Objective To evaluate the effectiveness of repetitive transcranial magnetic stimulation (rTMS) for treating dysfunction in patients with Parkinson’s disease (PD). Methods We searched the Cochrane Library (Issue 1, 2010), MEDLINE, EMbase, CBMdisc, and CNKI from the date of the database establishment to April 2010. Randomized controlled trials (RCTs) of rTMS for patients with PD were collected. The quality of the included RCTs was critically appraised and data were extracted by two reviewers independently. Meta-analyses were conducted for the eligible RCTs. Results Eight RCTs were included. The pooled results of the first 2 RCTs showed that, there was no significant difference compared with control group about treating PD patients with clinical motor dysfunction by high-frequency rTMS 10 days later (WMD= –4.75, 95%CI –13.73 to 4.23). The pooled analysis of another 3 studies showed that, no significant difference were found about improving symptoms with treatment of low-frequency rTMS for 1 month compared with control group (WDM= –8.51, 95%CI –18.48 to 1.46). The pooled analysis of last 3 studies showed that, patient with treatment of low-frequency rTMS for 3 months, had been significantly improved in clinical symptoms such as neurological, behavior and emotional state, clinical motor function, and activities of daily living (WDM= –5.79, 95%CI –8.44 to –1.13). The frontal or motor cortex rTMS manifested as low frequency (≤1Hz), high intensity (≥90% RMT), multi-frequency (≥3 times) and long time (≥3 months) had a positive effect on the clinical symptoms of patients with PD and also had a long-term effect. Conclusions rTMS can improve clinical symptoms and dysfunction of the patients with PD.
The application of dopamine agonists in Parkinson’s disease has been a hot topic in recent years. Can dopamine receptor agonists serve as the initial drugs for Parkinson’s disease? Does it improve the natural history of patients? Has it neuroprotective role? When and how to use dopamine receptor agonists? This article provides evidence on the pros and cons of dopamine receptor agonists in the treatment of Parkinson’s disease for helping clinical decision making.
Objective To investigate the association between parkin gene S/N167 polymorphism and the risk for Parkinson’s Disease (PD) using the methods of meta-analysis. Method References were retrieved through the computerized Medline, Cochrane Library and CBM search from 1998 to 2003. Similar search strategies were applied to each of these databases. The unpublished data of our study were also included.Studies eligible for this meta-analysis should meet the following inclusion criterias: ① presentation of original data and a cross-sectional design. ② PD as the outcome of interest. ③ an odds ratio (or enough information to calculate it) reported to quantify the association between the frequencies of genotypes and alleles of parkin gene S/N167 polymorphism and the risk for PD. All analyses were conducted with ’Review Manager’ Version 4.2 software. Results A total of 1 239 PD patients and 1 168 control studies were studied. The combined data statistics revealed the frequencies of the genotypes and alleles were higher, but showed no statistically difference, for the total PD group from that ofthe control group (Z=1.57, P=0.12). After stratification according to eastern or western origin, the frequencies of G/A+A/A genotype and a allele of eastern origin were significantly higher [test for overall effect: P=0.01, OR=1.41, 95%CI= (1.08 to1.83); P=0.01, OR=1.25, 95%CI= (1.08 to1.44), respectively] in the PD group than that in the control group. After including our unpublished data, the results remained constant, and the trend was much more pronounced. Conversely, there was no difference [test for overall effect: P=0.08, OR=0.55, 95%CI= (0.30 to1.02); P=0.08, OR=0.55, 95%CI= (0.28 to1.08)] in the frequencies of allele and genotype of western origin between the PD patients and the controls. Conclusions The meta-analysis suggests that the parkin gene S/N167 polymorphism might be a genetic risk factor for PD of eastern origin, but not a definite risk for PD of western origin.
Evidence has been retrieved through MEDLINE and Cochrane Libray about the treatment for patients with advanced Parkinson’s disease who suffered from on-off, dyskinesia and depression after chronic use of L-dopa. All of the evidence has been evaluated. Methods of evidence-based treatment were drawn up according to the evidence, clinciams’ experiences and patients’ preferences. All symptoms of the patient have been improved obviously.
The dysfunction of subthalamic nucleus is the main cause of Parkinson’s disease. Local field potentials in human subthalamic nucleus contain rich physiological information. The present study aimed to quantify the oscillatory and dynamic characteristics of local field potentials of subthalamic nucleus, and their modulation by the medication therapy for Parkinson’s disease. The subthalamic nucleus local field potentials were recorded from patients with Parkinson’s disease at the states of on and off medication. The oscillatory features were characterised with the power spectral analysis. Furthermore, the dynamic features were characterised with time-frequency analysis and the coefficient of variation measure of the time-variant power at each frequency. There was a dominant peak at low beta band with medication off. The medication significantly suppressed the low beta component and increased the theta component. The amplitude fluctuation of neural oscillations was measured by the coefficient of variation. The coefficient of variation in 4-7 Hz and 60-66 Hz was increased by medication. These effects proved that medication had significant modulation to subthalamic nucleus neural oscillatory synchronization and dynamic features. The subthalamic nucleus neural activities tend towards stable state under medication. The findings would provide quantitative biomarkers for studying the mechanisms of Parkinson’s disease and clinical treatments of medication or deep brain stimulation.
Objective To systematically review the efficacy and safety of CoenzymeQ10 for Parkinson’s disease. Methods Databases including PubMed, The Cochrane Library (Issue 1, 2015), EMbase, CBM, CNKI, WanFang Data and VIP were searched from inception to August 2015, to collect randomized controlled trials (RCTs) about CoenzymeQ10 for Parkinson’s disease. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then meta-analysis was performed using RevMan 5.3 software. Results A total of 5 RCTs involving 981 patients were included. The results of meta-analysis showed that, a) As for recently effectiveness, CoenzymeQ10 2 400 mg group was superior to the placebo group in total UPDRS score change (MD=1.09, 95%CI 0.94 to 1.24, P < 0.000 01), UPDRS-I score change (MD=0.19, 95%CI 0.17 to 0.21, P < 0.000 01), UPDRS-II score change (MD=0.27, 95%CI 0.21 to 0.32, P < 0.000 01), UPDRS-III score change (MD=0.65, 95%CI 0.54 to 0.76, P < 0.000 01), Hoehn & Yahr score change (MD=0.05, 95%CI 0.04 to 0.06, P < 0.000 01), and Schwab England score change (MD= –0.87, 95%CI –1.02 to –0.72, P < 0.000 01). b) As for long-term effectiveness, there were no differences between two groups, except that the UPDRS-II score change of CoenzymeQ10 1 200 mg group was superior to the placebo group. c) As for adverse reactions, there were no statistical differences between two groups except that the incidence of cholesterol of the CoenzymeQ10 600 mg group and incidence of diarrhea of the CoenzymeQ10 2 400 mg group were lower than that of the placebo group. Conclusion Current evidence shows that, the dosage of 2 400 mg/d CoenzymeQ10 is effective and safe for early Parkinson’s disease. Due to the limited quality and quantity of included studies, more higher quality studies are needed to verify the above conclusion.
1-methyl-6,7-dihydroxy-1,2,3,4-tetrahydroisoquinoline (Sal) is a kind of catechol isoquinoline compound, which mainly exists in mammalian brain and performs a variety of biological functions. Through in vivo metabolism, Sal can be transformed into endogenous neurotoxins and can participate the occurrence of Parkinson’s disease (PD). This has attracted widespread concern of researchers. Recently, many research works have shown that Sal may lead to alcohol addiction and regulate hormone release of the neuroendocrine system, which indicated that it is a potential regulator of dopaminergic neurons. In this paper, we discuss the neural functions of Sal on the above aspects, and wish to provide some theoretical supports for further research on its mechanism.
Diagnosis of Parkinson’s disease (PD) based on speech data has been proved to be an effective way in recent years. However, current researches just care about the feature extraction and classifier design, and do not consider the instance selection. Former research by authors showed that the instance selection can lead to improvement on classification accuracy. However, no attention is paid on the relationship between speech sample and feature until now. Therefore, a new diagnosis algorithm of PD is proposed in this paper by simultaneously selecting speech sample and feature based on relevant feature weighting algorithm and multiple kernel method, so as to find their synergy effects, thereby improving classification accuracy. Experimental results showed that this proposed algorithm obtained apparent improvement on classification accuracy. It can obtain mean classification accuracy of 82.5%, which was 30.5% higher than the relevant algorithm. Besides, the proposed algorithm detected the synergy effects of speech sample and feature, which is valuable for speech marker extraction.
Motor dysfunction is the main clinical symptom and diagnosis basis of patients with Parkinson’s disease (PD). A total of 30 subjects were recruited in this study, including 15 PD patients (PD group) and 15 healthy subjects (control group). Then 5 wearable inertial sensor nodes were worn on the bilateral upper limbs, lower limbs and waist of subjects. When completing the 6 paradigm tasks, the acceleration and angular velocity signals from different parts of the body were acquired and analyzed to obtain 20 quantitative parameters which contain information about the amplitude, frequency, and fatigue degree of movements to assess the motor function. The clinical data of the two groups were statistically analyzed and compared, and then Back Propagation (BP) Neural Network was used to classify the two groups and predict the clinical score. The final results showed that most of the parameters had significant difference between the two groups, ten times of 5-fold cross validation showed that the classification accuracy of the BP Neural Network for the two groups was 90%, and the predictive accuracy of Hoehn-Yahr (H-Y) staging and unified PD rating scale (UPDRS) Ⅲ score of the patients were 72.80% and 68.64%, respectively. This study shows the feasibility of quantitative assessment of motor function in PD patients using wearable sensors, and the quantitative parameters obtained in this paper may have reference value for future related research.
At present the parkinsonian rigidity assessment depends on subjective judgment of neurologists according to their experience. This study presents a parkinsonian rigidity quantification system based on the electromechanical driving device and mechanical impedance measurement method. The quantification system applies the electromechanical driving device to perform the rigidity clinical assessment tasks (flexion-extension movements) in Parkinson’s disease (PD) patients, which captures their motion and biomechanical information synchronously. Qualified rigidity features were obtained through statistical analysis method such as least-squares parameter estimation. By comparing the judgments from both the parkinsonian rigidity quantification system and neurologists, correlation analysis was performed to find the optimal quantitative feature. Clinical experiments showed that the mechanical impedance has the best correlation (Pearson correlation coefficient r = 0.872, P < 0.001) with the clinical unified Parkinson’s disease rating scale (UPDRS) rigidity score. Results confirmed that this measurement system is capable of quantifying parkinsonian rigidity with advantages of simple operation and effective assessment. In addition, the mechanical impedance can be adopted to help doctors to diagnose and monitor parkinsonian rigidity objectively and accurately.