Time course of loss of clinical benefit following withdrawal of levodopa/carbidopa and bromocriptine in early Parkinson' s disease.

Putative neuroprotective agents for Parkinson's disease can be assessed in untreated patients using progression of clinical disability as an index of disease progression. To avoid the confound associated with symptomatic therapy, progression of the underlying disease can be assessed by evaluating the progression of clinical disability from an untreated baseline to a final visit following wash-out of symptomatic medication. In this type of analysis it is critical to use a washout of sufficient duration to ensure elimination of symptomatic effects.

Time course of loss of clinical benefit following withdrawal of levodopa/carbidopa and bromocriptine in early Parkinson's disease.

Putative neuroprotective agents for Parkinson's disease can be assessed in untreated patients using progression of clinical disability as an index of disease progression. To avoid the confound associated with symptomatic therapy, progression of the underlying disease can be assessed by evaluating the progression of clinical disability from an untreated baseline to a final visit following wash-out of symptomatic medication. In this type of analysis it is critical to use a wash-out of sufficient duration to ensure elimination of symptomatic effects.

Improvements in daily functioning after deep brain stimulation of the thalamus for intractable tremor.

Deep brain stimulation (DBS) of the thalamus reduces tremor in patients with essential tremor (ET). However, few studies have determined the degree of improvement in daily functioning associated with DBS. We developed a self-report Tremor Activities of Daily Living Scale (TADLS) to compare daily functioning with the stimulator turned on and off.

Double-blind controlled trial of gabapentin in essential tremor.

Gabapentin has been reported to be effective for essential tremor (ET) based on open-label trials. We studied gabapentin (1800 mg/day) and placebo in a double-blind crossover design in 20 ET patients. Eighteen patients completed the study and two patients dropped out as a result of adverse effects which resolved when the medication was discontinued.

Motor complications of chronic levodopa therapy in Parkinson's disease.

We report on motor complications of chronic levodopa therapy among 811 levodopa-responsive patients with idiopathic Parkinson's disease (PD), stratified by duration after diagnosis. Predictable "offs" were noted in 20.2% of patients in the first 5 years, in 58.

Clinical expression of essential tremor: effects of gender and age.

Essential tremor (ET) is considered to be a monosymptomatic disorder consisting primarily of postural hand tremor. Nevertheless, clinical expression can vary based on the body region affected by tremor and the coexistence of other neurologic signs, such as tandem gait disturbance. We conducted a two-part study to test the hypothesis that variability in ET clinical expression is influenced by gender and age.

High-frequency unilateral thalamic stimulation in the treatment of essential and parkinsonian tremor.

Pharmacologic treatment for essential tremor and the tremor of Parkinson's disease is often inadequate. Stereotaxic surgery, such as thalamotomy, can effectively reduce tremors. We performed a multicenter trial of unilateral high-frequency stimulation of the ventral intermedius nucleus of the thalamus in 29 patients with essential tremor and 24 patients with Parkinson's disease, using a blinded assessment at 3 months after surgery to compare clinical rating of tremor with stimulation ON with stimulation OFF and baseline and a 1-year follow-up.

Effects of thalamic deep brain stimulation based on tremor type and diagnosis.

It has been suggested that deep brain stimulation (DBS) is less effective in alleviating proximal than distal postural arm tremor reduction is said to be less in essential tremor (ET) than in Parkinson's disease (PD). We analyzed blinded rater's tremor scores and subjects' disability ratings at 3-month follow-up to examine the effects of DBS based on tremor type (rest, kinetic, distal postural, proximal postural) and diagnosis (ET, PD). An independent examiner provided tremor scores using randomized videotaped footage of 19 ET and 10 PD subjects at baseline and at follow-up with DBS "on.

Benztropine versus clozapine for the treatment of tremor in Parkinson's disease.

Four open-label studies have reported beneficial effects of clozapine on the tremor of idiopathic Parkinson's disease (PD). We performed a double-blind crossover trial with a 2-week washout, comparing low-dose clozapine to benztropine for the treatment of tremor in PD. Twenty-two subjects enrolled and 19 completed the study.

Methazolamide for essential voice tremor.

We studied the safety and efficacy of methazolamide (average dose 168 mg/day) in a placebo-controlled blinded investigation in nine patients with essential voice tremor. There were no significant differences for physician or patient clinical rating scores. Digital audio tape recordings showed no difference for amplitude modulation, but frequency modulation was significantly altered by methazolamide.

Accuracy of reported family histories of essential tremor.

We studied the accuracy of reported family histories of essential tremor (ET) by questioning the patients in our clinic and subsequently by mail and phone. For individuals who continued to report a negative family history, we mailed a screening questionnaire to their first-degree relatives to further ascertain the presence of ET. On initial assessment, 67.

Deep brain stimulation for essential tremor.

We examined the effects and safety of deep brain stimulation (DBS) as a treatment for essential tremor (ET). Ten ET patients with disabling medication-refractory tremor underwent stereotactic implantation of a DBS lead in the left Vim thalamic nucleus and completed a 6-month follow-up. The Clinical Tremor Rating Scale and disability assessments were performed at baseline, 1-, 3-, and 6-month follow-up.

Weight change and body composition in patients with Parkinson's disease.

Objective: To compare reports of weight loss and actual measures of body composition to predict nutritional risk in patients with Parkinson's disease and matched control subjects.

Design: Patients and control subjects were asked to record prior changes in weight and activity. Body composition was then compared in both groups using percentage ideal body weight (IBW), body mass index (BMI), triceps skinfold (TSF) thickness, midarm muscle circumference, and percentage body fat (BF) as determined by bioelectrical impedance.

Botulinum toxin treatment of essential head tremor.

We examined in a double-blind, placebo-controlled study the effects of botulinum toxin in 10 patients with essential head tremor. Each subject received two treatments approximately 3 months apart, one with botulinum toxin injections and another with normal saline injections into the sternocleidomastoid and splenius capitis muscles. The subjects were assessed before each treatment and at 2, 4, and 8 weeks after injections.

The relationship of essential tremor to other movement disorders: report on 678 patients. Essential Tremor Study Group.

We examined 678 essential tremor patients in specialty, university, and private practice clinics. The mean age of patients was 65.2 years with a similar number of men and women.

Identical twins with similar onset of Parkinson's disease: a case report.

The role of heredity in Parkinson's disease (PD) is controversial. We report a pair of monozygotic twins (confirmed by DNA fingerprints) concordant for PD. Their disease began when they were 62 and 63 years old.

Double-blind controlled study of methazolamide in the treatment of essential tremor.

We studied the effect of the carbonic anhydrase inhibitor methazolamide in 25 patients with essential tremor (ET) in a double-blind, placebo-controlled trial. Tremor assessment included patient self-reporting of functional disability, clinical rating of motor tasks and tremor severity, and accelerometric measurements. There was no significant difference between methazolamide and placebo in any of the assessments.

Clinical experience with controlled-release carbidopa/levodopa in Parkinson's disease.

We converted 158 Parkinson's disease (PD) patients on stable doses of standard carbidopa/levodopa (Std-L) to controlled-release carbidopa/levodopa (L-CR). Of the 141 patients who completed the study, 103 (73%) preferred L-CR, 26 (18.5%) preferred Std-L, and 12 (8.

Olfactory function in essential tremor.

Olfactory function, assessed by the University of Pennsylvania Smell Identification Test, was normal in essential tremor (ET) patients and significantly reduced in patients with Parkinson's disease (PD). This finding further supports a lack of association between ET and PD.

The effect of acetazolamide on essential tremor: an open-label trial.

We studied the effect of the carbonic anhydrase inhibitor acetazolamide on 24 patients with essential tremor by patient self-evaluation of functional disability, rating of motor task function, and clinical rating of tremor severity. Acetazolamide significantly reduced tremor severity, but there was no statistically significant change in patient self-assessment of function or motor task rating. Although side effects were common, over half the patients elected to remain on the drug.

Classification of essential tremor.

Classification of essential tremor was attempted using tremor frequency; tremor duration; family history of tremor; responsiveness to alcohol, propranolol, and primidone; muscle contraction pattern; and long-latency reflexes. Sixty-one patients were evaluated. The majority of patients had a tremor frequency less than 7.

Is essential tremor benign?

We analyzed the results of the Sickness Impact Profile, a self-reporting measure of sickness-related dysfunction in 753 essential tremor (ET) patients, 87 controls from the general population, and 145 patients with Parkinson's disease (PD). Compared with the general population, ET patients had significantly greater dysfunction in all but one category. Communication, Work, Emotional Behavior, Home Management, and Recreation and Pastimes were particularly impaired in ET.

Driving in Parkinson's disease.

Altered motor or mental skills in Parkinson's disease (PD) could adversely affect driving ability. We interviewed 150 patients regarding their driving habits and compared them with 100 controls. Thirty patients had stopped driving because of PD.

Sexual dysfunction in Parkinson's disease.

Sexual functioning was investigated in 50 parkinsonian male and female patients using a questionnaire. A loss of sexual interest and functioning was reported in a high percentage of patients. Depression was not prevalent but 70% had some evidence of autonomic nervous system dysfunction that may be related to sexual dysfunction.