Author: Glenda Halliday, PhD
Publisher: Oxford University Press
ISBN: 019970788X
Category : Medical
Languages : en
Pages : 337
Book Description
Parkinson's disease becomes apparent only after substantial loss (>60%) of the dopamine neurons in the substantia nigra. By this time there has already been widespread neural inclusion formation in the peripheral and central nervous system of patients with the disease, although this has only been recognized more recently. Degeneration in these widespread regions of the peripheral and central nervous system is now known to impact on disease symptoms, progression and treatment over time. This book aims to provide a comprehensive review of these non-dopamine lesions in Parkinson's disease by assessing our current knowledge of their presence and pathophysiology, how they relate to different symptoms and, where relevant, discuss how they may be potentially treated. The book addresses most of the known symptoms that occur in patients with Parkinson's disease. In addition to the classic motor triad, motor speech, eye movements, olfactory dysfunction, autonomic dysfunction, pain and sensory abnormalities, sleep disturbances, depression and apathy, dopamine dysregulation syndromes, hallucinations and psychoses, cognitive impairment and dementia, and systemic manifestations are all reviewed. Early selective cell loss in non-dopaminergic regions is highlighted (the glutamate projection neurons of the presupplementary motor cortex and caudal intralaminar thalamus) in addition to the widespread inclusion formation in many regions outside the basal ganglia that characterize the disease. Overall this book provides a comprehensive analysis of the lesions associated with the most common symptoms found in patients with Parkinson's disease.
Non-dopamine Lesions in Parkinson's Disease
Author: Glenda Halliday, PhD
Publisher: Oxford University Press
ISBN: 019970788X
Category : Medical
Languages : en
Pages : 337
Book Description
Parkinson's disease becomes apparent only after substantial loss (>60%) of the dopamine neurons in the substantia nigra. By this time there has already been widespread neural inclusion formation in the peripheral and central nervous system of patients with the disease, although this has only been recognized more recently. Degeneration in these widespread regions of the peripheral and central nervous system is now known to impact on disease symptoms, progression and treatment over time. This book aims to provide a comprehensive review of these non-dopamine lesions in Parkinson's disease by assessing our current knowledge of their presence and pathophysiology, how they relate to different symptoms and, where relevant, discuss how they may be potentially treated. The book addresses most of the known symptoms that occur in patients with Parkinson's disease. In addition to the classic motor triad, motor speech, eye movements, olfactory dysfunction, autonomic dysfunction, pain and sensory abnormalities, sleep disturbances, depression and apathy, dopamine dysregulation syndromes, hallucinations and psychoses, cognitive impairment and dementia, and systemic manifestations are all reviewed. Early selective cell loss in non-dopaminergic regions is highlighted (the glutamate projection neurons of the presupplementary motor cortex and caudal intralaminar thalamus) in addition to the widespread inclusion formation in many regions outside the basal ganglia that characterize the disease. Overall this book provides a comprehensive analysis of the lesions associated with the most common symptoms found in patients with Parkinson's disease.
Publisher: Oxford University Press
ISBN: 019970788X
Category : Medical
Languages : en
Pages : 337
Book Description
Parkinson's disease becomes apparent only after substantial loss (>60%) of the dopamine neurons in the substantia nigra. By this time there has already been widespread neural inclusion formation in the peripheral and central nervous system of patients with the disease, although this has only been recognized more recently. Degeneration in these widespread regions of the peripheral and central nervous system is now known to impact on disease symptoms, progression and treatment over time. This book aims to provide a comprehensive review of these non-dopamine lesions in Parkinson's disease by assessing our current knowledge of their presence and pathophysiology, how they relate to different symptoms and, where relevant, discuss how they may be potentially treated. The book addresses most of the known symptoms that occur in patients with Parkinson's disease. In addition to the classic motor triad, motor speech, eye movements, olfactory dysfunction, autonomic dysfunction, pain and sensory abnormalities, sleep disturbances, depression and apathy, dopamine dysregulation syndromes, hallucinations and psychoses, cognitive impairment and dementia, and systemic manifestations are all reviewed. Early selective cell loss in non-dopaminergic regions is highlighted (the glutamate projection neurons of the presupplementary motor cortex and caudal intralaminar thalamus) in addition to the widespread inclusion formation in many regions outside the basal ganglia that characterize the disease. Overall this book provides a comprehensive analysis of the lesions associated with the most common symptoms found in patients with Parkinson's disease.
Etiology of Parkinson's Disease
Author: Jonas H. Ellenberg
Publisher: CRC Press
ISBN: 9780824788230
Category : Medical
Languages : en
Pages : 600
Book Description
This comprehensive reference provides a detailed overview of current concepts regarding the cause of Parkinson's disease-emphasizing the issues involved in the design, implementation, and analysis of epidemiological studies of parkinsonism.
Publisher: CRC Press
ISBN: 9780824788230
Category : Medical
Languages : en
Pages : 600
Book Description
This comprehensive reference provides a detailed overview of current concepts regarding the cause of Parkinson's disease-emphasizing the issues involved in the design, implementation, and analysis of epidemiological studies of parkinsonism.
Non-Motor Symptoms of Parkinson's Disease
Author: K. Ray Chaudhuri
Publisher: Oxford University Press, USA
ISBN: 0199684243
Category : Medical
Languages : en
Pages : 517
Book Description
Patients with Parkinson's disease (PD) are known to suffer from motor symptoms of the disease, but they also experience non-motor symptoms (NMS) that are often present before diagnosis or that inevitably emerge with disease progression. The motor symptoms of Parkinson's disease have been extensively researched, and effective clinical tools for their assessment and treatment have been developed and are readily available. In contrast, researchers have only recently begun to focus on the NMS of Parkinson's Disease, which are poorly recognized and inadequately treated by clinicians. The NMS of PD have a significant impact on patient quality of life and mortality and include neuropsychiatric, sleep-related, autonomic, gastrointestinal, and sensory symptoms. While some NMS can be improved with currently available treatments, others may be more refractory and will require research into novel (non-dopaminergic) drug therapies for the future. Edited by members of the UK Parkinson's Disease Non-Motor Group (PD-NMG) and with contributions from international experts, this new edition summarizes the current understanding of NMS symptoms in Parkinson's disease and points the way towards future research.
Publisher: Oxford University Press, USA
ISBN: 0199684243
Category : Medical
Languages : en
Pages : 517
Book Description
Patients with Parkinson's disease (PD) are known to suffer from motor symptoms of the disease, but they also experience non-motor symptoms (NMS) that are often present before diagnosis or that inevitably emerge with disease progression. The motor symptoms of Parkinson's disease have been extensively researched, and effective clinical tools for their assessment and treatment have been developed and are readily available. In contrast, researchers have only recently begun to focus on the NMS of Parkinson's Disease, which are poorly recognized and inadequately treated by clinicians. The NMS of PD have a significant impact on patient quality of life and mortality and include neuropsychiatric, sleep-related, autonomic, gastrointestinal, and sensory symptoms. While some NMS can be improved with currently available treatments, others may be more refractory and will require research into novel (non-dopaminergic) drug therapies for the future. Edited by members of the UK Parkinson's Disease Non-Motor Group (PD-NMG) and with contributions from international experts, this new edition summarizes the current understanding of NMS symptoms in Parkinson's disease and points the way towards future research.
Non-dopamine Lesions in Parkinson's Disease
Author: Glenda Halliday, PhD
Publisher: Oxford University Press
ISBN: 0190208732
Category : Medical
Languages : en
Pages : 336
Book Description
Parkinson's disease becomes apparent only after substantial loss (>60%) of the dopamine neurons in the substantia nigra. By this time there has already been widespread neural inclusion formation in the peripheral and central nervous system of patients with the disease, although this has only been recognized more recently. Degeneration in these widespread regions of the peripheral and central nervous system is now known to impact on disease symptoms, progression and treatment over time. This book aims to provide a comprehensive review of these non-dopamine lesions in Parkinson's disease by assessing our current knowledge of their presence and pathophysiology, how they relate to different symptoms and, where relevant, discuss how they may be potentially treated. The book addresses most of the known symptoms that occur in patients with Parkinson's disease. In addition to the classic motor triad, motor speech, eye movements, olfactory dysfunction, autonomic dysfunction, pain and sensory abnormalities, sleep disturbances, depression and apathy, dopamine dysregulation syndromes, hallucinations and psychoses, cognitive impairment and dementia, and systemic manifestations are all reviewed. Early selective cell loss in non-dopaminergic regions is highlighted (the glutamate projection neurons of the presupplementary motor cortex and caudal intralaminar thalamus) in addition to the widespread inclusion formation in many regions outside the basal ganglia that characterize the disease. Overall this book provides a comprehensive analysis of the lesions associated with the most common symptoms found in patients with Parkinson's disease.
Publisher: Oxford University Press
ISBN: 0190208732
Category : Medical
Languages : en
Pages : 336
Book Description
Parkinson's disease becomes apparent only after substantial loss (>60%) of the dopamine neurons in the substantia nigra. By this time there has already been widespread neural inclusion formation in the peripheral and central nervous system of patients with the disease, although this has only been recognized more recently. Degeneration in these widespread regions of the peripheral and central nervous system is now known to impact on disease symptoms, progression and treatment over time. This book aims to provide a comprehensive review of these non-dopamine lesions in Parkinson's disease by assessing our current knowledge of their presence and pathophysiology, how they relate to different symptoms and, where relevant, discuss how they may be potentially treated. The book addresses most of the known symptoms that occur in patients with Parkinson's disease. In addition to the classic motor triad, motor speech, eye movements, olfactory dysfunction, autonomic dysfunction, pain and sensory abnormalities, sleep disturbances, depression and apathy, dopamine dysregulation syndromes, hallucinations and psychoses, cognitive impairment and dementia, and systemic manifestations are all reviewed. Early selective cell loss in non-dopaminergic regions is highlighted (the glutamate projection neurons of the presupplementary motor cortex and caudal intralaminar thalamus) in addition to the widespread inclusion formation in many regions outside the basal ganglia that characterize the disease. Overall this book provides a comprehensive analysis of the lesions associated with the most common symptoms found in patients with Parkinson's disease.
Advances in Research on Neurodegeneration
Author: R. Horowski
Publisher: Springer Science & Business Media
ISBN: 3709106435
Category : Medical
Languages : en
Pages : 230
Book Description
The 10th International Winter Conference on Neurodegeneration (lWCN) has taken place from February 14-16,2002, at the lovely "SchloB Ziethen", an old prussian manor (in Prussia, 'faute de mieux', called 'SchloB', i. e. cas tle or residence). This place is 20 km off Tegel Airport, Berlin's main airport, and has been beautifully restored by baroness Edith von Thiingen (nee von BUlow, i. e. of historical Prussian aristocracy); it lends itself rather perfectly for the IWCN type of small interdisciplinary workshops on neurodegenera tion which combine short lectures with plenty of discussion. In this context, we could quote Alexander von Humboldt's famous opening words for one of the first international scientific meetings held at Berlin, on September 18, 1828: "The main purpose ... does not consist in a mutual reading of manuscripts all to be printed after at least one year in specialised publications, but in the personal communication amongst those who work in similar scientific fields; the oral and thus more stimulating exchange of ideas, might they represent facts, opinions or doubts; the foundation of friendly relations which convey illumination to our sciences, serene grace to our lives and tolerance and mildness to our habits ... Berlin, Sept. 18, 1828 Alexander von Humboldt To the IWCN aficionado, it may come as a little surprise that this is the pub lication of the 10th Winter Conference as this might mean that they must have missed number 9.
Publisher: Springer Science & Business Media
ISBN: 3709106435
Category : Medical
Languages : en
Pages : 230
Book Description
The 10th International Winter Conference on Neurodegeneration (lWCN) has taken place from February 14-16,2002, at the lovely "SchloB Ziethen", an old prussian manor (in Prussia, 'faute de mieux', called 'SchloB', i. e. cas tle or residence). This place is 20 km off Tegel Airport, Berlin's main airport, and has been beautifully restored by baroness Edith von Thiingen (nee von BUlow, i. e. of historical Prussian aristocracy); it lends itself rather perfectly for the IWCN type of small interdisciplinary workshops on neurodegenera tion which combine short lectures with plenty of discussion. In this context, we could quote Alexander von Humboldt's famous opening words for one of the first international scientific meetings held at Berlin, on September 18, 1828: "The main purpose ... does not consist in a mutual reading of manuscripts all to be printed after at least one year in specialised publications, but in the personal communication amongst those who work in similar scientific fields; the oral and thus more stimulating exchange of ideas, might they represent facts, opinions or doubts; the foundation of friendly relations which convey illumination to our sciences, serene grace to our lives and tolerance and mildness to our habits ... Berlin, Sept. 18, 1828 Alexander von Humboldt To the IWCN aficionado, it may come as a little surprise that this is the pub lication of the 10th Winter Conference as this might mean that they must have missed number 9.
Marsden's Book of Movement Disorders
Author: Ivan Donaldson
Publisher: Oxford University Press
ISBN: 0191502243
Category : Medical
Languages : en
Pages : 1512
Book Description
This book represents the final work of the late Professor C. David Marsden, who was the most influential figure in the field of movement disorders, in terms of his contributions to both research and clinical practice, in the modern era. It was conceived and written by David Marsden and his colleague at the Institute of Neurology, Prof. Ivan Donaldson. It was their intention that this would be the most comprehensive book on movement disorders and also that it would serve as the 'clinical Bible' for the management of these conditions. It provides a masterly survey of the entire topic, which has been made possible only by vast laboratory and bedside experience. Marsden's Book of Movement Disorders covers the full breadth of movement disorders, from the underlying anatomy and understanding of basal ganglia function to the diagnosis and management of specific movement disorders, including the more common conditions such as Parkinson's Disease through to rare, and very rare conditions such as Niemann-Pick disease. Chapters follow a structured format with historical overviews, definitions, clinical features, differential diagnosis, investigations and treatment covered in a structured way. It is extensively illustrated with many original photographs and diagrams of historical significance. Among these illustrations are still images of some original film clips of some of Dr. Marsden's patients published here for the first time. Comprehensively referenced and updated by experts from the Institute of Neurology at Queen Square, this book is a valuable reference for, not just movement disorder specialists and researchers, but also for clinicians who care for patients with movement disorders.
Publisher: Oxford University Press
ISBN: 0191502243
Category : Medical
Languages : en
Pages : 1512
Book Description
This book represents the final work of the late Professor C. David Marsden, who was the most influential figure in the field of movement disorders, in terms of his contributions to both research and clinical practice, in the modern era. It was conceived and written by David Marsden and his colleague at the Institute of Neurology, Prof. Ivan Donaldson. It was their intention that this would be the most comprehensive book on movement disorders and also that it would serve as the 'clinical Bible' for the management of these conditions. It provides a masterly survey of the entire topic, which has been made possible only by vast laboratory and bedside experience. Marsden's Book of Movement Disorders covers the full breadth of movement disorders, from the underlying anatomy and understanding of basal ganglia function to the diagnosis and management of specific movement disorders, including the more common conditions such as Parkinson's Disease through to rare, and very rare conditions such as Niemann-Pick disease. Chapters follow a structured format with historical overviews, definitions, clinical features, differential diagnosis, investigations and treatment covered in a structured way. It is extensively illustrated with many original photographs and diagrams of historical significance. Among these illustrations are still images of some original film clips of some of Dr. Marsden's patients published here for the first time. Comprehensively referenced and updated by experts from the Institute of Neurology at Queen Square, this book is a valuable reference for, not just movement disorder specialists and researchers, but also for clinicians who care for patients with movement disorders.
An Essay on the Shaking Palsy
Author: James Parkinson
Publisher:
ISBN:
Category : Parkinson's disease
Languages : en
Pages : 86
Book Description
Publisher:
ISBN:
Category : Parkinson's disease
Languages : en
Pages : 86
Book Description
Leucine-Rich Repeat Kinase 2 (LRRK2)
Author: Hardy J. Rideout
Publisher: Springer
ISBN: 3319499696
Category : Medical
Languages : en
Pages : 280
Book Description
This is the first book to assemble the leading researchers in the field of LRRK2 biology and neurology and provide a snapshot of the current state of knowledge, encompassing all major aspects of its function and dysfunction. The contributors are experts in cell biology and physiology, neurobiology, and medicinal chemistry, bringing a multidisciplinary perspective on the gene and its role in disease. The book covers the identification of LRRK2 as a major contributor to the pathogenesis of Parkinson's Disease. It also discusses the current state of the field after a decade of research, putative normal physiological roles of LRRK2, and the various pathways that have been identified in the search for the mechanism(s) of its induction of neurodegeneration.
Publisher: Springer
ISBN: 3319499696
Category : Medical
Languages : en
Pages : 280
Book Description
This is the first book to assemble the leading researchers in the field of LRRK2 biology and neurology and provide a snapshot of the current state of knowledge, encompassing all major aspects of its function and dysfunction. The contributors are experts in cell biology and physiology, neurobiology, and medicinal chemistry, bringing a multidisciplinary perspective on the gene and its role in disease. The book covers the identification of LRRK2 as a major contributor to the pathogenesis of Parkinson's Disease. It also discusses the current state of the field after a decade of research, putative normal physiological roles of LRRK2, and the various pathways that have been identified in the search for the mechanism(s) of its induction of neurodegeneration.
Levodopa pharmacokinetics -from stomach to brain
Author: Maria Nord
Publisher: Linköping University Electronic Press
ISBN: 9176855570
Category :
Languages : sv
Pages : 81
Book Description
Parkinson’s disease (PD) is one of the most common neurodegenerative disorders and it is caused by a loss of dopamine (DA) producing neurons in the basal ganglia in the brain. The PD patient suffers from motor symptoms such as tremor, bradykinesia and rigidity and treatment with levodopa (LD), the precursor of DA, has positive effects on these symptoms. Several factors affect the availability of orally given LD. Gastric emptying (GE) is one factor and it has been shown to be delayed in PD patients resulting in impaired levodopa uptake. Different enzymes metabolize LD on its way from the gut to the brain resulting in less LD available in the brain and more side effects from the metabolites. By adding dopa decarboxylase inhibitors (carbidopa or benserazide) or COMT-inhibitors (e.g. entacapone) the bioavailability of LD increases significantly and more LD can pass the blood-brain-barrier and be converted to DA in the brain. It has been considered of importance to avoid high levodopa peaks in the brain because this seems to induce changes in postsynaptic dopaminergic neurons causing disabling motor complications in PD patients. More continuously given LD, e.g. duodenal or intravenous (IV) infusions, has been shown to improve these motor complications. Deep brain stimulation of the subthalamic nucleus (STN DBS) has also been proven to improve motor complications and to make it possible to reduce the LD dosage in PD patients. In this doctoral thesis the main purpose is to study the pharmacokinetics of LD in patients with PD and motor complications; in blood and subcutaneous tissue and study the effect of GE and PD stage on LD uptake and the effect of continuously given LD (CDS) on LD uptake and GE; in blood and cerebrospinal fluid (CSF) when adding the peripheral enzyme inhibitors entacapone and carbidopa to LD infusion IV; in brain during STN DBSand during oral or IV LD treatment. To conclude, LD uptake is more favorable in PD patients with less severe disease and GE is delayed in PD patients. No obvious relation between LD uptake and GE or between GE and PD stage is seen and CDS decreases the LD levels. Entacapone increases the maximal concentration of LD in blood and CSF. This is more evident with additional carbidopa and important to consider in avoiding high LD peaks in brain during PD treatment. LD in brain increases during both oral and IV LD treatment and the DA levels follows LD well indicating that PD patients still have capacity to metabolize LD to DA despite probable pronounced nigral degeneration. STN DBS seems to increase putaminal DA levels and together with IV LD treatment also increases LD in brain possibly explaining why it is possible to decrease LD medication after STN DBS surgery. Parkinsons sjukdom (PS) är en av de vanligaste s.k. neurodegenerativasjukdomarna och orsakas av förlust av dopamin(DA)producerande nervceller i hjärnan. Detta orsakar motoriska symptom såsom skakningar, stelhet och förlångsammade rörelser. Levodopa (LD) är ett ämne, som kan omvandlas till DA i hjärnan och ge symptomlindring och det är oftast förstahandsval vid behandling av patienter med PS. Flera faktorer påverkar tillgängligheten av LD, bl.a. den hastighet som magsäcken tömmer sig med och denna verkar förlångsammad hos personer med PS vilket ger sämre tillgänglighet av LD i blodet och därmed i hjärnan. LD bryts även ner i hög grad av olika enzym ute i kroppen vilket leder till mindre mängd LD som hamnar i hjärnan och till fler nedbrytningsprodukter som orsakar biverkningar. Tillägg av enzymhämmare leder till ökad mängd LD som kan nå hjärnan och omvandlas till DA. Det anses viktigt att undvika höga toppar av LD i hjärnan då dessa verkar bidra till utvecklandet av besvärliga motoriska komplikationer hos patienter med PS. Om LD ges mer kontinuerligt, exempelvis som en kontinuerlig infusion in i tarmen eller i blodet, så minskar dessa motoriska komplikationer. Inopererande av stimulatorer i vissa delar av hjärnan (DBS) har också visat sig minska dessa motoriska komplikationer och även resultera i att man kan minska LD-dosen. Huvudsyftet med den här avhandlingen är att studera LD hos patienter med PS; i blod och fettvävnad då LD ges i tablettform och se om det finns något samband med LD-upptag och hastigheten på magsäckstömningen (MT) och om kontinuerligt given LD påverkar LD-upptaget eller MT; i blod och i ryggmärgsvätska då enzymhämmarna entakapon och karbidopa tillsätts LD; i hjärna vid behandling med DBS och då LD ges både som tablett och som infusion i blodet. Sammanfattningsvis kan vi se att LD-upptaget är mer gynnsamt hos patienter med PS i tidigare skede av sjukdomens komplikationsfas. MT är förlångsammad hos patienter med PS och det är inget tydligt samband mellan LD-upptag och MT eller mellan MT och sjukdomsgrad. Kontinuerligt given LD minskar LDnivåerna. Enzymhämmaren entakapon ökar den maximala koncentrationen av LD i blod och ryggmärgsvätska och effekten är mer tydlig vid tillägg av karbidopa vilket är viktigt att ta i beaktande vid behandling av PS för att undvika höga toppar av LD i hjärnan. LD ökar i hjärnan då man behandlar med LD i tablettform och som infusion i blodet och DA-nivåerna i hjärnan följer LD väl vilket visar på att patienter med PS fortfarande kan omvandla LD till DA trots trolig uttalad brist av de DA-producerande nervcellerna i hjärnan. DBS verkar öka DA i vissa områden i hjärnan och tillsammans med LD-infusion i blodet verkar det även öka LD i hjärnan och det kan förklara varför man kan sänka LDdosen efter DBS-operation.
Publisher: Linköping University Electronic Press
ISBN: 9176855570
Category :
Languages : sv
Pages : 81
Book Description
Parkinson’s disease (PD) is one of the most common neurodegenerative disorders and it is caused by a loss of dopamine (DA) producing neurons in the basal ganglia in the brain. The PD patient suffers from motor symptoms such as tremor, bradykinesia and rigidity and treatment with levodopa (LD), the precursor of DA, has positive effects on these symptoms. Several factors affect the availability of orally given LD. Gastric emptying (GE) is one factor and it has been shown to be delayed in PD patients resulting in impaired levodopa uptake. Different enzymes metabolize LD on its way from the gut to the brain resulting in less LD available in the brain and more side effects from the metabolites. By adding dopa decarboxylase inhibitors (carbidopa or benserazide) or COMT-inhibitors (e.g. entacapone) the bioavailability of LD increases significantly and more LD can pass the blood-brain-barrier and be converted to DA in the brain. It has been considered of importance to avoid high levodopa peaks in the brain because this seems to induce changes in postsynaptic dopaminergic neurons causing disabling motor complications in PD patients. More continuously given LD, e.g. duodenal or intravenous (IV) infusions, has been shown to improve these motor complications. Deep brain stimulation of the subthalamic nucleus (STN DBS) has also been proven to improve motor complications and to make it possible to reduce the LD dosage in PD patients. In this doctoral thesis the main purpose is to study the pharmacokinetics of LD in patients with PD and motor complications; in blood and subcutaneous tissue and study the effect of GE and PD stage on LD uptake and the effect of continuously given LD (CDS) on LD uptake and GE; in blood and cerebrospinal fluid (CSF) when adding the peripheral enzyme inhibitors entacapone and carbidopa to LD infusion IV; in brain during STN DBSand during oral or IV LD treatment. To conclude, LD uptake is more favorable in PD patients with less severe disease and GE is delayed in PD patients. No obvious relation between LD uptake and GE or between GE and PD stage is seen and CDS decreases the LD levels. Entacapone increases the maximal concentration of LD in blood and CSF. This is more evident with additional carbidopa and important to consider in avoiding high LD peaks in brain during PD treatment. LD in brain increases during both oral and IV LD treatment and the DA levels follows LD well indicating that PD patients still have capacity to metabolize LD to DA despite probable pronounced nigral degeneration. STN DBS seems to increase putaminal DA levels and together with IV LD treatment also increases LD in brain possibly explaining why it is possible to decrease LD medication after STN DBS surgery. Parkinsons sjukdom (PS) är en av de vanligaste s.k. neurodegenerativasjukdomarna och orsakas av förlust av dopamin(DA)producerande nervceller i hjärnan. Detta orsakar motoriska symptom såsom skakningar, stelhet och förlångsammade rörelser. Levodopa (LD) är ett ämne, som kan omvandlas till DA i hjärnan och ge symptomlindring och det är oftast förstahandsval vid behandling av patienter med PS. Flera faktorer påverkar tillgängligheten av LD, bl.a. den hastighet som magsäcken tömmer sig med och denna verkar förlångsammad hos personer med PS vilket ger sämre tillgänglighet av LD i blodet och därmed i hjärnan. LD bryts även ner i hög grad av olika enzym ute i kroppen vilket leder till mindre mängd LD som hamnar i hjärnan och till fler nedbrytningsprodukter som orsakar biverkningar. Tillägg av enzymhämmare leder till ökad mängd LD som kan nå hjärnan och omvandlas till DA. Det anses viktigt att undvika höga toppar av LD i hjärnan då dessa verkar bidra till utvecklandet av besvärliga motoriska komplikationer hos patienter med PS. Om LD ges mer kontinuerligt, exempelvis som en kontinuerlig infusion in i tarmen eller i blodet, så minskar dessa motoriska komplikationer. Inopererande av stimulatorer i vissa delar av hjärnan (DBS) har också visat sig minska dessa motoriska komplikationer och även resultera i att man kan minska LD-dosen. Huvudsyftet med den här avhandlingen är att studera LD hos patienter med PS; i blod och fettvävnad då LD ges i tablettform och se om det finns något samband med LD-upptag och hastigheten på magsäckstömningen (MT) och om kontinuerligt given LD påverkar LD-upptaget eller MT; i blod och i ryggmärgsvätska då enzymhämmarna entakapon och karbidopa tillsätts LD; i hjärna vid behandling med DBS och då LD ges både som tablett och som infusion i blodet. Sammanfattningsvis kan vi se att LD-upptaget är mer gynnsamt hos patienter med PS i tidigare skede av sjukdomens komplikationsfas. MT är förlångsammad hos patienter med PS och det är inget tydligt samband mellan LD-upptag och MT eller mellan MT och sjukdomsgrad. Kontinuerligt given LD minskar LDnivåerna. Enzymhämmaren entakapon ökar den maximala koncentrationen av LD i blod och ryggmärgsvätska och effekten är mer tydlig vid tillägg av karbidopa vilket är viktigt att ta i beaktande vid behandling av PS för att undvika höga toppar av LD i hjärnan. LD ökar i hjärnan då man behandlar med LD i tablettform och som infusion i blodet och DA-nivåerna i hjärnan följer LD väl vilket visar på att patienter med PS fortfarande kan omvandla LD till DA trots trolig uttalad brist av de DA-producerande nervcellerna i hjärnan. DBS verkar öka DA i vissa områden i hjärnan och tillsammans med LD-infusion i blodet verkar det även öka LD i hjärnan och det kan förklara varför man kan sänka LDdosen efter DBS-operation.
Recent Developments in Parkinson's Disease
Author: Stanley Fahn
Publisher:
ISBN:
Category : Medical
Languages : en
Pages : 412
Book Description
Publisher:
ISBN:
Category : Medical
Languages : en
Pages : 412
Book Description