part review is to explain current drug treatment in part I and discuss investigational drug therapy and miscellaneous drugs in the management of parkinsonism in part II. The medical approach to this disease is still based on the imbalance between a deficiency of dopamine and a functional increase in acetylcholine. Anticholinergic agents are used to treat the tremors in the early stages of the disease.

Magnetic resonance imaging of the midbrain in Parkinson's disease.

We have analyzed magnetic resonance images of the midbrain in patients with Parkinson's disease, and have found that there is a narrowing of the signal from the pars compacta of the substantia nigra relative to controls. The nature of the histological changes that may be responsible for this effect is discussed. Magnetic resonance imaging has the potential of becoming a useful diagnostic tool in the management of parkinsonism.

Drug holiday in the management of Parkinson disease.

Department of Neurological Sciences, Rush-Presbyterian-St. Lukes Medical Center, Chicago, Illinois 60612

Drug holiday and management of Parkinson disease

De novo regeneration of immunity is a major problem after allogeneic hematopoietic stem cell transplantation (HCT). HCT modeling in severely compromised immune-deficient animals transplanted with human stem cells is currently limited because of incomplete maturation of lymphocytes and scarce adaptive responses. Dendritic cells (DC) are pivotal for the organization of lymph nodes and activation of naive T and B cells. Human DC function after HCT could be augmented with adoptively transferred donor-derived DC. In this study, we demonstrate that adoptive transfer of long-lived human DC coexpressing high levels of human IFN-α, human GM-CSF, and a clinically relevant Ag (CMV pp65 protein) promoted human lymphatic remodeling in immune-deficient NOD.Rag1^−/−.IL-2rγ^−/− mice transplanted with human CD34⁺ cells. After immunization, draining lymph nodes became replenished with terminally differentiated human follicular Th cells, plasma B cells, and memory helper and cytotoxic T cells. Human Igs against pp65 were detectable in plasma, demonstrating IgG class-switch recombination. Human T cells recovered from mice showed functional reactivity against pp65. Adoptive immunotherapy with engineered DC provides a novel strategy for de novo immune reconstitution after human HCT and a practical and effective tool for studying human lymphatic regeneration in vivo in immune deficient xenograft hosts.

Drug holidays in management of Parkinson disease

Drug holidays in management of Parkinson disease

Drug holiday and management of Parkinson disease.

Chronic treatment of parkinsonism with levodopa or levodopa/carbidopa is associated with problems that include dyskinesia, on-off phenomena, hallucinosis, and possible loss of therapeutic efficacy. We studied the effects of a period of transient drug withdrawal (drug holiday) in 16 patients who manifested these complications of chronic levodopa therapy. Patients were evaluated daily before, during, and after the period of drug withdrawal. Eleven of the 16 patients exhibited enhanced motor responsiveness after the holiday and required only half of the initial daily dose for improved motor performance. Most levodopa-induced side effects decreased after the holiday. Hallucinosis was ameliorated in all cases. The frequency of on-off phenomena and myoclonus also diminished. Sensitivity to levodopa-induced dyskinesia was not affected by the drug holiday. Because most patients required lower dosage after the holiday, dyskinesias were no longer present. These observations suggest that parkinsonian patients who suffer complications of chronic levodopa therapy may benefit from a period of drug withdrawal.

Considerations in the management of parkinsonism

Considerations in the management of parkinsonism

Advances in the management of parkinson's disease.

The treatment of Parkinson's disease today is complex, time-consuming, but rewarding. The introduction of levodopa has not cured the disease, but has provided the most powerful therapy available yet. Its use is limited by side effects and careful titration to optimum dosage, often in combination with other drugs, is required. Despite best therapy, some patients never respond, and others begin to lose benefit after some years of therapy. New problems, such as the "on-off" effect have appeared with long-term treatment, and require careful adjustment of dosage. As with any replacement therapy, a balance between sub-optimal benefit and side effects has to be discovered and maintained by careful and frequent review. New approaches to treatment may offer further improvement in the near future.

Individualization of drug therapy for the parkinsonian patient

<b>Dr. Lamar:</b>Our discussion today will focus on the need to individualize the total management of a parkinsonian patient to assure an optimal therapeutic benefit. This approach is especially important because of the well-recognized, remarkable variation in therapeutic response that exists among parkinsonian patients and even within the same patient from day to day. Perhaps 15% of parkinsonian patients do not achieve even a modicum of desired therapeutic response from one or more of the antiparkinsonian drugs they receive, while an equal proportion of patients derive intolerable drug side-effects—sometimes at low doses. Other patients may suffer from drug-drug interactions following coadministration of two or more antiparkinsonian drugs. The objective of this round is to discuss factors that must be considered to achieve optimal therapeutic results in the management of parkinsonism. The moderator of this conference will be Dr. Joseph R. Bianchine. <b>Dr. Bianchine:</b>Dr. Gordon, will you define Parkinson disease

Individualization of Drug Therapy for the Parkinsonian Patient

Dr. Lamar: Our discussion today will focus on the need to individualize the total management of a parkinsonian patient to assure an optimal therapeutic benefit. This approach is especially important because of the well-recognized, remarkable variation in therapeutic response that exists among parkinsonian patients and even within the same patient from day to day. Perhaps 15% of parkinsonian patients do not achieve even a modicum of desired therapeutic response from one or more of the antiparkinsonian drugs they receive, while an equal proportion of patients derive intolerable drug side-effects—sometimes at low doses. Other patients may suffer from drug-drug interactions following coadministration of two or more antiparkinsonian drugs. The objective of this round is to discuss factors that must be considered to achieve optimal therapeutic results in the management of parkinsonism. The moderator of this conference will be Dr. Joseph R. Bianchine. Dr. Bianchine: Dr. Gordon, will you define Parkinson disease

L-dopa for parkinsonism

Existing anti-Parkinsonian drugs help 60–80% of patients,1 mainly by reducing rigidity. Stereotaxic surgery also reduces rigidity but has proved particularly helpful in the alleviation of tremor.2 Evidence is now accumulating that a new drug, L-dopa (l-dihydroxyphenylalanine), is useful in the management of Parkinsonism. Its salient therapeutic action is the reduction of hypokinesia, making it easier to initiate voluntary movement. It also helps to control oculogyric crises, which are generally refractory to all other forms of treatment.

Management of parkinsonism with L-dopa.

Management of parkinsonism with L-dopa.

Management of Parkinsonism.

Management of Parkinsonism.

BILATERAL STEREOTAXIC LESIONS IN THE MANAGEMENT OF PARKINSONISM AND THE DYSKINESIAS.

Since the establishment of stereotaxic surgery as a therapeutic procedure of value in the management of Parkinsonism and the dyskinesias, most centres specializing in this operation have carried it out bilaterally in some of their patients. However, bilateral stereotaxic surgery has been associated with a certain amount of hazard, somewhat greater than in the case of unilateral operations. There has been a general reluctance to subject these patients to operation on both hemispheres, and the criteria for selection for surgery have been more strictly applied before the second procedure.

Management of Parkinsonism

Management of Parkinsonism