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- Timpka, Jonathan, et al.
(författare)
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Device-Aided Treatment Strategies in Advanced Parkinson's Disease
- 2017
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Ingår i: International Review of Neurobiology. - : Elsevier. - 0074-7742. ; 132, s. 453-474
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Tidskriftsartikel (refereegranskat)abstract
- With peroral levodopa treatment, a majority of patients develop motor fluctuations and dyskinesia already within a few years of therapy. Device-aided Parkinson (PD) therapies refer to deep brain stimulation (DBS), levodopa-carbidopa intestinal gel infusion (LCIG), and subcutaneous infusion of the dopamine agonist apomorphine and represent effective strategies counteracting motor fluctuations and dyskinesia. These three therapy options seem to be similarly effective in reducing "time with PD symptoms (off time)" by at least 60%-65%. The use of advanced therapy also leads to a significant reduction of dyskinesia. Recent studies also indicate that these therapies can improve a number of nonmotor symptoms in advanced PD. Altogether this results in an improved health-related quality of life in most treated patients. The side effects and complications are quite different between the three; for DBS, serious adverse events include intracranial bleeding and infection, LCIG complications relate to the infusion equipment and the establishment of the percutaneous endoscopic gastrostomy, while for apomorphine infusion the most common side effect is a formation of noduli (local inflammation) at the point of infusion. The device-aided therapies are all indicated for the treatment of motor fluctuations and/or dyskinesia when peroral/transdermal PD medications cannot be further optimized. However, the choice of device-aided therapy is made on basis of indications/contraindications, but also the patients' symptom profile and his/her personal preferences. Therefore, it is important these treatments are discussed early, well before motor and nonmotor symptoms have deteriorated excessively.
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| 2. |
- Timpka, Jonathan, et al.
(författare)
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Etiology and pathogenesis of parkinson’s disease
- 2017
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Ingår i: Movement Disorders Curricula. - Vienna : Springer Vienna. - 9783709116272 - 9783709116289 ; , s. 95-101
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Bokkapitel (refereegranskat)abstract
- The etiology of Parkinson’s disease (PD) is still far from fully known. In the new millennium, an increased knowledge of the genetic forms of PD has contributed to an improved understanding of underlying cellular mechanisms that are central also in sporadic PD. Although steadily improving, the challenge to fully understand the origin, function, and consequences of Lewy bodies still remains. Toxicological or viral exposure has been hypothesized to function as stressors that, together with a genetic susceptibility, precipitate the development of PD. Meanwhile the impact of these environmental factors is somewhat controversial, it is clear that old age is the single most important risk factor for PD. The improved access to molecular genetic methods has, as in many fields of medicine, reformed PD research, and this is likely where the most significant progress will be made in the near future. Due to the heterogeneous clinical features within the PD entity and the similarities to several closely related diseases, it is reasonable to take into consideration that what is today defined as PD may not be one disease, but rather several diseases with similar clinical features.
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| 3. |
- Timpka, Jonathan, et al.
(författare)
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Workforce unavailability in Parkinson's disease
- 2017
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Ingår i: Acta Neurologica Scandinavica. - : Hindawi Limited. - 0001-6314 .- 1600-0404. ; 135:3, s. 332-338
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: Individuals with Parkinson's disease (PD) become unavailable in the workforce earlier than comparable members of the general population. This may result in significant social insurance expenses, but as workforce participation can be a source for social interaction and a vital part of the personal identity, there are likely to be personal implications extending far beyond the economic aspects. This study aimed to identify aspects that may contribute to workforce unavailability in people with PD. Materials & methods: This was a cross-sectional registry study using data from the Swedish national quality registry for PD and included persons with PD in Skåne County, Sweden who were younger than 65 years. Variables were selected from the registry based on earlier studies and clinical experience and were tested for association with unavailability in the workforce: first in a series of simple regression analyses and then in a multiple logistic regression analysis. Results: A total of 99 persons with PD-of whom 59 were available and 40 were unavailable in the workforce-were included in the study. Age (OR per year: 1.47, 95% CI: 1.18-1.85; P <0.01) and anxiety (OR: 6.81, 95% CI: 1.20-38.67; P = 0.03) were significant contributing factors for unavailability in the workforce. Conclusions: Based on the findings in this exploratory study, anxiety-a potentially modifiable factor-and age may be contributing factors for workforce unavailability in PD. However, prospective studies are warranted to confirm the findings and the causation of the association between anxiety and workforce unavailability needs to be clarified.
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