To determine the effects of a high-intensity exercise therapy using sensorimotor and visual stimuli on nondemented Parkinson disease (PD) patients' clinical symptoms, mobility, and standing balance.
...Randomized clinical intervention, using a before-after trial design.
University hospital setting.
A total of 72 PD patients with Hoehn and Yahr stage of 2-3, of whom 64 were randomized, and 55 completed the study.
PD patients were randomly assigned to a no physical intervention control (n=20 of 29 completed, 9 withdrew before baseline testing) or to a high-intensity agility program (15 sessions, 3 weeks, n=35 completed).
Primary outcome was the Movement Disorders Society-Unified Parkinson Disease Rating Scale (MDS-UPDRS) motor experiences of daily living (M-EDL). Secondary outcomes were Beck Depression score, Parkinson Disease Questionnaire-39 (PDQ-39), EuroQoL Five-Dimension (EQ5D) Questionnaire visual analog scale, Schwab and England Activities of Daily Living (SE ADL) Scale, timed Up and Go (TUG) test, and 12 measures of static posturography.
The agility program improved MDS-UPDRS M-EDL by 38% compared with the 2% change in control (group by time interaction, P=.001). Only the intervention group improved in PDQ-39 (6.6 points), depression (18%), EQ5D visual analog scale score (15%), the SE ADL Scale score (15%), the TUG test (39%), and in 8 of 12 posturography measures by 42%-55% (all P<.001). The levodopa equivalent dosage did not change.
A high-intensity agility program improved nondemented, stage 2-3 PD patients' clinical symptoms, mobility, and standing balance by functionally meaningful margins at short-term follow-up.
Deep brain stimulation (DBS) teleprogramming may help reducing travel-related and other financial burdens for patients and maintaining DBS care in special situations. To determine travel-related ...burdens of DBS patients and explore effects of COVID-19 on DBS care. Travel- and visit-related data of 319 patients were retrospectively analyzed for the first year, five years, and ten years after initiating DBS. Frequencies of in-person and telemedicine visits over the 18-month periods just before and after the outbreak of COVID-19 in Hungary were also compared. Average travel distance during an in-person visit was 415.2 ± 261.5 km, while average travel time was 342.1 ± 199.4 min. Travel costs for the first year, five years, and ten years were 151.8 ± 108.7, 461.4 ± 374.6, and 922.7 ± 749.1 Euros, respectively. Travel distance, age, and type and severity of disease could help identify patients who would particularly benefit from teleprogramming. We detected a significant decrease in the number of visits during COVID-19 pandemic (from 3.7 ± 2.1 to 2.4 ± 2.7; p < 0.001) which mainly resulted from the decreased frequency of in-person visits (3.6 ± 2.0 vs. 1.7 ± 1.8; p < 0.001). Our results support the introduction of DBS teleprogramming in Hungary which could save money and time for patients while maintaining a secure delivery of DBS.
INTRODUCTIONParkinson’s disease (PD) is a progressive neurodegenerative condition and it is unclear if long-term nonpharmaceutical interventions can slow the progression of motor and nonmotor ...symptoms and lower drug dose.
METHODSIn a randomized trial, after an initial 3-wk-long, 15-session supervised high-intensity sensorimotor agility exercise (E) program designed to improve postural instability, the exercise+maintenance (E + M, n = 19) group continued to exercise three times per week for 2 yr, whereas E (n = 16), and the no exercise and no maintenance control (C, n = 20) continued habitual living. Eight outcomes were measured before and after the 3-wk initial exercise program and then at 3, 6, 9, 12, 18, and 24 months in all patients.
RESULTSThe group–time interactions (all P < 0.005) revealed robust and favorable effects of the initial 3-wk agility program on all six nonmotor (e.g., primary outcome Movement Disorder Society Unified Parkinson Disease Rating Scale, Motor Experiences of Daily Living, ~7 points; EuroQoL, ~9 points) and on each of the two motor outcomes (timed up and go test~6 s; posturographyup to 7 mm improvements in center of pressure path). E + M maintained but did not further improve the benefits produced by the initial 3-wk program. In E, the favorable effects of the 3-wk agility program lasted for 3 to 12 months. In C, patients declined steadily in all outcomes over 2 yr. By year 2, Leva-dopa equivalents increased by 99.4 mg·d (time main effect, P = 0.008).
CONCLUSIONSA high-intensity sensorimotor agility program with but not without a 2-yr maintenance program slowed the progression of parkinsonian symptoms.
The three dimensional printing (3DP) in the pharmaceutical domain constitutes an alternative, innovative approach compared to the conventional production methods. Fused deposition modelling (FDM), is ...a simple, cost-effective 3DP technique, however the range of pharmaceutical excipients that can be applied for this methodology is restricted. The study set to define the requirements of the FDM printability, using as technical support custom made, pharmaceutical polymer based filaments and to evaluate if these new dosage forms can live up to the current GMP/GCP quality standards. Formulation rationale was assessed in accordance to the apparatus functionality. Blends were pre-screened based on the processability under the API (carvedilol) thermogravimetric analysis determined critical limit. The technological process implied the use of FDM coupled with hot melt extrusion (HME), while printability was defined by means of thermal, rheological and mechanical measurements. From the pharmaceutical standpoint, the consistency of the in vitro dissolution kinetics was monitored ‘at release’ and ‘in stability’, while the print process impact was evaluated based on the previously determined processability potential. Results showed that FDM printability is multifactorial, with brittleness and melt viscosity as primary limitation factors. The increase in shear-thinning and flexural modulus can enable broader processability intervals, which in turn proved to be essential in limiting degradation product formation. The 3DP tablets released the API in an extended rate, however the temperature and humidity along production and storage should be carefully considered as it may affect the final product quality in time. In conclusion, HME + FDM can be considered as an alternative production methodology, with prospects of applicability in the clinical sector, however for some formulations extensive packaging development will be necessary before confirming their suitability.
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Management of Parkinson’s disease (PD) is complicated due to its progressive nature, the individual patient heterogeneity, and the wide range of signs, symptoms, and daily activities that are ...increasingly affected over its course. The last 10–15 years have seen great progress in the identification, evaluation, and management of PD, particularly in the advanced stages. Highly specialized information can be found in the scientific literature, but updates do not always reach general neurologists in a practical and useful way, potentially creating gaps in knowledge of PD between them and neurologists subspecialized in movement disorders, resulting in several unmet patient needs. However, general neurologists remain instrumental in diagnosis and routine management of PD. This review provides updated practical information to identify problems and resolve common issues, particularly when the advanced stage is suspected. Some tips are provided for efficient communication with the members of a healthcare team specialized in movement disorders, in order to find support at any stage of the disease in a given patient, and especially for a well-timed decision on referral.
Internet gaming disorder (IGD) is an emerging problem. Rarely, media reports about people, who have died during playing video games, but thus far no systematic, scientific study is available about ...the topic. We investigated such cases, looking for common characteristics, connection between gaming and death, and the possible reasons leading to death.
Cases were collected through internet search with general keywords, with ones specific to identified cases, and by working along cross references.
24 cases were found: one from 1982, the others between 2002 and 2021. Twenty-three of the victims were male, age ranged from 11 to 40 years. More than half of the cases originated from Southeast Asia, and 12 deaths happened in internet cafes. Gamers played action-rich multiplayer games. In 18 cases the gaming session before death was extremely long (around a day or even several days) with minimal rest. The cause of death was pulmonary embolism in 5 cases, cerebral hemorrhage in 2 cases, most of the rest was presumably due to fatal cardiac arrhythmia.
Long sedentary position and dehydration may precipitate thromboembolism, acute blood pressure elevation during gaming may promote cerebral hemorrhage, and several factors (including acute and chronic sleep deprivation, exhaustion, stress) can lead to acute autonomic dysfunction and fatal arrhythmia.
Incidence of non-violent death cases linked to playing video games is presumably very low. It mostly occurs in young males and it is often characterized by extremely long gaming time.
Minimal clinically important difference (MCID) is the smallest change in an outcome, which a patient identifies as meaningful. Although the 2 most frequently applied Parkinson's disease (PD) "quality ...of life" questionnaires (the PDQ-39 and PDQ-8) provide encouragingly similar results, their MCID thresholds appear to be vastly different. Our aim was to calculate the MCID estimates for both PDQ-39 and PDQ-8 Summary Indices (PDQ-39-SI and PDQ-8-SI) by the utilization of both anchor- and distribution-based techniques.
Nine hundred eighty-five paired investigations of 365 patients were included. Three different techniques were used simultaneously to calculate the MCID values.
First, we replicated the previously published results demonstrating how both PDQ-39-SI and PDQ-8-SI provide similar values and respond in a similar way to changes. Subsequently, we calculated the MCID thresholds. The most optimal estimates for MCID thresholds for PDQ-39-SI were -4.72 and +4.22 for detecting minimal clinically important improvement and worsening. For PDQ-8-SI, these estimates were -5.94 and +4.91 points for detecting minimal clinically important improvement and worsening respectively.
Our study is the first one that directly compared the MCID estimates for both PDQ-39-SI and PDQ-8-SI on a large pool of patients including all disease severity stages. These MICD estimates varied across PD severity.
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