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Martinez-Martin P.,Carlos III Institute of Health | Martinez-Martin P.,CIBER ISCIII | Lyons K.E.,University of Kansas Medical Center | Rodriguez-Blazquez C.,CIBER ISCIII | And 9 more authors.
Movement Disorders | Year: 2011

Health-related quality of life is an important patient-reported outcome used in intervention trials and for monitoring the consequences of health status on physical, mental, and social domains. Parkinson's disease is a complex disorder that strongly affects patients' quality of life. Several health-related quality of life tools have been used in Parkinson's disease. A Movement Disorder Society Task Force was commissioned to rate the psychometric quality of available health-related quality of life scales as applied to Parkinson's disease. Following the methodology adopted by previous work of the Movement Disorder Society Task Force, a review of generic and specific health-related quality of life scales applied in studies on Parkinson's disease was completed. Considering the scales from 3 perspectives-use in Parkinson's disease, use by multiple research groups, and clinimetric properties-a final classification as "recommended," "suggested," or "listed" was applied to each reviewed instrument. Four generic scales (EuroQoL, Nottingham Health Profile, 36-Item Short-Form Health Survey, and Sickness Impact Profile) and 5 specific scales (39-Item Parkinson's Disease Questionnaire, Parkinson's Disease Questionnaire Short Form, Parkinson's Disease Quality of Life Questionnaire, Parkinson's Impact Scale, and Scales for Outcomes in Parkinson's Disease-Psychosocial) reached the level of "recommended." The 39-item Parkinson's Disease Questionnaire is the most thoroughly tested and applied questionnaire. Three other generic measures (Quality of Life Questionnaire 15D, Schedule for the Evaluation of Individual Quality of Life-Direct Weighting, and World Health Organization Quality of Life Assessment Short Version) and the specific Parkinson's Disease Quality of Life Scale are "suggested." With a little additional effort in completing the stipulated requirements, they could reach the "recommended" level. At present there is a wide variety of health-related quality of life measures for application in the Parkinson's disease setting, and the task force does not recommend the development of a new scale. Selection of the most appropriate instrument for a particular objective requires consideration of the characteristics of each scale and the goals of the assessment. © 2011 Movement Disorder Society. Source

Antonini A.,IRCCS San Camillo | Martinez-Martin P.,CIBER ISCIII | Chaudhuri R.K.,Kings College | Merello M.,Movement Disorders Section. FLENI. Buenos Aires | And 11 more authors.
Movement Disorders | Year: 2011

Wearing-off occurs in the majority of patients with Parkinson's disease after a few years of dopaminergic therapy. Because a variety of scales have been used to estimate wearing-off, the Movement Disorder Society commissioned a task force to assess their clinimetric properties. A systematic review was conducted to identify wearing-off scales that have either been validated or used in Parkinson's patients. A scale was designated "Recommended" if it had been used in clinical studies beyond the group that developed it, if it had been specifically used in Parkinson's disease reports, and if clinimetric studies had established that it is valid, reliable, and sensitive. "Suggested" scales met 2 of the above criteria, and those meeting 1 were "Listed." We identified 3 diagnostic and 4 severity rating scales for wearing-off quantification. Two questionnaires met the criteria to be Recommended for diagnostic screening (questionnaires for 19 and 9 items), and 1 was Suggested (questionnaire for 32 items). Only the patient diaries were Recommended to assess wearing-off severity, with the caveat of relatively limited knowledge of validity. Among the other severity assessment tools, the Unified Parkinson Disease Rating Scale version 3 and the version revised from the Movement Disorders Society were classified as Suggested, whereas the Treatment Response Scale was Listed. © 2011 Movement Disorder Society. Source

Semmar N.,Laboratoire Of Pharmacologie Medicale Et Clinique | Semmar N.,Institute Superieur Des Science Biologiques Appliquees Of Tunis Issbat
Chemical Biology and Drug Design | Year: 2010

The flexibility of metabolic systems implies a high variability of metabolic profiles linked to different regulation ratios between metabolites. Such regulations are controlled by several interactive metabolic pathways resulting in multidirectional continuums of metabolic profiles. This article presents a new metabolomic approach helping to graphically analyse the flexibility of metabolic regulation systems. Its principle consists in extracting a metabolic backbone from iterative combinations of metabolic profiles representing different metabolic trends. The iterated combinations were performed on the basis of Scheffe matrix then averaged to calculate a response matrix of smoothed metabolic profiles. From such a smoothed matrix, a graphical analysis of relationships between metabolites highlighted different scale-dependent variation paths responsible for the observed metabolic trends. Such a flexibility favouring some metabolites at the expense of others was indirectly checked by a single kinetic approach by considering both the variation of maximal concentrations and the metabolic trends in time. This kinetic approach highlighted a succession of metabolic trends linked to the variation of maximal concentrations in time. Finally, a delayed regulation of a metabolite was highlighted both by the kinetic approach and by a dynamic application of the metabolomic approach. This new approach was illustrated on a dataset of blood concentrations of levodopa and its metabolites analysed in 34 patients at different times. © 2009 John Wiley & Sons A/S. Source

Dodel R.,University of Marburg | Jonsson B.,Stockholm School of Economics | Reese J.P.,University of Marburg | Winter Y.,University of Marburg | And 11 more authors.
Movement Disorders | Year: 2014

Health economic studies in Parkinson's disease (PD) have become increasingly common in recent years. Because several methodologies and instruments have been used to assess cost and outcomes in PD, the Movement Disorder Society (MDS) commissioned a Task Force to assess their properties and make recommendations regarding their use. A systematic literature review was conducted to explore the use of those instruments in PD and to determine which should be selected for this review. We assessed approaches to evaluate cost of illness (COI), cost effectiveness, and cost utilities, which include the use of direct (standard gamble, time trade-off. and visual analogue scales) and indirect instruments to measure health status and utilities. No validated instruments/models were identified for the evaluation of COI or cost-effectiveness in patients with PD; therefore, no instruments in this group are recommended. Among utility instruments, only a few of these outcome instruments have been used in the PD population, and only limited psychometric data are available for these instruments with respect to PD. Because psychometric data for further utility instruments in conditions other than PD already exist, the standard gamble and time trade-off methods and the EQ-5D (a European quality-of-life health states instrument) and Health Utility Index instruments met the criteria for scales that are "recommended (with limitations)," but only the EQ-5D has been assessed in detail in PD patients. The MDS Task Force recommends further study of these instruments in the PD population to establish core psychometric properties. For the assessment of COI, the Task Force considers the development of a COI instrument specifically for PD, like that available for Alzheimer's disease. © 2013 Movement Disorder Society. Source

Guilhaumou R.,Aix - Marseille University | Guilhaumou R.,Laboratoire Of Pharmacocinetique Et Toxicologie | Guilhaumou R.,Laboratoire Of Pharmacologie Medicale Et Clinique | Solas C.,Aix - Marseille University | And 8 more authors.
Cancer Chemotherapy and Pharmacology | Year: 2011

Purpose: The aim of this study was to investigate the impact of plasma and intracellular exposure and CYP3A4, CYP3A5, and ABCB1 polymorphisms on vincristine neurotoxicity. We subsequently assessed the impact of ABCB1 polymorphisms on intracellular vincristine accumulation. Methods: Children treated for solid tumors were enrolled in the study (n = 26) and received 1.5 mg/m2 of vincristine per course. Individual pharmacokinetic parameters and CYP3A4, CYP3A5, and ABCB1 genotypes were available from a previous analysis. A global toxicity score (pain, peripheral neurotoxicity, and gastrointestinal toxicity) was collected at each course. Vincristine in plasma and PBMCs were quantified by LC-MS/MS. Results: Vincristine plasma and intracellular concentrations ranged from 0.40 to 89.6 ng/ml and from 0.00225 to 1.85 ng/10 6 cells over a 24-h interval, respectively. The global toxicity score ranged from 0 to 6 and was not correlated with individual pharmacokinetics parameters. Neurotoxicity events (global score ≥3) were observed in 8 patients but the incidence was not influenced by the different studied polymorphisms. The global toxicity score was correlated with age, body surface area, and dose in mg. A trend to higher intracellular/plasma ratio of vincristine was found for patients with heterozygous diplotype (CGC-TTT) of ABCB1. Conclusions: None of the different genetic covariates nor plasma and intracellular exposure was predictive of the observed neurotoxicity in our pediatric population. Nevertheless, the heterozygote diplotype of ABCB1 appears to influence the intracellular accumulation of vincristine. Owing to the small sample size, further evaluations are needed in a larger patient cohort. © 2011 Springer-Verlag. Source

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