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Sutton A.C.,Albany Medical College | Yu W.,Albany Medical College | Calos M.E.,Albany Medical College | Smith A.B.,Albany Medical College | And 7 more authors.
Journal of Neurophysiology | Year: 2013

Deep brain stimulation (DBS) employing high-frequency stimulation (HFS) is commonly used in the globus pallidus interna (GPi) and the subthalamic nucleus (STN) for treating motor symptoms of patients with Parkinson's disease (PD). Although DBS improves motor function in most PD patients, disease progression and stimulation-induced nonmotor complications limit DBS in these areas. In this study, we assessed whether stimulation of the substantia nigra pars reticulata (SNr) improved motor function. Hemiparkinsonian rats predominantly touched with their unimpaired forepaw >90% of the time in the stepping and limb-use asymmetry tests. After SNr-HFS (150 Hz), rats touched equally with both forepaws, similar to naive and shamlesioned rats. In vivo, SNr-HFS decreased beta oscillations (12-30 Hz) in the SNr of freely moving hemiparkinsonian rats and decreased SNr neuronal spiking activity from 28 ± 1.9 Hz before stimulation to 0.8 ± 1.9 Hz during DBS in anesthetized animals; also, neuronal spiking activity increased from 7 ± 1.6 to 18 ± 1.6 Hz in the ventromedial portion of the thalamus (VM), the primary SNr efferent. In addition, HFS of the SNr in brain slices from normal and reserpinetreated rat pups resulted in a depolarization block of SNr neuronal activity. We demonstrate improvement of forelimb akinesia with SNr-HFS and suggest that this motor effect may have resulted from the attenuation of SNr neuronal activity, decreased SNr beta oscillations, and increased activity of VM thalamic neurons, suggesting that the SNr may be a plausible DBS target for treating motor symptoms of DBS. © 2013 the American Physiological Society.


Fietzek U.M.,Center for Parkinsons Disease and Movement Disorders | Schroeteler F.E.,Center for Parkinsons Disease and Movement Disorders | Ziegler K.,Center for Parkinsons Disease and Movement Disorders | Zwosta J.,Center for Parkinsons Disease and Movement Disorders | Ceballos-Baumann A.O.,Center for Parkinsons Disease and Movement Disorders
Clinical Rehabilitation | Year: 2014

Objective: To investigate the efficacy of a two-week programme of repetitive exercise with cueing and movement strategies upon freezing of gait in people with Parkinson's disease. Design: Randomized cross-over trial. Setting: Specialist clinic for Parkinson's disease. Subjects: A total of 22 patients with Parkinson's disease and freezing while other symptoms had favorably responded to dopaminergic treatment. Intervention: Patients were randomized into a four-week cross-over trial, and received either treatment (Group 1) or no treatment (Group 2) during Period 1, and switched during Period 2. Treatment consisted of a two-week programme during which the patients exercised cueing, and movement strategies together with a physiotherapist. Main measure: The primary outcome measure was a freezing score assessed from blinded and random ratings of video recordings. The secondary outcome measure was a patient-reported freezing questionnaire. Mean differences between the treatment periods (treatment arms) were evaluated for treatment (period) effects. Sums of treatment periods were evaluated for carry-over effects. Results: The programme led to a significant treatment effect in the freezing score of 3.0 improvement (95% confidence interval 0.9-5.0; p < 0.01). No carry-over or period effects were detected. The questionnaire revealed a period effect, so groups were compared after Period 1, where a significant difference was found (15.0 vs. 11.7; p < 0.05). Conclusions: The two-week physiotherapy programme reduced the severity of freezing in patients with Parkinson's disease. © The Author(s) 2014.


Fietzek U.M.,Center for Parkinsons Disease and Movement Disorders | Schroeder A.S.,Ludwig Maximilians University of Munich | Wissel J.,Neurologische Rehabilitationsklinik | Heinen F.,Ludwig Maximilians University of Munich | And 2 more authors.
Movement Disorders | Year: 2010

A standardization of injection procedures for the various botulinum toxin (BoNT) indications has not been achieved to date. One established option to guide the therapist's needle is sonography guidance. It provides real-time visualization of the injection process, which is quick, allows perfect precision, and the procedure as such is painless. To demonstrate these qualities, we have recorded six split-screen video segments that show the handling of the probe and the needle during BoNT injections concurrently with the respective crosssectional sonography recordings. The video sequences show differentiation of the pollicis longus muscle and individual finger flexor fascicles, needle tracking, and real-time sonography-guided injection of the gastrocnemius, rectus femoris, and iliopsoas muscles. We hope this short presentation will help to encourage a more widespread use of the technique as well as further research on sonography guidance for precise delivery of BoNT injections to various target muscles. © 2010 Movement Disorder Society.


Lehnerer S.M.,Center For Parkinsons Disease And Movement Disorders | Fietzek U.M.,Center For Parkinsons Disease And Movement Disorders | Messner M.,Center For Parkinsons Disease And Movement Disorders | Ceballos-Baumann A.O.,Center For Parkinsons Disease And Movement Disorders | Ceballos-Baumann A.O.,TU Munich
Journal of Neural Transmission | Year: 2014

Continuous jejunal levodopa infusion is an increasingly used therapy option in patients with Parkinson’s disease who experience severe fluctuations from oral levodopa. In a number of recent reports polyneuropathy in patients receiving jejunal levodopa infusion was referenced to cobalamin (vitamin B12) deficiency. We describe one of three cases from our hospital with severe subacute polyneuropathy that developed during jejunal levodopa infusion, and occurred despite vitamin substitution therapy and normal vitamin B12 and holotranscobalamin serum levels. © Springer-Verlag Wien 2014.


Fietzek U.M.,Center for Parkinsons Disease and Movement Disorders | Zwosta J.,Center for Parkinsons Disease and Movement Disorders | Schroeteler F.E.,Center for Parkinsons Disease and Movement Disorders | Ziegler K.,Center for Parkinsons Disease and Movement Disorders | And 2 more authors.
Parkinsonism and Related Disorders | Year: 2013

Oral levodopa has been proposed to be one of the more effective medications to alleviate freezing of gait, but there is limited data on its efficacy. We evaluated the gait phenomenology of 20 Parkinson's disease patients with freezing of gait before and 60min after a standardized levodopa dose using a rating scale based on the assumption that festination and akinetic freezing share a common pathophysiology. Levodopa abolished festination and freezing in 20% of patients (p<0.0001), and reduced the freezing sum score from a median of 15 (IQR 6.75-27.5) to 3.5 (1-11.25), p<0.001) in all but one of the remainder. Pre-dose ratings correlated with post-dose ratings, in that those patients with lower pre-dose item-scores also showed lower post-dose outcome scores. Levodopa's effect on both festination and akinetic freezing was linear, thereby supporting the concept that festination and freezing are variants on a continuity of episodic gait disorders in PD. © 2013 Elsevier Ltd.


Hirsch M.A.,Carolinas Rehabilitation | Sanjak M.,Center for Parkinsons Disease and Movement Disorders | Sanjak M.,University of North Carolina at Charlotte | Englert D.,Center for Parkinsons Disease and Movement Disorders | And 2 more authors.
Parkinsonism and Related Disorders | Year: 2014

Increasing physical activity, as part of an active lifestyle, is an important health goal for individuals with Parkinson's disease (PD). Exercise can positively impact health related quality of life. Given this, how can we promote physically active lifestyles among PD patients (most of whom are sedentary)? Here we suggest that health care professionals could significantly expand their impact by collaborating with PD patients and their spouses (or caregivers) as partners-in-care. We outline reasons why partners-in-care approaches are important in PD, including the need to increase social capital, which deals with issues of trust and the value of social networks in linking members of a community. We then present results of a qualitative study involving partners-in-care exercise beliefs among 19 PD patients and spouses, and conclude with our perspective on future benefits of this approach. © 2013 Elsevier Ltd.


Simons J.A.,University of Lübeck | Simons J.A.,Center for Parkinsons Disease and Movement Disorders | Fietzek U.M.,Center for Parkinsons Disease and Movement Disorders | Waldmann A.,University of Lübeck | And 3 more authors.
Parkinsonism and Related Disorders | Year: 2014

Background: Dysphagia in patients with Parkinson's disease (PD) significantly reduces quality of life and predicted lifetime. Current screening procedures are insufficiently evaluated. We aimed to develop and validate a patient-reported outcome questionnaire for early diagnosis of dysphagia in patients with PD. Methods: The two-phased project comprised the questionnaire, diagnostic scales construction (N=105), and a validation study (N=82). Data for the project were gathered from PD patients at a German Movement Disorder Center. For validation purposes, a clinical evaluation focusing on swallowing tests, tests of sensory reflexes, and fiberoptic endoscopic evaluation of swallowing (FEES) was performed that yielded a criteria sum score against which the results of the questionnaire were compared. Specificity and sensitivity were evaluated for the detection of noticeable dysphagia and for the risk of aspiration. Results: The Munich Dysphagia Test - Parkinson's disease (MDT-PD) consists of 26 items that show high internal consistency (α=0.91). For the validation study, 82 patients, aged 70.9±8.7 (mean±SD), with a median Hoehn & Yahr stage of 3, were assessed. 73% of patients had dysphagia with noticeable oropharyngeal symptoms (44%) or with penetration/aspiration (29%). The criteria sum score correlated positively with the screening result (r=0.70, p<0.001). The MDT-PD sum score classified not noticeable dysphagia vs. risk of aspiration (noticeable dysphagia) with a sensitivity of 90% (82%) and a specificity of 86% (71%), and yielded similar results in cross-validation, respectively. Conclusions: MDT-PD is a valid screening tool for early diagnosis of swallowing problems and aspiration risk, as well as initial graduation of dysphagia severity in PD patients. © 2014 Elsevier Ltd.


Ziegler K.,Center for Parkinsons Disease and Movement Disorders | Schroeteler F.,Center for Parkinsons Disease and Movement Disorders | Ceballos-Baumann A.O.,Center for Parkinsons Disease and Movement Disorders | Fietzek U.M.,Center for Parkinsons Disease and Movement Disorders
Movement Disorders | Year: 2010

Festination and freezing of gait (FOG) are sudden episodic inabilities to initiate or sustain locomotion mostly experienced during the later stages of Parkinson's disease (PD) or other higher-level gait disorders. The aim of this study was to develop a clinical rating instrument for short-interval rating of festination and FOG. Foot movements of 33 patients were video taped and rated during 12 episodes in a standardized course on a four-level interval scale according to severity. Motor blocks were provoked in four situations and by three levels of dual-tasking (tasks). Addition of the item scores produced a FOG score. The assessment requires less than 15 min. The inter-rater and re-test reliability of the FOG score is high (Kendall κ = 0.85-0.92, P < 0.0001). Variability of the item scale due to situations and tasks can be attributed to unidimensional group factors (Cronbach's α 0.84 and 0.94). Group comparisons and a logistic regression model show significant effects for both situations and tasks on the item scale (Friedman test: " situation": P < 0.0001, "task": P < 0.0001). Six patients with PD have significantly different scores during mobile (practical ON; 6.2 ± 3.9) and immobile (practical OFF; 15.8 ± 4.6) medication states (P < 0.05). The FOG score correlates with the 10 m number of steps (ρ = 0.58; P = 0.001) and with the self-evaluation of FOG (ρ = 0.51; P < 0.01). Our results encourage the further use of the FOG score to evaluate festination and FOG. © 2010 Movement Disorder Society.


PubMed | TU Munich, University Hospital of Muenster, University of Lübeck and Center for Parkinsons Disease and Movement Disorders
Type: Journal Article | Journal: Parkinsonism & related disorders | Year: 2014

Dysphagia in patients with Parkinsons disease (PD) significantly reduces quality of life and predicted lifetime. Current screening procedures are insufficiently evaluated. We aimed to develop and validate a patient-reported outcome questionnaire for early diagnosis of dysphagia in patients with PD.The two-phased project comprised the questionnaire, diagnostic scales construction (N = 105), and a validation study (N = 82). Data for the project were gathered from PD patients at a German Movement Disorder Center. For validation purposes, a clinical evaluation focusing on swallowing tests, tests of sensory reflexes, and fiberoptic endoscopic evaluation of swallowing (FEES) was performed that yielded a criteria sum score against which the results of the questionnaire were compared. Specificity and sensitivity were evaluated for the detection of noticeable dysphagia and for the risk of aspiration.The Munich Dysphagia Test - Parkinsons disease (MDT-PD) consists of 26 items that show high internal consistency ( = 0.91). For the validation study, 82 patients, aged 70.9 8.7 (mean SD), with a median Hoehn & Yahr stage of 3, were assessed. 73% of patients had dysphagia with noticeable oropharyngeal symptoms (44%) or with penetration/aspiration (29%). The criteria sum score correlated positively with the screening result (r = 0.70, p < 0.001). The MDT-PD sum score classified not noticeable dysphagia vs. risk of aspiration (noticeable dysphagia) with a sensitivity of 90% (82%) and a specificity of 86% (71%), and yielded similar results in cross-validation, respectively.MDT-PD is a valid screening tool for early diagnosis of swallowing problems and aspiration risk, as well as initial graduation of dysphagia severity in PD patients.


PubMed | Center for Parkinsons Disease and Movement Disorders
Type: Journal Article | Journal: Journal of neurology, neurosurgery, and psychiatry | Year: 2012

This review considers novels, plays and poems dealing with movement disorders in order to show the relevance in the literary context. The motifs are arranged and compared following a modern neurological nosology according to Parkinson syndromes, dystonia, myoclonus, tics, hemifacial spasm, Tourette syndrome, Huntingtons disease and hyperekplexia. There is considerable variety in how movement disorders are depicted and how much influence they have on the plot structures. Their usage ranges from a brief reference in order to accentuate aspects of a characters personality or social position, such as in Shakespeare, Dickens, Tolstoy or Galds; to truly constituting one of the plots main themes as, for example, with the representation of Lewy body disease in Franzens The Corrections and Huntingtons disease in Vonneguts Galpagos, Sawyers Frameshift or McEwans Saturday. The symbolic connotation of the disease is of major importance, as is its social and psychological impact. Some 20th century authors transfer rhythm patterns of specific movement disorders into the textual structure, including, among others, Beckett.

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