How People Living with Parkinson's Disease in Four European Countries View Occupational Therapy

Jelka Jansa¹, Ana Aragon² and Åsa Lundgren-Nilsson³

Affiliations: ¹Neurologic Clinic, University Medical Centre Ljubljana, Zaloska 2, 1000 Ljubljana, Slovenia; ²Faculty of Health and Social Sciences, Leeds Metropolitan University, Leeds, UK and ³Department of Clinical Neuroscience and Rehabilitation, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden

Correspondence: Jelka Jansa, Neurologic Clinic, University Medical centre Ljubljana, Zaloska 2, 1000 Ljubljana, Slovenia. e-mail: jelka.jansa@siol.net

INTRODUCTION

People with Parkinson's disease (Parkinson's) experience diverse symptoms that impact on many aspects of daily life. Occupational therapy (OT) aims to optimize independence, coping, and social participation and can make a valuable contribution to management of the condition.

METHOD

A prospective study was undertaken using an anonymous, open Web-based questionnaire, devised to explore the experiences and opinions of OT among a group of people living with Parkinson's in Norway, Slovenia, Sweden, and the United Kingdom.

RESULTS

The views of 230 respondents with many of the typically recognized demographic and clinical features of Parkinson's populations were collected. The need for help in daily life was commonly reported, encompassing activities related to self-care, productivity, and leisure. Approximately half the people surveyed (54%) reported having seen an occupational therapist since their diagnosis. The location, frequency, and duration of interventions varied considerably between the four countries. The content of OT was diverse and included assistance for using arms and hands, carrying out daily activities, and concerned receipt of advice about aids, equipment, environmental adaptations, further support and services, and education about Parkinson's. Among the people who had received OT, there was a high level of consensus that they would recommend it to others with Parkinson's.

CONCLUSION

In this sample, differences in OT services for people with Parkinson's were reported. Where OT services were received, it was seen as an important intervention. Further studies with a larger sample and involving more countries are needed to verify and build-on these findings.

Common Neurological Alterations of the Dentato-Rubro-Olivary Pathway (Guillain–Mollaret Triangle) in Different Pathological Fields: From Palatal Myoclonus to Sudden Unexplained Fetal and Infant Death—A Possible Interpretation

Affiliation: Department of Surgical, Reconstructive and Diagnostic Sciences, “Lino Rossi” Research Center for the study and prevention of sudden perinatal death and SIDS, University of Milan, Milan, Italy Fondazione IRCCS Cà Granda – Ospedale Maggiore Policlinico, Milan, Italy

Correspondence: Anna M. Lavezzi, Department of Surgical, Reconstructive and Diagnostic Sciences, “Lino Rossi” Research Center, University of Milan, Via della Commenda 19, 20122 Milan, Italy. Tel: +39-02-50320821; Fax: +39-02-50320823; e-mail: anna.lavezzi@unimi.it

ABSTRACT

We discussed the anatomy and the developmental alterations of a neuronal circuit, already implied in the pathogenesis of the palatal myoclonus, and connecting the dentate nucleus in the cerebellum with the red nucleus and the inferior olivary nucleus in the brainstem, in the context of our findings obtained in a wide set of sudden intrauterine unexplained death (SIUD) and sudden infant death syndrome (SIDS). We observed high incidence of developmental alterations (hypoplasia, hyperplasia, and high c-fos neuronal immunopositivity) of the three nuclei in both SIDS and SIUD, frequently associated to serotonergic abnormalities and to maternal smoking in pregnancy. We underlined the likeness of these neurological abnormalities with the neuropathologic picture marking the palatal myoclonus. We concluded that the network connecting the dentate, the red, and the inferior olivary nuclei is involved in the pathogenesis of a wide spectrum of manifestations, which, even if quite different, can be ascribed to a defective muscular contraction, frequently triggered from hypoxic conditions. Wrong contraction of eye, face, and throat muscles can lead to palatal myoclonus; wrong contracture of the upper airway muscles can be involved in the pathogenetic mechanism of the sudden fetal death and sudden infant death in the first months of life.

Efficacy and Tolerability of a Combination Treatment of Memantine and Donepezil for Alzheimer's Disease: A Literature Review Evidence

Mario Riverol^1,3, Andrea Slachevsky^4,5 and Oscar L. López^1,2

Affiliations: ¹Department of Neurology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA ²Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA ³Department of Neurology, Clínica Universidad de Navarra, Pamplona, Spain ⁴Unidad de Neurología Cognitiva y Demencia, Servicio de Neurología, Hospital del Salvador. Facultad de Medicina Universidad de Chile, Santiago, Chile ⁵Servicio de Neurologia, Clínica Alemana, Santiago, Chile

Correspondence: Mario Riverol, University of Pittsburgh School of Medicine, Oxford Building, Suite 830, 3501 Forbes Avenue, Pittsburgh, PA 15213, USA. e-mail: riverolm@upmc.edu

INTRODUCTION

Two types of drugs have been approved for the symptomatic treatment of Alzheimer's disease (AD): the cholinesterase inhibitors (ChEIs) and memantine. There is a growing interest to know whether the combination of these drugs is safe and if it adds any clinical benefit to patients.

OBJECTIVE

To systematically review published medical literature assessing the efficacy and tolerability of a combination treatment of memantine and donepezil in AD patients.

METHODS

We searched PubMed for English and Spanish-language literature, using the terms “Alzheimer′s disease,” “cholinesterase inhibitors,” “donepezil,” and “memantine.” Our review focused on clinical trials and observational studies.

RESULTS

Eleven publications representing seven unique studies were selected for this review. Three were randomized double-blind, placebo-controlled trials and four were observational studies.

CONCLUSIONS

Available data revealed that the combination of memantine and donepezil slowed down cognitive decline, prolonged functional independence, and improved behavioral symptoms in patients with moderate to severe AD. The long-term use of the dual therapy decreased the risk of nursing home admission. More longitudinal studies are needed to further examine the role of combined therapy in the management of AD patients.

Different Dyskinesias in Parkinson's Disease and Their Relationship to Levodopa

Clare Loane, Paul Su and Marios Politis

Affiliation: Centre for Neuroscience, Division of Experimental Medicine, Faculty of Medicine and Neurology Group, Clinical Sciences Centre, Medical Research Council, Hammersmith Hospital, Imperial College London, London, UK

Correspondence: Marios Politis, Hammersmith Hospital, DuCane Road London W12 0NN, UK; Tel: +44 020 8383 3751; Fax: +44 020 8383 1783; e-mail: marios.politis@imperial.ac.uk

ABSTRACT

Levodopa is the principal agent in the treatment of Parkinson's disease (PD). Unfortunately the therapeutic benefits are optimal only in the early stages of the disease, with long-term use associated with motor complications such as levodopa-induced dyskinesia (LID). Risk factors associated with the development of LID are generally accepted to involve the degree of dopamine (DA) denervation in the nigrostriatal pathway, levodopa dose, and duration of levodopa treatment. Little is known regarding the underlying mechanisms of LID, although it is known that levodopa plasma concentrations are closely associated with the onset of some types of LIDs (peak-dose and biphasic dyskinesias) and it appears that increased DA turnover plays a crucial role in LID development. Recent evidence suggests that other cell types such as serotonin neurons possess the ability to convert levodopa into DA, subsequently storing and releasing it thereby increasing the levels of extracellular DA, exacerbating LID. This review will highlight the evidence to date from in vitro and in vivo studies utilizing both animal models and patients, regarding the relationship between levodopa treatment and the development of LID. Understanding the pathogenesis of LID is a therapeutic priority in tackling motor complications related to levodopa treatment in PD.

Differential Diagnosis of Longitudinally Extensive Transverse Myelitis in Adults

Christopher Eckstein, Stephanie Syc and Shiv Saidha

Affiliation: Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA

Correspondence: Dr Shiv Saidha, Department of Neurology, Johns Hopkins University School of Medicine, Pathology 627, 600 North Wolfe Street, Baltimore, MD 21287, USA. Tel: +1-4106141653; Fax: +1-4105026736; e-mail: ssaidha2@jhmi.edu

ABSTRACT

Longitudinally extensive transverse myelitis (LETM), characterized by spinal cord inflammation extending three or more vertebral segments in length, may be caused by a multitude of disorders. LETM is most commonly associated with neuromyelitis optica (NMO). Such is the frequent association between these two entities that there is a growing tendency amongst physicians to regard them as being practically synonymous with each other. The objective of this review is to highlight the wide range of disorders that may cause LETM and to emphasize the need to carefully consider all potential etiologies in the assessment of LETM. In particular, we focus on the salient clinical, laboratory, and radiographic features of these various disorders, which help them to be differentiated from one another.

Aspirin-Associated Intracerebral Hemorrhage: Risk Factors and Management

Jung-Hwan Oh¹ and Jay Chol Choi²

Affiliations: ¹Department of Neurology, Cheju Halla General Hospital, and ²Department of Neurology and Cerebrovascular Center, Jeju National University,
Jeju, Korea

Correspondence: Jay Chol Choi, MD, PhD, Department of Neurology, Jeju National University Hospital, 1753-3 Ara-dong, Jeju-si, Jeju-do, 690-767, Korea. Tel: +82-70-7791-3233; Fax: +82-64-717-1109; e-mail: iguazzu@hanmail.net

ABSTRACT

Aspirin therapy has been shown to be associated with an increased risk of bleeding, such as intracerebral hemorrhage (ICH), in both primary and secondary prevention trials. Suggested risk factors for aspirin-associated ICH are advanced age, Asian or African American ethnicity, head trauma, epistaxis, cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy, cerebral amyloid angiopathy, combination antiplatelet therapy, concurrent anticoagulation, and presence of cerebral microbleeds on brain magnetic resonance imaging. Aspirin-associated ICH is associated with lobar or cerebellar location, increased hematoma growth, and increased mortality, compared with ICH that occurs without antiplatelet therapy. Currently, there are no specific clinical guidelines for management of aspirin-associated ICH. Patients should be managed according to clinical guidelines for management of spontaneous ICH. Physicians should always consider both the benefits and the risks of using aspirin for patients with risk factors for the development of ICH.

Intracranial Hypotension Mimicking Cervical Radiculopathy

Enrico Ferrante¹, Dante Facchetti¹, Ines Arpino², Pietro Tiraboschi¹, and Alberto Citterio¹

Affiliations: ¹Neurosciences and Anaesthesiology Departments, Niguarda Ca’ Granda Hospital, Milan, Italy and ²Anaesthesiology Departments, Niguarda Ca’ Granda Hospital, Milan, Italy

Correspondence: Enrico Ferrante, Divisione di Neurologia Ospedale Niguarda Cà Granda, Piazza Ospedale Maggiore, 3-20162 Milan, Italy. e-mail: enricoferrante@libero.it

ABSTRACT

Intracranial hypotension typically presents with an orthostatic headache, often with one or more of the following symptoms: nausea, vomiting, change in hearing, diplopia, blurred vision, and neck pain. Rarely it presents with upper limb numbness, paresthesias, and aches. We report the case of a 35-year-old man who—after a polytrauma car accident—had an orthostatic headache, diplopia, and bilateral muffled hearing. After 7 months he started presenting progressive weakness of the right upper limb and atrophy mainly of the right deltoid, biceps and triceps muscles, and milder weakness of the right forearm and left arm muscles without pain or loss of sensation. A neurophysiological examination showed marked neurogenic impairment in muscles of C5–C6 and C7 bilaterally suggestive of motor cervical radiculopathy. A spine MRI revealed an epidural CSF collection at the cervico-thoracic junction and a CT myelography revealed an extravasation of contrast medium at the same level. The man was diagnosed with an intracranial hypotension form of cervical CSF leakage by dural tear and a lumbar autologous epidural blood patch was performed with a progressive, albeit partial, improvement of the motor impairment during the following 24 months. Pure motor cervical radiculopathy with spinal amyotrophy is yet another mode of the still broadening clinical presentation of intracranial hypotension syndrome.