Because of availability in the UK, there is a higher use of apomorphine infusion compared with centres in North America.
The main alternative for such advanced patients in centres where apomorphine infusion is not widely adopted is surgical treatment. Unified Parkinsona€™s Disease Rating Scale (UPDRS part III).13 The same observer preformed all assessments. Effect of bilateral STN DBS on UPDRS part II activities of daily living (ADL) and part III subscores, both on and off medication. In keeping with other studies, there was an overall reduction in medication postoperatively. Bilateral STN DBS also resulted in a significant reduction in off period motor fluctuations by 46.2%. No formal cognitive testing was performed in this series but median MMSE score was unchanged.
The help of Dr Rhys Davies, Dr Richard Nicholas and the staff on the Walton Centre clinical trials unit is gratefully appreciated.
We will be provided with an authorization token (please note: passwords are not shared with us) and will sync your accounts for you. The aim of this study was to identify changes of sleep spindles (SS) in the EEG of patients with Parkinson's disease (PD). Parkinson's disease (PD) is a neurodegenerative disorder (NDD) characterized primarily by motor symptoms, including bradykinesia, rigidity, postural instability, and tremor. In this study, we aimed to identify changes in SS density and specific morphological characteristics of SS in patients with PD.
Polysomnographic (PSG) EEG data from 15 patients with PD and 15 sex- and age-matched control subjects with no history of movement disorder, dream-enacting behavior or other previously diagnosed sleep disorders were included in this study. For each subject, eight blocks of five consecutive epochs of non-REM sleep stage 2 (N2) of 30-s duration were selected randomly from the PSG recording in between lights off and lights on. The final SS identifications used for morphology measures were defined using the group consensus rule described in Warby et al.
Median total UPDRS off medication was 120 (range 109a€“157) and on treatment was 66 (range 53a€“94).
This finding has been previously noted and discussed by other centres.16,17 Dyskinesia reduction after bilateral STN DBS is thought to be primarily attributable to a concomitant reduction in medication. Double-blind evaluation of subthalamic nucleus deep brain stimulation in advanced Parkinsona€™s disease.
Chronic subthalamic nucleus stimulation reduces medication requirements in Parkinsona€™s disease.
Levodopa withdrawal after bilateral subthalamic nucleus stimulation in advanced Parkinson disease.
Accuracy of clinical diagnosis of idiopathic Parkinsona€™s disease: a clinico-pathological study of 100 cases.


Clinical rating of dyskinesias in Parkinsona€™s disease: use and reliability of a new rating scale.
Deep-brain stimulation of the subthalamic nucleus or the pars interna of the globus pallidus in Parkinsona€™s disease. Effect of subthalamic nucleus stimulation on levodopa-induced dyskinesia in Parkinsona€™s disease. Neuropsychological consequences of chronic bilateral stimulation of the subthalamic nucleus in Parkinsona€™s disease. Neural mechanisms underlying parkinsonian symptoms based upon regional uptake of 2-deoxyglucose in monkeys exposed to 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine. This means that you will not need to remember your user name and password in the future and you will be able to login with the account you choose to sync, with the click of a button. This page doesn't support Internet Explorer 6, 7 and 8.Please upgrade your browser or activate Google Chrome Frame to improve your experience. Five sleep experts manually identified SS at a central scalp location (C3-A2) in 15 PD and 15 age- and sex-matched control subjects. Although the disease process in PD is not restricted to a specific brain area, these symptoms are mostly caused by the loss of dopaminergic neurons in the substantia nigra pars compacta resulting in a reduction or depletion of dopamine (Galvin et al., 2001). Stating the presence of at least two of the four motor symptoms resting tremor, bradykinesia, rigidity, and postural imbalance typically makes the clinical diagnosis of PD, although it has been indicated that the pathological changes in the striatal dopaminergic system develop several years before the clinical appearance of PD.
Since five sleep experts identified SS independently, we were also able to assess inter-expert variation of SS identification in EEG of patients and controls. The subjects were all recruited from the Danish Center for Sleep Medicine (DCSM) in the Department of Clinical Neurophysiology, Glostrup University Hospital in Denmark. The program mimics a standard sleep scoring program in a clinical setting, and includes the standard features so the experts have the same opportunities to view and navigate the PSG data as they are used to when analyzing sleep in the clinic.
Las caracteristicas patologicas incluyen perdida de las neuronas que contienen melanina de la sustancia nigra y de otros nucleos pigmentados del tallo cerebral. Each SS was given a confidence score, and by using a group consensus rule, 901 SS were identified and characterized by their (1) duration, (2) oscillation frequency, (3) maximum peak-to-peak amplitude, (4) percent-to-peak amplitude, and (5) density. Lewy body aggregations of alpha-synuclein in the brain are a central feature of PD pathology (Galvin et al., 2001).
The diagnosis of RBD requires complaints or an anamnesis describing dream enactment behaviors as well as a manifestation of REM sleep without atonia (RSWA) as measured by polysomnography (PSG) (Stevens and Comella, 2013; American Academy of Sleep Medicine, 2014). A di-synaptic circuit between thalamic reticular neurons and thalamocortical relay cells, both located in the thalamus, can spontaneously generate spindle-like oscillations, which are conveyed to the cortex by the axons of the thalamocortical relay cells.
By identifying specific changes in SS characteristics, we aimed to better understand the mechanism and to what extent the neurodegenerative progress influences SS characteristics, also identifying specific spindle features that may be useful as prognostic biomarkers of disease.
All patients were evaluated by a movement specialist with a comprehensive medical and medication history and a PSG analyzed according to the American Academy of Sleep Medicine (AASM) standard (Iber et al., 2007).
One-by-one and in the prioritized order, the blocks were visually checked for major movements or other contaminating artifacts.


Spindle identifications from five different experts with weighted confidence scores for each SS were averaged at each sample point and aggregated into a single consensus. Los cuerpos de lewy estan presentes en la sustancia nigra y en el locus coeruleus y puede tambien encontrarse en una afeccion relacionada (enfermedad DEL CUERPO DE LEWY, DIFUSA) caracterizada por demencia en combinacion con grados variables de parkinsonismo. Between-group comparisons were made for all SS characteristics computed, and significant changes for PD patients vs. These inclusions typically start in caudal areas of the brain and progress anteriorly (Braak et al., 2003), and may take place years prior to involvement of the substantia nigra and associated development of motor symptoms. The idiopathic form of RBD (iRBD) is diagnosed when no concurrent neurological disease is found, and International classification of Sleep Disorders criteria for RBD are met (Stevens and Comella, 2013; American Academy of Sleep Medicine, 2014). A secondary aim was to help guide the specialized development of automatic SS detectors to be used on EEG from patients with NDDs.
The diagnostic certainty for PD at Danish neurological departments has been reported to be 82% (Wermuth et al., 2012). Sample points that had an average score of higher than the group consensus threshold Tgc = 0.25 were included in the final group consensus, and the morphology measures were computed on these group consensus SS.
None of the PD patients had dementia at inclusion, but one of the patients with PD later developed Multiple System Atrophy (MSA), indicated as the Parkinsonian type (MSA-P) as the patient had predominating PD-like symptoms.
A total of five independent sleep experts identified SS in these blocks, where only the C3-A2 EEG derivation was visible.
Specifically, SS density was lower, duration was longer, oscillation frequency slower and maximum peak-to-peak amplitude higher in patients vs.
Stage 1 and 2 were considered as pre-Parkinsonian states, stage 3 and 4 as Parkinsonian states and 5 and 6 as late-Parkinsonian states (Braak et al., 2003). SS have been reported to have a gating role with regard to the flow of thalamic sensory input, and thus may have a sleep-preserving role (De Gennaro and Ferrara, 2003). Subjects were excluded from the study if they were taking medications known to effect sleep (antidepressants, antipsychotics, hypnotics).
We also computed inter-expert reliability in SS scoring and found a significantly lower reliability in scoring definite SS in patients when compared to controls.
In addition to ethical concerns regarding discontinuing dopaminergic treatment in these subjects, we wanted to avoid deleterious discontinuation effects on the PSG, as well as unpleasant and negative motor effects that could interfere with the study. The experts assigned a confidence score to each identified spindle, to indicate the amount of confidence in the identification (as described previously in Warby et al., 2014). The quality of each PSG recording was individually examined, and recordings with disconnections or significant amounts of signal artifact were not included. We also note that the SS morphological changes observed here may affect automatic detection of SS in patients with PD or other neurodegenerative disorders (NDDs).



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