Publications by authors named "Wolfgang Jost"
Background And Objective: Non-motor symptoms frequently develop throughout the disease course of Parkinson's disease (PD), and pose affected individuals at risk of complications, more rapid disease progression and poorer quality of life. Addressing such symptom burden, the 2023 revised "Parkinson's disease" guideline of the German Society of Neurology aimed at providing evidence-based recommendations for managing PD non-motor symptoms, including autonomic failure, pain and sleep disturbances.
Methods: Key PICO (Patient, Intervention, Comparison, Outcome) questions were formulated by the steering committee and refined by the assigned authors.
Advanced therapy in advanced Parkinson's disease: money's too tight to mention.
J Neural Transm (Vienna)
December 2024
Article Synopsis
- The study aimed to compare the skin adhesion of a new rotigotine transdermal patch (ROT-TDS) to an existing product for patients with Parkinson's disease (PD).
- Research included pharmacokinetic testing on healthy adults and a trial on PD patients to assess adhesion and safety.
- Results showed that ROT-TDS had similar effectiveness and safety as the reference patch but also demonstrated better skin adhesion, with a higher percentage of patches staying adhered through the dosing period.
Dopamine agonists in the treatment of Parkinson's disease: the show must go on.
J Neural Transm (Vienna)
December 2024
Article Synopsis
- - Dopamine agonists (DA) have been effective in treating Parkinson's disease since the 1990s, particularly in Europe, due to their established efficacy and improved tolerability, along with the availability of longer-lasting preparations.
- - However, concerns about cardiac issues and impulse control disturbances have led to a reduction in higher doses and a decline in the use of non-ergoline DAs.
- - Despite these setbacks, DAs remain crucial for treatment alongside levodopa, and their optimized use is essential for the well-being of patients, emphasizing the need for a balanced approach rather than avoiding them altogether.
Article Synopsis
- The therapy for Parkinson's disease (PD) is personalized to target both motor and non-motor symptoms, with adjustments needed as the disease progresses and neurodegeneration occurs.
- Monitoring dopamine substituting drugs, particularly measuring plasma levels of levodopa, is suggested to optimize treatment efficacy and manage variability in response.
- Limited understanding of how other medications and factors like gut motility affect levodopa levels complicates treatment; further research is needed on the interactions and impacts of multiple drugs used by PD patients.
Article Synopsis
- The akinetic crisis is a severe, potentially life-threatening condition in Parkinson's disease characterized by extreme rigidity and akinesia that does not respond to levodopa, often accompanied by high fever and altered consciousness.
- Although akinetic crises are rare, milder forms of motor deterioration in Parkinson's patients frequently lead to hospitalizations, highlighting the broader spectrum of akinetic symptoms.
- The review explores clinical symptoms, risk factors, diagnostic methods like DAT-SPECT for assessing levodopa-resistance, and discusses the role of inflammatory cytokines in progression, along with guidelines for managing these conditions.
Article Synopsis
- MANAGE-PD is a web-based tool designed to help doctors identify Parkinson's disease patients whose symptoms aren't well managed by oral medications, with a modified version available in Germany called Parkinson Check.
- A study conducted in Germany in 2022 assessed the real-world utility of both tools using patient and physician ratings of disease control, involving 278 patients from 19 different sites.
- The results showed that 57.6% of patients received the same disease control assessment from both physicians and MANAGE-PD, with higher agreement in specialist clinics compared to neurologist practices, and the Parkinson Check demonstrated strong concordance (>80%) between physician and patient responses.
Article Synopsis
- The study aimed to create a shorter version of the Progressive Supranuclear Palsy quality of life scale (PSP-QoL) to make it easier for patients, especially those with cognitive impairments, to complete.
- Involved a retrospective analysis of data from 245 PSP patients in Germany, resulting in a condensed 12-item scale that covers mental and physical aspects of daily living.
- The new scale, called the PSP-ShoQoL, showed strong correlations with existing measures of quality of life and demonstrated its sensitivity to changes over time.
Article Synopsis
- Botulinum neurotoxin (BoNT) has been utilized since the 1970s, primarily by blocking acetylcholine release in motor neurons and associated areas to affect muscle movement.
- It is increasingly being used to treat various motor and non-motor symptoms of Parkinson's disease, sometimes becoming the preferred treatment for specific symptoms.
- The text aims to summarize the indications for BoNT use, its potential side effects, and the regulatory approvals for its therapies addressing both primary and secondary symptoms of Parkinson's disease.
[Intrajejunal levodopa in Parkinson's disease: Optimization of PEG application].
Fortschr Neurol Psychiatr
July 2024
Article Synopsis
- PEG is important in treating advanced Parkinson's disease through intrajejunal levodopa delivery, but its standard administration (JET-PEG) can lead to complications due to absorption area limitations and improper placement techniques.
- High complication rates, like local infections and catheter dislocations, highlight the need for improved PEG placement and follow-up care.
- A modified application technique and the new Hybrid-PEG method have shown effectiveness in reducing complications, emphasizing the importance of anatomical and surgical details in their implementation.*
Article Synopsis
- Patients with Lewy body diseases, including Parkinson's disease and related dementias, have a higher risk of dementia, which significantly affects survival rates.
- A study analyzed cerebral glucose metabolism using PET scans and found that lower metabolism in specific brain regions predicted shorter survival, with significant differences in median survival based on the severity of metabolic decline.
- The findings suggest that PET scans could be a valuable tool for earlier predictions of survival in these patients, potentially aiding in treatment decisions, such as whether to consider deep brain stimulation.
Article Synopsis
- Upper and lower limb spasticity often occurs with central nervous system disorders, but there's limited knowledge on treating both limbs with botulinum toxins.
- The study aimed to assess the use of onabotulinumtoxinA (onabotA) and its effects on spasticity in limbs, based on data gathered from an international registry over two years.
- Results showed significant participant and physician satisfaction, along with improvements in pain, disability, and quality of life after onabotA treatment, although a small percentage reported adverse effects.
Sublingual apomorphine in the treatment of Parkinson's disease.
J Neural Transm (Vienna)
October 2024
Article Synopsis
- Advanced Parkinson’s disease (PD) leads to disability fluctuations based on levodopa levels, causing OFF phases that worsen symptoms like tremors, pain, and depression.
- Adjusting levodopa can help temporarily, but "on demand" therapies are increasingly necessary for quick relief.
- Recent developments in on-demand treatments, especially sublingual apomorphine (SL-APO), are discussed, highlighting clinical trial results that show promise for managing PD fluctuations.
Article Synopsis
- The study investigates how the microstructural integrity of specific brain areas (substantia nigra, subthalamic nucleus, putamen) relates to the effectiveness of deep brain stimulation (DBS) in patients with Parkinson's disease.
- It involved 23 Parkinson's patients who underwent advanced MRI to assess brain microstructure before receiving STN-DBS and measured their motor improvements afterward.
- Results indicated a trend where poorer response to DBS correlated with increased free interstitial fluid in the substantia nigra and subthalamic nucleus, suggesting these areas may serve as biomarkers for predicting treatment outcomes, but further research is needed for definitive conclusions.
Advanced therapies in Parkinson's disease: an individualized approach to their indication.
J Neural Transm (Vienna)
November 2024
Article Synopsis
- - Device aided therapies (DAT) like LCIG, LECIG, CSAI, and DBS are used for Parkinson's disease when medications alone aren't enough, each with unique effectiveness, risks, and suitability.
- - These therapies should be evaluated individually as patients experience symptoms differently over time; one-size-fits-all approaches may not be effective.
- - The study emphasizes the need for ongoing assessments of patients to tailor DAT to their specific needs, enhancing both motor and non-motor symptom management.
Article Synopsis
- In Parkinson's disease treatment, different methods like Levodopa/Carbidopa Intestinal Gel (LCIG), Levodopa/Carbidopa/Entacapone Intestinal Gel (LECIG), and deep brain stimulation (DBS) are used, each with distinct effectiveness and side effects.
- The authors argue that patients don't all reach the same stage for these treatments at the same time, suggesting that individual disease progression should guide treatment initiation rather than a fixed timeline.
- The review emphasizes personalized treatment approaches that focus on improving quality of life and engagement rather than adhering to a standardized treatment schedule.
Article Synopsis
- The study aimed to assess different MRI techniques for distinguishing between various neurodegenerative Parkinson syndromes (NPS) like Parkinson's disease, multiple system atrophy, and progressive supranuclear palsy.
- Researchers analyzed macrostructural and microstructural MRI data from patients with NPS and healthy controls, using machine learning to compare their diagnostic performances.
- The results indicated that combining macrostructural and microstructural MRI provided the best classification accuracy, highlighting the added value of advanced imaging techniques over traditional methods.
Article Synopsis
- - Sialorrhea is a chronic condition characterized by excessive saliva production, impacting patients' health and quality of life, with several treatment options available, including non-drug methods and medications.
- - Recent Phase III trials have led to the approval of IncobotulinumtoxinA (Xeomin®) in the USA and EU for treating chronic sialorrhea in both adults and children, highlighting the growing interest in Botulinum Neurotoxin A (BoNT/A) injections.
- - This review outlines a comprehensive framework for managing sialorrhea, providing updates on treatment recommendations for physicians, patient selection criteria, dosing guidelines, and the safety and long-term benefits of BoNT/A injections.
Article Synopsis
- Multiple system atrophy (MSA) presents in two main forms: MSA-P with Parkinson's symptoms and MSA-C with cerebellar issues, both causing impaired dexterity.
- The study compared brain imaging and dexterity performance between MSA patients and healthy controls to understand how different degeneration patterns contribute to motor difficulties.
- Results show cerebellar degeneration affects dexterity in both MSA types, indicating it may be a useful biomarker for tracking disease progression, while nigrostriatal degeneration showed no significant impact on dexterity.
Article Synopsis
- Advanced therapies (ATs) like deep brain stimulation and pump therapies are used for advanced Parkinson's disease but may lose effectiveness or cause side effects, necessitating changes or combinations of treatments.
- A nationwide study in Germany analyzed data from 22 centers to assess the effects and reasons for modifications in these ATs, using retrospective questionnaires to gather relevant clinical information since 2005.
- Results showed that 148 modifications across 116 patients led to significant improvements in symptom control and reduced side effects, with the main reasons for changes being inadequate symptom management and side effects from previous treatments.
Article Synopsis
- Progressive supranuclear palsy (PSP) patients, typically older adults, have a distinct pattern of health comorbidities and often take multiple medications compared to those without neurodegenerative diseases.
- The study analyzed data from over 600 patients, revealing higher rates of circulatory and nervous system diseases in PSP patients, alongside increased occurrences of conditions like diabetes and polyneuropathies.
- The PSP group showed significantly more polypharmacy, leading to a higher risk of severe drug interactions, highlighting the need for careful management of treatment in these patients.
Pain in Parkinson's Disease: Pathophysiology, Classification and Treatment.
J Integr Neurosci
September 2023
Article Synopsis
- Continuous medical advancements are leading to longer lifespans but have also resulted in a rise in neurological disorders, particularly Parkinson's disease (PD), which has doubled in cases from 1995 to 2015 and is expected to double again by 2030.
- PD is known for motor symptoms like tremors and rigidity, but many patients also suffer from non-motor symptoms, including pain, which is often overlooked but greatly affects their quality of life.
- This review explores the nature of pain in PD, its classification and management, while emphasizing the importance of recognizing and effectively treating this often silent disability.
Article Synopsis
- Upper and lower limb spasticity (ULS, LLS) often arises after a stroke or due to neurological disorders, causing mobility challenges and reduced quality of life for patients.
- OnabotulinumtoxinA emerged as a treatment option after earlier medications were ineffective and painful; it gained approval following successful trials focused on measuring patient-centered outcomes.
- The positive results from ULS trials informed the design of similar trials for LLS, leading to approval and demonstrating that onabotulinumtoxinA significantly enhances patient satisfaction and quality of life.