Onset of dyskinesia with adjunct ropinirole prolonged-release or additional levodopa in early Parkinson's disease.

Levodopa-induced dyskinesia can result in significant functional disability and reduced quality of life in patients with Parkinson's disease (PD). The goal of this study was to determine if the addition of once-daily ropinirole 24-hour prolonged-release (n = 104) in PD patients not optimally controlled with levodopa after up to 3 years of therapy with less than 600 mg/d delays the onset of dyskinesia compared with increasing doses of levodopa (n = 104). During the study, 3% of the ropinirole prolonged-release group (mean dose 10 mg/d) and 17% of the levodopa group (mean additional dose 284 mg/d) developed dyskinesia (P < 0.

Early pharmacologic treatment in Parkinson's disease.

Early treatment of Parkinson's disease (PD) affords an opportunity to forestall clinical progression. Levodopa is the most effective treatment for PD motor signs and symptoms, but its use is associated with the development of motor fluctuations and dyskinesias. Because of this, levodopa use is commonly withheld until the patient experiences functional disability.

Task force report on scales to assess dyskinesia in Parkinson's disease: critique and recommendations.

Drug-induced dyskinesia is a common phenomenon in Parkinson's disease (PD) and is often socially as well as physically disabling for patients. The Movement Disorders Society commissioned a task force to assess available clinical rating scales, critique their clinimetric properties, and make recommendations regarding their clinical utility. A task force composed six clinical researchers who systematically searched the literature for scales measuring dyskinesia in PD, evaluated the scales' previous use, performance parameters, and quality of validation data (if available).

Double-blind study of pardoprunox, a new partial dopamine agonist, in early Parkinson's disease.

This study examined the efficacy and safety of the partial dopamine agonist, pardoprunox (SLV308), in the treatment of patients with early Parkinson's disease (PD). Patients were randomized to receive pardoprunox (n = 69) or placebo (n = 70). Pardoprunox was titrated to each patient's optimal dose (9-45 mg/d) over 2 to 6 weeks and then maintained at this dose for a further 3 weeks.

Causes and Consequences of Cognitive Functioning Across the Life Course.

Research on variation in cognitive abilities has focused largely on their genetic or experiential sources and on their economic consequences. This article takes a broader look at the consequences of cognitive ability-IQ-across the life course. Contrary to received wisdom, the effects of IQ on economic success are almost entirely mediated by educational attainment.

Natural history and expansive clinical profile of stress (tako-tsubo) cardiomyopathy.

Objectives: This study was designed to define more completely the clinical spectrum and consequences of stress cardiomyopathy (SC) beyond the acute event.

Background: Stress cardiomyopathy is a recently recognized condition characterized by transient cardiac dysfunction with ventricular ballooning.

Methods: Clinical profile and outcome were prospectively assessed in 136 consecutive SC patients.

New considerations in the medical management of early Parkinson's disease: impact of recent clinical trials on treatment strategy.

The best approach to medical management of early Parkinson's disease remains controversial. Recent studies suggest that early use of MAO-B inhibitors may improve long-term outcome. Long-term follow-up to a delayed-start rasagiline study indicated that patients who were treated with rasagiline from the start did better through 5.

Do Older Adults Know Their Spouses' End-of-Life Treatment Preferences?

When terminally ill patients become mentally incapacitated, the patient's surrogate often makes treatment decisions in collaboration with health care providers. We examine how surrogates' errors in reporting their spouse's preferences are affected by their gender, status as durable power of attorney for health care (DPAHC), whether the surrogate and spouse held discussions about end-of-life preferences, and the spouse's health status. We apply structural equation models to data from 2,750 married couples in their mid 60s who participated in the 2004 wave of the Wisconsin Longitudinal Study.

Development and Industrialization of the Implantable Cardioverter-Defibrillator: A Personal and Historical Perspective.

The implantable cardioverter-defibrillator (ICD) is the standard of care for preventing sudden cardiac death. Contemporary ICDs are capable of providing a variety of therapeutic functions and can automatically gather and store diagnostic data that can guide both device and drug therapy and alert caregivers of impending battery depletion or lead problems. Moreover, much of the diagnostic data can be monitored remotely, so that many patients can be evaluated in their homes.

Deaths and cardiovascular injuries due to device-assisted implantable cardioverter-defibrillator and pacemaker lead extraction.

Aims: An estimated 10,000-15,000 pacemaker and implantable cardioverter-defibrillator (ICD) leads are extracted annually worldwide using specialized tools that disrupt encapsulating fibrous tissue. Additional information is needed regarding the safety of the devices that have been approved for lead extraction. The aim of this study was to determine whether complications due to device-assisted lead extraction might be more hazardous than published data suggest, and whether procedural safety precautions are effective.

Levodopa response in early Parkinson's disease.

To further characterize the short-term levodopa response in early PD, we performed a retrospective analysis of the ELLDOPA study which randomized 361 early PD subjects to placebo, levodopa 150, 300, or 600 mg/day. We evaluated change in UPDRS motor scores (UPDRSm) from baseline to weeks 9 and 24, and identified changes in UPDRSm that best discriminated treatment with levodopa from placebo. Linear regressions were used to determine associations between baseline characteristics and changes in UPDRSm.

Sleep disorders in Parkinson's disease.

Sleep disorders occur commonly in Parkinson's disease (PD), and reduce quality of life. Sleep-related problems in PD include insomnia, restless legs syndrome, rapid eye movement sleep behavior disorder, sleep apnea, parasomnias, excessive daytime sleepiness, and sleep attacks. This article reviews sleep disorders and their treatment in PD.

Orally disintegrating selegiline in Parkinson patients with dopamine agonist-related adverse effects.

Objective: To determine whether adding orally disintegrating selegiline (ODS) while decreasing dopamine agonist (DA) dosages would reduce DA-related adverse effects (AEs) of excessive daytime sleepiness (EDS), pedal edema, hallucinations, and impulse control disorders (ICDs) without compromising efficacy in Parkinson disease (PD) patients.

Methods: This was a 12-week open-label study of 60 PD patients with motor fluctuations and DA-related AEs of EDS, pedal edema, hallucinations, and ICDs. Orally disintegrating selegiline was initiated at 1.

Levodopa/carbidopa/entacapone 200/50/200 mg (Stalevo 200) in the treatment of Parkinson's disease: a case series.

Levodopa continues to be the most efficacious and widely used treatment for Parkinson's disease. Levodopa dosing is understood to be critical for the optimal control of symptoms, and increasing the levodopa dose is a common method to treat advancing disease. Escalating levodopa dosages coupled with disease progression is associated with increasing likelihood of developing levodopa-induced dyskinesia.

A double-blind, delayed-start trial of rasagiline in Parkinson's disease.

Background: A therapy that slows disease progression is the major unmet need in Parkinson's disease.

Methods: In this double-blind trial, we examined the possibility that rasagiline has disease-modifying effects in Parkinson's disease. A total of 1176 subjects with untreated Parkinson's disease were randomly assigned to receive rasagiline (at a dose of either 1 mg or 2 mg per day) for 72 weeks (the early-start group) or placebo for 36 weeks followed by rasagiline (at a dose of either 1 mg or 2 mg per day) for 36 weeks (the delayed-start group).

Do birth cohorts matter? Age-period-cohort analyses of the obesity epidemic in the United States.

Many studies have cited the importance of secular changes or "period effects" as causes of the U.S. obesity epidemic.

Occupation and risk of parkinsonism: a multicenter case-control study.

Background: We examined risk of parkinsonism in occupations (agriculture, education, health care, welding, and mining) and toxicant exposures (solvents and pesticides) putatively associated with parkinsonism.

Objective: To investigate occupations, specific job tasks, or exposures and risk of parkinsonism and clinical subtypes.

Design: Case-control.

GCH1 in early-onset Parkinson's disease.

Mutations in GTP-cyclohydrolase 1 (GCH1) cause autosomal dominant dopa-responsive dystonia (DRD), characterized by childhood-onset foot dystonia that later generalizes. DRD patients frequently present with associated Parkinsonism. Conversely, early-onset Parkinson's disease (EOPD) patients commonly display dystonia.

Levodopa/carbidopa/entacapone in Parkinson's disease.

Levodopa is the most efficacious agent for the treatment of motor features of Parkinson's disease but its chronic use is associated with the development of motor complications. Mounting evidence indicates the short half-life of levodopa and resultant pulsatile stimulation of striatal dopamine receptors leads to wearing off, motor fluctuations and dyskinesias. Longer acting dopaminergic agents, such as dopamine agonists, are less likely to cause motor fluctuations and dyskinesias but are not as efficacious for control of motor symptoms.

Fentanyl-induced bradykinesia and rigidity after deep brain stimulation in a patient with Parkinson disease.

A 58-year-old man with advanced Parkinson disease underwent battery replacement for a deep brain stimulator and experienced severe bradykinesia and rigidity postoperatively for 36 hours. The patient was administered fentanyl as an anesthetic during the procedure and as an analgesic periodically during the day after surgery. The severe bradykinesia and rigidity persisted despite reactivation of the deep brain stimulator and immediate reinstitution of Parkinson disease medications, but resolved completely several hours after discontinuation of fentanyl.

Levodopa: past, present, and future.

Levodopa has been the mainstay of treatment for Parkinson's disease (PD) for more than 40 years. During this time, researchers have strived to optimize levodopa formulations to minimize side effects, enhance central nervous system (CNS) bioavailability, and achieve stable therapeutic plasma levels. Current strategies include concomitant treatment with inhibitors of dopa decarboxylase (DDC) and catechol-O-methyltransferase (COMT) to prolong the peripheral levodopa half-life and increase CNS bioavailability.