Introduction
A significant proportion of patients with Parkinson’s disease (PD) display a set of impulsive-compulsive behaviors at some point during the course of illness. These behaviors range from ...the so-called behavioral addictions to dopamine dysregulation syndrome, punding and hoarding disorders. These behaviors have been consistently linked to the use of dopaminergic medications used to treat PD motor symptoms (dopamine agonists, levodopa, and other agents) and less consistently to neuromodulation techniques such as deep brain stimulation (DBS). Since there are still no approved treatments for these conditions, their pharmacological management is still a big challenge for clinicians.
Methods
We conducted an extensive review of current pharmacological and neuromodulation literature for the management of impulsive-compulsive disorders in PD patients.
Results
Pharmacological treatment approaches for impulsive-compulsive behaviors and DDS in PD patients include reduction of levodopa (LD), reduction/cessation of dopamine agonist (DA), and initiation of infusion therapies (apomorphine infusion and duodopa). Also, atomoxetine, a noradrenergic agent approved for the treatment of attention deficit hyperactivity disorder, showed some interesting preliminary results but there is still a lack of controlled longitudinal studies. Finally, while DBS effects on impulsive-compulsive disorders are still controversial, non-invasive techniques (such as transcranial magnetic stimulation and transcranial direct current stimulation) could have a potential positive effect but, again, there is still a lack of controlled trials.
Conclusion
Managing impulsivity and compulsivity in PD patients is still a non-evidence-based challenge for clinicians. Controlled trials on promising approaches such as atomoxetine and non-invasive neuromodulation techniques are needed.
Parkinson’s disease (PD) is a chronic neurodegenerative disorder, characterized by considerable clinical heterogeneity. Extracellular vesicles (EVs) were proposed as new biomarkers for PD because of ...their role as vehicles of multiple PD related molecules, but technical limitations exist in their detection and characterization in a clinical environment. We propose herein a Raman based protocol for the label-free analysis of circulating EVs as diagnostic and predictive tool for PD. After purification from serum of PD patients and healthy subjects, EVs were analyzed by Raman spectroscopy demonstrating the feasibility and reproducibility of the proposed biophotonic approach, its moderate accuracy in distinguishing PD patients from controls by their EV profile and the correlation between Raman data and clinical scales. Once validated, the Raman spectroscopy of circulating EVs could represent a reliable, automatable and sensitive method for the stratification of PD patients and for the evaluation of the effectiveness of rehabilitation and pharmacological treatments.
Extracellular vesicles (EVs) circulating in blood mirror the processes occurring throughout the body, including the brain. The Raman microspectroscopy of circulating EVs has demonstrated that vesicles from the serum of Parkinson’s patients owe a biochemical profile that makes them significantly different from those of healthy control subjects of comparable age. The positive correlation with the commonly used clinical scales suggests that the proposed method can represent a reproducible, fast and label-free method for both the identification and classification of patients with Parkinson’s disease and the evaluation of the disease rate of progression, before and after rehabilitation and pharmacological therapy. Display omitted
Background
If Parkinson’s Disease (PD) may represent a risk factor for Coronavirus disease 2019 (COVID-19) is debated and there are few data on the direct and indirect effects of this pandemic in PD ...patients.
Objective
In the current study we evaluated the prevalence, mortality and case-fatality of COVID-19 in a PD cohort, also exploring possible risk factors. We also aimed to investigate the effect of lockdown on motor/non-motor symptoms in PD patients as well as their acceptability/accessibility to telemedicine.
Method
A case-controlled survey about COVID-19 and other clinical features in PD patients living in Tuscany was conducted. In non-COVID-19 PD patients motor/non-motor symptoms subjective worsening during the lockdown as well as feasibility of telemedicine were explored.
Results
Out of 740 PD patients interviewed, 7 (0.9%) were affected by COVID-19, with 0.13% mortality and 14% case-fatality. COVID-19 PD patients presented a higher presence of hypertension (
p
< 0.001) and diabetes (
p
= 0.049) compared to non-COVID-19. In non-COVID-19 PD population (
n
= 733) about 70% did not experience a subjective worsening of motor symptoms or mood, anxiety or insomnia. In our population 75.2% of patients was favorable to use technology to perform scheduled visits, however facilities for telemedicine were available only for 51.2% of cases.
Conclusion
A higher prevalence of COVID-19 respect to prevalence in Tuscany and Italy was found in the PD population. Hypertension and diabetes, as for general population, were identified as risk factors for COVID-19 in PD. PD patients did not experience a subjective worsening of symptoms during lockdown period and they were also favorable to telemedicine, albeit we reported a reduced availability to perform it.
Late-onset Huntington disease: An Italian cohort Volpi, Eleonora; Terenzi, Federica; Bagnoli, Silvia ...
Journal of clinical neuroscience,
April 2021, 2021-Apr, 2021-04-00, 20210401, Letnik:
86
Journal Article
Recenzirano
•In this Italian cohocrt, LoHD patients are 25.2% of total cases.•LoHD and CoHD patients are comparable in terms of clinical presentation and disease progression.•The Allele 1 resulted longer among ...LoHD, suggesting a possible protective role on the disease onset.
Huntington’s disease (HD) is an autosomal dominant neurodegenerative disorder caused by a CAG expansion greater than 35 triplets in the IT-15 gene, with a clinical onset usually in the forties. Late-onset form of HD is defined as disease onset after the age of 59 years. The aim of the present study is to investigate the clinical-demographic features of Late-onset HD population (LoHD) in comparison to Classic-onset patients (CoHD).
We analyzed a well-characterized Italian cohort of 127 HD patients, identifying 25.2% of LoHD cases. The mean age of onset was 65.9 and the mean length of pathological allele was 42.2. The 53.1% of LoHD patients had no family history of HD. No significant differences were observed in terms of gender, type of symptoms at disease onset, and clinical performance during the follow-up visits. The non-pathological allele resulted longer among LoHD patients. There is evidence that longer non-pathological allele is associated with a higher volume of basal ganglia, suggesting a possible protective role even in the onset of HD. In conclusion, LoHD patients in this Italian cohort were frequent, representing a quarter of total cases, and showed clinical features comparable to CoHD subjects. Due to the small sample size, further studies are needed to evaluate the influence of non-pathological alleles on disease onset.
We reported the case of a John Cunningham virus (JCV) and human herpesvirus 6 (HHV-6) mediated progressive multifocal leukoencephalopathy (PML) after human stem cell transplant, reactivated 6 months ...later in absence of immunosuppressive therapy, successfully treated with anti-5HT2A receptors agents and antiviral therapy. Few cases of JCV and HHV-6 coinfection associated PML are described in literature and the role of HHV-6 in the pathogenesis and prognosis of PML is not completely clear. Our case suggests that, in a possible PML, the research of HHV-6 and JCV should be always performed on cerebrospinal fluid (CSF) and on blood samples and in case of detection of HHV-6 DNA a “chromosomally integrated human herpesvirus 6” (ciHHV-6) should be excluded. Furthermore we recommend to start an appropriate therapy with antiviral and anti-5HT2A receptors agents in case of possible PML due to JCV and HHV-6 coinfection.
Background: Parkinson's disease (PD) is an age-related neurodegenerative pathology characterized by progressive movement disorders and by intraneuronal accumulation of misfolded a-synuclein. As for ...most neurodegenerative diseases in the early diagnosis, the monitoring and the evaluation of the rehabilitation outcome are difficult to be objectively assessed, but mainly rely on clinical scaling. Circulating extracellular vesicles (EVs) deriving from all body organs can provide an overview of the patient's clinical status and of the disease progression that might be related to the prognosis and the rehabilitation outcome. Methods: Serum EVs were isolated by size-exclusion chromatography and ultracentrifugation. Then, Raman analysis was performed in order to obtain a snapshot ofthe EV biochemical profile. Following the labelfree biophotonic procedure previously optimized in our laboratory, spectra were obtained taking advantage ofa Raman microspectroscope (Aramis, Horiba) operating with a 532-nm laser beam in the spectral ranges 600-1800 and 2600-3200 cm-1. Multivariate statistical analysis was applied for the comparison ofthe Raman fingerprints from healthy subjects and PD patients. Results: The preliminary results of our pilot study demonstrated the ability of the proposed method to highlight the differences in the biochemical composition of EVs from human serum. In particular, we demonstrated the presence in the serum of PD patients of EVs associated or loaded with atypical cargoes compared to age- and sexmatched healthy controls. Summary/Conclusion: Although preliminary, our data provide support to the already proposed prion hypothesis of PD pathogenesis. Moreover, our data suggest the possibility to evaluate the spectrum of circulating EV populations as a whole, using the Raman fingerprint as a biomarker, complementary to specific molecular markers.
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