| 1. |
|
|
| 2. |
- Moro, Elena, et al.
(författare)
-
Long-Term Results of a Multicenter Study on Subthalamic and Pallidal Stimulation in Parkinson's Disease
- 2010
-
Ingår i: Movement Disorders. - : Wiley. - 0885-3185. ; 25:5, s. 578-586
-
Tidskriftsartikel (refereegranskat)abstract
- We report the 5 to 6 year follow-up of a multicenter study of bilateral subthalamic nucleus (STN) and globus pallidus internus (GPi) deep brain stimulation (DBS) in advanced Parkinson's disease (PD) patients. Thirty-live STN patients and 16 GPi patienis were assessed at 5 to 6 years after DBS surgery. Primary outcome measure was the stimulation effect on the motor Unified Parkinson's Disease Rating Scale (UPDRS) assessed with a prospective cross-over double-blind assessment without medications (stimulation was randomly switched on or off). Secondary outcomes were motor UPDRS changes with unblinded assessments in off- and on-medication states with and without stimulation, activities of daily living (ADL), anti-PD medications, and dyskinesias. In double-blind assessment, both STN and GPi DBS were significantly effective in improving the motor UPDRS scores (STN. P < 0.0001, 45.4%; GPi, P = 0.008, 20.0%) compared with of regardless of the sequence of stimulation. In open assessment. both STN- and GPi-DBS significantly improved the off-medication motor UPDRS when compared with before surgery (STN. P < 0.001, 50.5%; GPi, P = 0.002, 35.6%). Dyskinesias and ADL were significantly improved in both groups. Anti-PD medications were significantly reduced only in the STN group. Adverse events were more frequent in the STN group. These results confirm the long-term efficacy of STN and GPi DBS advanced PD. Although the surgical targets were not randomized, there was a trend to 1 better outcome of motor signs in the STN-DBS patients and fewer adverse events in the GPi-DBS group. (C) 2010 Movement Disorder Society
|
|
| 3. |
- Volkmann, Jens, et al.
(författare)
-
Long-Term Effects of Pallidal or Subthalamic Deep Brain Stimulation on Quality of Life in Parkinson's Disease
- 2009
-
Ingår i: Movement Disorders. - : Wiley. - 0885-3185. ; 24:8, s. 1154-1161
-
Tidskriftsartikel (refereegranskat)abstract
- We assessed the effects of deep brain stimulation of the subthalamic nucleus (STN-DBS) or internal pallidum (GPi-DBS) on health-related quality of life (HrQoL) in patients with advanced Parkinson's disease participating in a previously reported multicenter trial. Sickness Impact Profile (SIP) questionnaires were available for analysis in a Subgroup of n = 20/20 patients with GPi-DBS and n = 45/49 patients with STN-DBS at baseline, 6 and 36 months. The SIP provides a physical dimension and a psychosocial dimension sum score and 12 category scores: Alertness/Intellectual Behavior (AIB), Ambulation (A), Body Care and Movement (BCM), Communication (C), Eating (E), Emotional Behavior (EB), Home Management (HM), Mobility (M), Recreation and Pastimes (RP), Sleep and Rest (SR), Social Interaction (SI), and Work (W). Motor functioning was assessed by means of the Unified Parkinson's Disease Rating Scale and diaries. At 6 months significant improvements in off-period motor symptoms and activities of daily living were paralleled by significant reductions in the total, physical, and psychosocial SIP score in both treatment groups. At 3 years, sustained improvements were observed in the physical dimension score, BCM, E, M, RP after STN-DBS and M, SI after GPi-DBS. All other SIP subscores approached baseline values, but were still the same or better (except C) whereas motor functioning remained stable after 36 months. STN-DBS and GPi-DBS led to significant early improvements in HrQoL. Despite sustained motor improvements many of these initial benefits were lost after 3 years. This may reflect either progression of the disease or adaptive changes in the subjective perception of health-related wellbeing over time. (C) 2009 Movement Disorder Society
|
|
| 4. |
- Bergstedt, Johan, et al.
(författare)
-
Förändringar i Eklandskapet 1927 till 2013: i den första riksskogstaxeringens fotspår
- 2017
-
Ingår i: Svensk Botanisk Tidskrift. - 0039-646X. ; 111:6, s. 331-343
-
Tidskriftsartikel (refereegranskat)abstract
- Transects covering 90 km inan area south of Linköping in the province of Östergötland, SE Sweden, were relocated and reinventoried in 2013 using the same methodology as in the first national forest inventory of 1927. Data for land-use, forest type and species-specific tree sizes were obtained and compared with values from 1927. The results show that arable fields and pastures have decreased, while forests and areas covered by roads etc. have increased considerably. Picea abies has increased more than Pinus sylvestris. The reasons for the changes are discussed.
|
|
| 5. |
- Hagell, Peter, et al.
(författare)
-
Testing the SF-36 in Parkinson's disease : Implications for reporting rating scale data.
- 2008
-
Ingår i: Journal of Neurology. - : Springer Science and Business Media LLC. - 1432-1459 .- 0340-5354. ; 255:2, s. 246-254
-
Tidskriftsartikel (refereegranskat)abstract
- Rating scales are increasingly the primary outcome measures in clinical trials. However, clinically meaningful interpretation of such outcomes requires that the scales used satisfy basic requirements (scaling assumptions) within the data. These are rarely tested. The SF-36 is the most widely used patient-reported rating scale. Its scaling assumptions have been challenged in neurological disorders but remain untested in Parkinson's disease (PD).We therefore tested these by analyzing SF-36 data from 202 PD patients (54% men; mean age 70) to determine if it was legitimate to report scores for the eight SF-36 scales and its two summary measures of physical and mental health, and if those scores were reliable and valid. Results supported generation of the eight SF-36 scale scores and their reliabilities were generally good (>/= 0.74 in all but one instance). However, we found limitations that question the meaningfulness of four scales and other limitations that restrict the ability of four scales to detect change in clinical trials (floor/ceiling effects, 19.6-46.2 %). The two SF-36 summary measures were not found to be valid indicators of physical and mental health. This study demonstrates important limitations of the SF-36 and provides the first evidence- based guidelines for its use in PD. The limitations of the SF-36 demonstrated here may explain some unexpected findings in previous studies. However, the main implication is a general one for the clinical research community regarding requirements for reporting rating scale endpoints. Specifically, investigators should routinely provide scale evaluations based on data from within major clinical trials.
|
|
| 6. |
|
|
| 7. |
|
|
| 8. |
- Puschmann, Andreas, et al.
(författare)
-
First neuropathological description of a patient with Parkinson's disease and LRRK2 p.N1437H mutation.
- 2012
-
Ingår i: Parkinsonism & Related Disorders. - : Elsevier BV. - 1873-5126 .- 1353-8020. ; 18:4, s. 332-338
-
Tidskriftsartikel (refereegranskat)abstract
- The c.4309A>C mutation in the LRRK2 gene (LRRK2 p.N1437H) has recently been reported as the seventh pathogenic LRRK2 mutation causing monogenic Parkinson's disease (PD). So far, only two families worldwide have been identified with this mutation. By screening DNA from seven brains of PD patients, we found one individual with seemingly sporadic PD and LRRK2 p.N1437H mutation. Clinically, the patient had levodopa-responsive PD with tremor, and developed severe motor fluctuations during a disease duration of 19 years. There was severe and painful ON-dystonia, and severe depression with suicidal thoughts during OFF. In the advanced stage, cognition was slow during motor OFF, but there was no noticeable cognitive decline. There were no signs of autonomic nervous system dysfunction. Bilateral deep brain stimulation of the subthalamic nucleus had unsatisfactory results on motor symptoms. The patient committed suicide. Neuropathological examination revealed marked cell loss and moderate alpha-synuclein positive Lewy body pathology in the brainstem. There was sparse Lewy pathology in the cortex. A striking finding was very pronounced ubiquitin-positive pathology in the brainstem, temporolimbic regions and neocortex. Ubiquitin positivity was most pronounced in the white matter, and was out of proportion to the comparatively weaker alpha-synuclein immunoreactivity. Immunostaining for tau was mildly positive, revealing non-specific changes, but staining for TDP-43 and FUS was entirely negative. The distribution and shape of ubiquitin-positive lesions in this patient differed from the few previously described patients with LRRK2 mutations and ubiquitin pathology, and the ubiquitinated protein substrate remains undefined.
|
|
| 9. |
|
|
| 10. |
- Törnqvist, Anna Lena
(författare)
-
Deep Brain Stimulation in Parkinson's disease and essential tremor Outcome and experiences from patients' and spouses' perspectives
- 2005
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The treatment related effects and personalized goal fulfilment of Deep Brain Stimulation (DBS) have been assessed in studies with different designs. The brain targets included the thalamus for medically intractable tremor in Parkinson's disease (PD) or essential tremor (ET) and the subthalamicus for reducing hypo-, bradykinesia, tremor, rigidity and dystonia in PD. A Swedish multi-center study showed that the tremor reduction in PD and ET was sustained (p<0.025) for 6 to 7 years. Thalamic and subthalamic DBS also improved the patients? everyday life at a 12-month follow-up. Patients could perform activities they had pre-operatively formulated as goals, with a total or partial overall fulfilment. In spite of a 53% drug reduction, the patients treated with subthalamic DBS could perform basic transfers in a similar speed as pre-operatively and perceived improved health. The effect of subthalamic DBS on the intelligibility of speech showed that the DBS settings were of importance for the speech. Higher amplitude and faster rates increased the risk of impaired intelligibility in patients with PD who perceived speech impairments. Subthalamic DBS had a positive influence on the couples? social life. In contrast to pre-operatively, patients and spouses could perform social activities of their own choice. Non-motor symptoms that were pre-operatively just mentioned caused annoyance in the post-operative period. These remaining symptoms were preferred relative to the pre-operative PD condition. The results of these studies can be used in pre-operative information for future patients, as well as in the post-operative support of the patients and their spouses.
|
|
