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J Kulisevsky

Publications and source records attributed to J Kulisevsky.

82 records · Page 5Linked to original sources
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[Dopamine agonists situation in Parkinson disease].

The development of a variety of side effects associated with long term treatment of Parkinson s disease has prompted the introduction of new drugs and new treatment strategies. The use of dopamine agonists in combination with levodopa has proved to be useful in advanced patients with motor fluctuations. Recent studies indicate that the use of dopamine agonists in monotherapy from the early stages of the disease can be as effective as levodopa for clinical improvement with the added advantage of a significant less presentation of diskinesias. Ropinirol the first dopaminergic agonist demonstrating this effect in a 5 year controlled study, has well tolerance, both in combination or in monotherapy. Although low doses can be useful for individual patients, doses of approximately 15 16 mg/day proved to be safe and effective in long term studies.

Antiparkinson Agents↗
PubMedDate not supplied

[Weight gain after functional surgery for Parkinsons disease].

BACKGROUND: The origin of weight gain after functional surgery for Parkinson's disease (PD) is incompletely known. We have done a prospective study to determine the possible causes of weight gain after pallidal and subthalamic surgery. PATIENTS AND METHOD: Twenty-seven patients were studied (9 unilateral pallidotomy, 9 bilateral deep brain stimulation (DBS) of palidum, and 9 bilateral DBS of suthalamic nucleus) with a follow-up of 12 months. The relationship between weight gain and changes in motor situation, levodopa dosage, dyskinesias, dysphagia and mood state were analyzed. The patients filled a questionnaire about the severity and etiology of weight gain. RESULTS: Weight gain was noted in 26 patients (mean of 4.7 kg at 12 months). It was found a significant correlation between weight gain and improvement of dyskinesias (AIMS) (r = 0.461; p = 0.023), the scores of the UPDRS part III, (r = 0.479; p = 0.028), and a significant inverse correlation with the pre-operative weight of the patient (r = 0.399; p = 0.050). Weight gain was most pronounced with bilateral than unilateral pallidal surgery (p = 0.021). The majority of patients referred weight gain as an slight adverse event and secondary to the improvement of dyskinesias. CONCLUSION: Functional surgery for PD, independently of the surgical target, provokes weight gain which is benign in the majority of cases. Reduction of energy expenditure with respect to the pre-operative situation would be the responsible of that phenomenon.

Globus Pallidus↗
PubMedDate not supplied

[Sustained attention in the preclinical phase of Alzheimer's disease].

INTRODUCTION: Deterioration of attention in the preclinical phase of dementia of Alzheimer s type (DAT) is not very well known neither available studies are conclusive. OBJECTIVE: We outline if would be possible to identify a deficit of sustained attention in preclinical phase of DAT and if this attentional dysfunction could help to identify those patients, referred by subjective memory complaints (SMC), who will progress in a few years to DAT. PATIENTS AND METHODS: We compared basal exploration in a task of sustained attention (CPT) of 70 patients referred by SMC and followed longitudinally for 2 years. Twenty seven patients developed probable DAT and forty three remained clinically stable. RESULTS: Patients who will be diagnosed 2 years later with DAT performed significantly more poorly than patients who did not develop DAT. Patients who will be diagnosed 2 years later with DAT made a higher number of omission errors and obtained a lower number of correct responses. CONCLUSION: CPT paradigm is a vigilance task that detects deterioration of sustained attention in the preclinical phase of DAT and could be an objective indicator of the cognitive decline in the preclinical phase of Alzheimer s disease.

Activities of Daily Living↗
PubMedDate not supplied

[Validation of the translation to Catalan and Spanish of cognitive evoked potential N400].

INTRODUCTION: The cognitive evoked potential N400 permits an objective assessment of the verbal semantic processing. It has been suspected to be clinically useful in cognitive abnormalities and a correlation with attentional and memory functions has been found. The present study tries to validate the translation and adaptation of the English paradigm to the Catalan and Spanish languages. METHOD: The study was performed on 16 healthy volunteers with Catalan native language and 16 volunteers with Spanish native language. Three blocks of 50 sentences (4-9 words) were administered using headphones. The last word of 50 % of the sentences was incongruent. The beginning of this word was the trigger for the EEG average. EEG leads used were: Fz, Cz, Pz, C3, C4, T3, T4 with biauricular reference. The measures were amplitude and latency of the potential obtained after the subtraction of the EEG average of congruent and incongruent sentences. A t-test for one sample (the original potential) was applied. RESULTS: Amplitude and latency of the potential obtained by the Catalan and Spanish languages were not result statistically different from the original potential. The major amplitude was obtained in Cz. Mean amplitudes: Catalan language: 5.3 2.3 V (95 % CI for the difference: 0.39 2.12 V); Spanish language: 5.2 2.3 V (95 % CI for the difference: 0.43 2.32 V). CONCLUSIONS: The Catalan and Spanish version of the N400 evoked potential offer the possibility to use an objective instrument for the study of language in neuroscience.

Adult↗
PubMedDate not supplied

[Psychogenic tremor: clinical, electrophysiologic and psychopathologic assessment].

There are few studies analyzing the incidence, clinical characteristics and diagnostic work-up of psychogenic tremor. We studied the clinical and electrophysiological characteristics and the associated psychopathology in a series of patients with psychogenic tremor. All patients (n = 8) diagnosed with documented or clinically established psychogenic tremor in the movement disorders section of our Department of Neurology in a two-years period were analysed. Psychogenic tremor was diagnosed in 9.5% of the patients that consulted for postural or action tremor of the upper limbs. In all cases tremor had a variable frequency and amplitude and improvement with distraction. Electrophysiological studies revealed asynchronic muscle activity and considerable variation of the dominant frequency when weight was added to the patient hands. Six patients were initially misdiagnosed of essential tremor (n = 3); Parkinson's disease (n = 1); and cerebrovascular disease (n = 2). Final psychiatric diagnoses were depression (n = 4); conversive disorder (n = 2); and malignering (n = 2). Psychogenic tremor is a relatively frequent cause of tremor in a Movement Disorders Clinic and has a characteristic clinical and electrophysiological pattern.

Adult↗
PubMedDate not supplied

A six-month study of pergolide and levodopa in de novo Parkinson's disease patients.

Formal studies examining the antiparkinsonian efficacy of levodopa and pergolide monotherapy in de novo Parkinson's disease (PD) are lacking. The authors conducted a preliminary, 6-month, open-label parallel experimental study with de novo consecutive PD patients who were randomly assigned to three daily doses of pergolide (n = 10; mean age, 63.7 years; mean Hohen & Yahr score, 1.5; mean final dose, 2.8 mg daily) or levodopa (n = 10; mean age, 67.3 years; mean Hohen & Yahr score, 1.8; mean final dose, 435 mg daily). Doses were titrated individually according to patients' evaluation of their own functional ability, known side-effects, and a monthly administration of the Unified Parkinson's Disease Rating Scale (UPDRS) by a clinician blind to the treatment regime. All patients completed the study. There were no significant basal differences between groups and no significant treatment ortreatment-by-time effects in UPDRS scores (according to two-way ANOVA). A clear time effect was observed for most of the functional and motor variables (p < 0.001), with significant improvement during the first month that was maintained for the duration of the study in both groups. Side effects were mild, transient, and comparable. In this preliminary study, pergolide and levodopa exhibited similar symptomatic efficacy and incidence of side effects in the short-term treatment of de novo PD patients at their usual age of clinical manifestation.

Adult↗