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The Monthly Transmitter (January 2012)


The Transmitter


January 2012

Article Review

Prepared by Dr. Kathryn Chung and Susan O'Connor, Northwest PADRECC 

Telephone-based cognitive-behavioral therapy for depression in Parkinson disease.

Depression is relatively common in Parkinson disease and effective treatment options including face to face cognitive behavioral therapy (CBT) are available.   Unfortunately, many barriers can impede access to face to face therapy, including geographical restriction, or special transportation needs.  With the advent of telemedicine, it is worthwhile determining if telephone-based CBT could recapitulate the successes of face to face psychotherapy.  In this pilot trial, 21 depressed PD patients (with a Clinical Impression Scale of ≥ 4, meaning moderately severe, or worse) participated in a 10 week trial of telephone-based CBT.  The primary outcome measured was the change in score in the Hamilton Rating Scale for Depression (HAM-D17), with a substantial number of secondary outcomes (10) including change in Beck Depression  Inventory Scales, a Clinical Global Impression of Improvement Scale (CGI-I), and quality of life (Short Form-36).  Results showed a mean change in HAM-D17 of 7.91 points (P<0.001) and at 4 weeks after CBT concluded, 52% of subjects were classified as responders (>50% improvement on HAM-D17 or much improved or very much improved on CGI-I).  Feasibility was considered quite high, as 95% of subjects completed all 10 CBT sessions.  Overall, results were similar to this  groups prior findings of the benefits of face to face CBT.  The authors acknowledge the limits of a small pilot trial and its uncontrolled design.  This work is important, as it provides evidence that a more feasible solution to a common problem in PD may not sacrifice efficacy. 

Journal of Geriatric Psychiatry and Neurology 24 (4);

Beyond Nine Years of Continuous Subthalamic Nucleus Deep Brain Stimulation in Parkinson’s Disease

Previous studies have demonstrated that deep brain stimulation (DBS ) of the subthalamic nucleus (STN) and the globus pallidus pars interior (Gpi) is superior to medical management for the treatment of levodopa induced motor complications in advanced parkinson’s disease (PD).  In this study, Zibetti et al evaluated 14 patients treated with STN stimulation for at least 9 years. All subjects were assessed prior to surgery, at 1, 5 and > 9 years.  The researchers found that SNT-DBS significantly improved the motor Unified Parkinson’s Disease Rating Scale (UPDRS) score at all follow up visits with 42% improvement at 9 years.  In addition, there was a 39% reduction in the dosage of dopaminergic drugs. Off period duration and time spent with dyskinesia was reduced by 64% and 65% respectively. At 9 years, patients did, however, report an overall decline in activities of daily living and neuropsychological assessment showed that 29% of patients developed significant cognitive dysfunction.  The results of this study indicate a long-term effect of DBS of the STN on the cardinal motor symptoms and motor complications in advanced PD. Worsening of disability due to disease progression and emergence of cognitive impairment was observed. To date, this is the longest reported study of outcomes following STN-DBS in PD.

Zibetti et al. Beyond Nine Years of Continuous Subthalamic Nucleus Deep Brain Stimulation in Parkinson’s Disease.  Movement Disorders 2011; 26: 2327-2334.


Neuropathy and Levodopa:  A Review of Neuropathy in Parkinson Disease: Prevalence and Determinants

In the November volume of Neurology,  Y.A. Rajabally and J. Martey reported on a possible association between levodopa use in individuals with Parkinson’s disease (PD) and neuropathy.  The goal of this study was to establish the prevalence of neuropathy in patients with PD and to evaluate for possible associations between neuropathy, vitamin B12 levels and levodopa exposure.  In this study 37 consecutive patients with PD were compared to age matched controls. The diagnosis of neuropathy was based off a neuropathy screening scale.  They found an increase in neuropathy in the PD group compared to the control group, 37.8% to 8.1%.   Next they compared the prevalence of B12 deficiency in the group of PD patients with neuropathy to a control group of consecutive neuropathy patients without PD.  Here they found that B12 deficiency is significantly more common in PD patients with neuropathy than a control group with neuropathy without PD.  Finally they determined if cumulative levodopa exposure resulted in B12 deficiency.  Here they found that cumulative levodopa exposure does correlate to lower B12 levels only in PD individuals with neuropathy.  In the PD group as a single cohort, there was no significant correlation between cumulative levodopa exposure and neuropathy.  This study highlights that neuropathy is prevalent in the PD population, and that if neuropathy is suspected, checking B12 levels may be warranted. This neuropathy may be related to levodopa exposure, however more studies are needed to determine how significant a role levodopa plays in the development of neuropathy.

Neurology 2011 Nov 29;77(22):1947-50




Committee Activities

Clinical Care Committee

·         Rotation of Committee Chair: Leadership for the clinical care committee rotates amongst the PADRECCs.  Richmond/Southeast leads the committee for January/February and San Francisco for March/April.  Committee meets the first Tuesday of the month at 12pm ET.


·         Standardize Clinical Care: Continues to discuss a variety of clinical issues, provide clinical support to the Consortium network, and work on measures to standardize clinical care across the PADRECC network.  Recent agenda issues discussed:          

o   Use and benefits of Rasagaline

o   Tetrabenazine use in HD, Tourette’s, management of tics

o   DAT scan usage

o   Increased use of GPi site for DBS

o   Use of CVT (clinical video teleheath)/telemed for movement disorders


·         PD Handbook:  A handbook for the VHA that addresses such things as definition of PD, purpose, authority and scope, system of care, population served, etc. is in the final stage of completion. An appendix is being added that includes publications by PADRECC staff.


·         PADRECC Transmitter: PADRECC clinicians provide reviews of recent movement disorder publications that are included in the PADRECC Transmitter



Education Committee

·         PADRECC/EES Movement Disorder Series:  The FY 2012 series is underway.  The 2nd  audio conference for this series was  held on January 12th titled:    "Pain in Parkinson's Disease."   The audio conferences will be archived on the website under the Movement Disorder Series tab.  All evaluations for CMEs will now be done electronically through EES.  Please take a look at the Dates To Remember section for  a listing of upcoming audio conferences.    


·         Patient Education Video Project: 8 videos were taped for FY 2011.  The videos are in the final stage of editing and once completed they will be available on DVD, the PADRECC website and You Tube.  Request was accepted by EES for taping of 8 more videos in FY2012. Topics and speakers are being selected for the next round of videos.   

·         PADRECC Transmitter: The committee continues to assemble and distribute this e-newsletter every other month.


·         National Website:  The committee is assisting in updating the National VA PADRECC/Consortium Website.


·         National Newsletter:  The committee is in the process of  assembling the Annual National Newsletter which will be distributed in 2012.






Dates to Remember

March 8, 2012

EES/PADRECC Movement Disorder Series

Mood Disorders in PD


April 21-28, 2012

American Academy of Neurology Annual Conference

New Orleans, LA


May 10, 2012

EES/PADRECC Movement Disorder Series

Pharmacy and Therapeutics


June 17-21, 2012

16th International Congress of Parkinson's Disease and Movement Disorders

Dublin, Ireland


July 12, 2012

EES/PADRECC Movement Disorder Series

Rehab Issues in PD


September 13, 2012

EES/PADRECC Movement Disorder Series







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