| 1. |
- Rahne, Karl-Erik, et al.
(författare)
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Motor fluctuations and Helicobacter pylori in Parkinson's disease
- 2013
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Ingår i: Journal of Neurology. - : Springer Science and Business Media LLC. - 0340-5354 .- 1432-1459. ; 260:12, s. 2974-2980
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Tidskriftsartikel (refereegranskat)abstract
- The presence of Helicobacter pylori(HP) in the gastrointestinal tract may limit the absorption of levodopa.The objectives of this study were to investigate whether HPinfection may affect the clinical response to levodopa aswell as levodopa dose requirement in patients with Par-kinson’s disease (PD) as well as to investigate whether HPinfection may affect plasma levels of vitamin B12, folicacid, and homocysteine. Seventy-five patients with PDdiagnosed at least 4 years ago were included. Symptomfluctuations were assessed by UPDRS-IV and the WOQ9wearing-off-scale. Plasma levels of vitamin B12, folic acid,and homocysteine were analyzed. Screening for HP wasperformed with a 13C-labeled urea breath test (DiabactUBT). A propensity-matched analysis was made where each patient in the HP-infected group was matched withone patient in the non-infected group with respect to age and gender. Of the 75 included patients, 20 were HPinfected (27 %). Median Hoehn & Yahr scores were 3 inboth HP infected patients and the matched group (n=20).HP-infected patients had decreased ‘‘complications of therapy’’ with average total UPDRS-IV score of 4.8±3.0vs. 7.7±3.8 (p\0.05), despite no significant differencein levodopa equivalent dose. Wearing-off and sleep disturbance were significantly less common in the HP group(p\0.05). There were no differences regarding vitaminB12, folic acid, or homocysteine values. HP infection in patients with PD may result in a decreased occurrence of symptom fluctuations according to this small study. This finding may be due to altered absorption of levodopa in the gastrointestinal tract in patients with HP infection, but further studies are required
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| 2. |
- Thomas, Ilias, et al.
(författare)
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Sensor-based algorithmic dosing suggestions for oral administration of levodopa/carbidopa microtablets for Parkinson's disease : a first experience
- 2019
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Ingår i: Journal of Neurology. - : Springer Science and Business Media LLC. - 0340-5354 .- 1432-1459. ; 266:3, s. 651-658
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: Dosing schedules for oral levodopa in advanced stages of Parkinson's disease (PD) require careful tailoring to fit the needs of each patient. This study proposes a dosing algorithm for oral administration of levodopa and evaluates its integration into a sensor-based dosing system (SBDS).MATERIALS AND METHODS: In collaboration with two movement disorder experts a knowledge-driven, simulation based algorithm was designed and integrated into a SBDS. The SBDS uses data from wearable sensors to fit individual patient models, which are then used as input to the dosing algorithm. To access the feasibility of using the SBDS in clinical practice its performance was evaluated during a clinical experiment where dosing optimization of oral levodopa was explored. The supervising neurologist made dosing adjustments based on data from the Parkinson's KinetiGraph™ (PKG) that the patients wore for a week in a free living setting. The dosing suggestions of the SBDS were compared with the PKG-guided adjustments.RESULTS: The SBDS maintenance and morning dosing suggestions had a Pearson's correlation of 0.80 and 0.95 (with mean relative errors of 21% and 12.5%), to the PKG-guided dosing adjustments. Paired t test indicated no statistical differences between the algorithmic suggestions and the clinician's adjustments.CONCLUSION: This study shows that it is possible to use algorithmic sensor-based dosing adjustments to optimize treatment with oral medication for PD patients.
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| 3. |
- Volkmann, J, et al.
(författare)
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Selecting deep brain stimulation or infusion therapies in advanced Parkinson's disease : an evidence-based review
- 2013
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Ingår i: Journal of Neurology. - : Springer Science and Business Media LLC. - 0340-5354 .- 1432-1459. ; 260:11, s. 2701-2714
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Tidskriftsartikel (refereegranskat)abstract
- Motor complications in Parkinson’s disease (PD) result from the short half-life and irregular plasma fluctuations of oral levodopa. When strategies of providing more continuous dopaminergic stimulation by adjusting oral medication fail, patients may be candidates for one of three device-aided therapies: deep brain stimulation (DBS), continuous subcutaneous apomorphine infusion, or continuous duodenal/jejunal levodopa/carbidopa pump infusion (DLI). These therapies differ in their invasiveness, side-effect profile, and the need for nursing care. So far, very few comparative studies have evaluated the efficacy of the three device-aided therapies for specific motor problems in advanced PD. As a result, neurologists currently lack guidance as to which therapy could be most appropriate for a particular PD patient. A group of experts knowledgeable in all three therapies reviewed the currently available literature for each treatment and identified variables of clinical relevance for choosing one of the three options such as type of motor problems, age, and cognitive and psychiatric status. For each scenario, pragmatic and (if available) evidence-based recommendations are provided as to which patients could be candidates for either DBS, DLI, or subcutaneous apomorphine.
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