Parkinson’s Disease Research, Education and Clinical Centers
The Monthly Transmitter (September 2011)
Prepared by Dr. Indu Subramanian, West LA PADRECC
The authors investigated the frequency, phenomenology, and associated risk factors of REM sleep behavior disorder (RBD) in Parkinson disease (PD). An unselected cohort of sleep-disturbed patients with PD (n=457) was investigated with video-supported polysomnography. The overall frequency of RBD was 46%. According to our cohort and modified definition, there was no preferred PD subtype for RBD (p=0.142). There was no gender preference (p=0.770). RBD was associated with older age (p=0.000). Adjusted for age and gender, patients with PD and RBD had longer disease duration (p=0.024), higher Hoehn & Yahr stages (p=0.002), more falls (p=0.018), more fluctuations (p=0.005), more psychiatric comorbidity (p=0.026), and a higher dose of levodopa (p=0.002). The presence of RBD was related to slightly increased sleep efficiency (p=0.007), a higher amount of REM sleep (p=0.000), and more periodic leg movements during sleep (p=0.019). The authors concluded that RBD is a frequent and clinically relevant nocturnal disturbance for all stages of PD. It increases with age and disease duration and may contribute to the nocturnal problems of patients with PD and their bed partners.
Neurology. 2011 Sep 13;77(11):1048-54. Epub 2011 Aug 10.
The authors looked at referral patterns to a large movement disorders center to investigate the current level of knowledge surrounding DBS candidacy by retrospectively analyzing the charts for 197 patients referred for DBS in a 5 year span. Standardized criteria for DBS patient selection were used to categorize referred DBS candidates as the following: good candidates, possible future candidates, poor candidates because of neurological contraindications, or poor candidates because of medical contraindications. Yearly percentages were computed. Referral sources were categorized as movement disorder specialists vs non-movement disorder physicians and self-referred. In total, 165 referrals (83.8%) had ailments for which DBS was indicated, and 100 referrals (50.8%) were good candidates (62 with idiopathic Parkinson disease, 35 with dystonia, and 3 with essential tremor). Referrals by movement disorder specialists vs other sources differed significantly in their percentages of good candidates (66.7% vs 40.4%, P = .002) and possible future candidates (14.7% vs 32.7%, P = .02) but not poor candidates (18.7% vs 25.0%, P = .60). Over the observed period of referrals, the yearly percentages significantly decreased for good candidates and increased for possible future candidates and poor candidates. The authors concluded that compared with findings in prior studies, the quality of DBS referrals has improved. The increase in referral of possible future candidates and poor candidates may reflect greater confidence in the procedure.
Arch Neurol. 2011 Aug;68(8):1027-32.
The authors objective was to assess the 10-year motor outcome of deep brain stimulation of the subthalamic nucleus (STN-DBS) in patients with Parkinson disease (PD). 18 Patients with PD with bilateral STN-DBS were assessed according to the Core Assessment Program for Surgical Interventional Therapies in Parkinson's Disease protocol and videotaped at baseline and 1, 5, and 10 years after surgery. An independent rater blinded to stimulation and medication condition scored the 10-year video assessments. The primary outcome was the change in blinded Unified Parkinson's Disease Rating Scale (UPDRS) motor scores/subscores between the no medication/stimulation condition vs the no medication/no stimulation condition at 10 years. Secondary outcomes were the changes in blinded UPDRS motor scores between the medication/no stimulation and medication/stimulation conditions, UPDRS II scores, UPDRS IV dyskinesia and motor fluctuations scores, and anti-PD medication dose (levodopa equivalent daily dose) at different points. In the 18 patients available for follow-up at 10 years, STN-DBS still significantly improved the UPDRS total motor score (P = .007) and resting and action tremor (P < .01 and P = .02, respectively) and bradykinesia (P = .01) subscores. The UPDRS II scores in the medication and no medication conditions, UPDRS IV dyskinesia and motor fluctuations scores, and the levodopa equivalent daily dose were also significantly reduced compared with baseline. Axial signs showed the most progressive decline in stimulation and levodopa response over the years. The authors conclude that stimulation-induced motor improvement was sustained overall at 10 years, although part of the initial benefit wore off mainly because of progressive loss of benefit on axial signs over time.
Arch Neurol. 2011 Aug 8. [Epub ahead of print]
This study aims to determine the content of pre- and post-operative patient education for deep brain stimulation (DBS)--an increasingly popular procedure used globally-- in an effort to guide standardization among nurses. The study used survey methodology with a convenience sample of nurses involved in a Veterans Administration cooperative study for patients with Parkinson’s disease. Of the 19 study coordinators responding, 16 were nurses; education ranged from bachelor’s to medical degrees; 90% teach 54% of the same preoperative content and 80% teach 23% of the same postoperative content; 95% provide education face-to-face; 90% include family caregivers. Most address preoperative anxiety in all aspects of their education. Before standardizing content, future research should address patient and family perspectives about helpful content.
Lanier, E., Buffum, M. (2011). What are neuroscience nurses teaching parkinson’s patients and families before deep brain stimulation? Journal of Neuroscience Nursing, 43(1), E1-E7.
Permission to reprint granted by Journal of Neuroscience Nursing, 9/26/11.
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