Every silver lining has a cloud.
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Angioplasty↗
Biomedical subjects
Joseph H Friedman
Publications and source records attributed to Joseph H Friedman.
The surgeon general: why not have one?
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Health Policy↗
Ophthalmologic features of Parkinson's disease.
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Aged↗
Botulinum toxin type B for gait freezing in Parkinson's disease.
BACKGROUND: Freezing of Gait (FOG) can be a serious problem in Parkinson's disease (PD) and is usually refractory to medical treatment. Botulinum toxin (BTX) type A has been reported to relieve FOG in small open label studies. MATERIAL/METHODS: We performed a double-blind, placebo-controlled, parallel-group study using BTX-B injections on the soleus-gastrocnemius muscle complex of the predominantly affected leg in freezing. Patients were evaluated at baseline and monthly thereafter until endpoint was reached. UPDRS parts II and III, Visual Analog Scale (VAS), Clinical Global Impression Scale (CGIS) and Modified Webster Step-Seconds test were the used to measure efficacy. RESULTS: 14 out of 17 patients screened with idiopathic PD and FOG refractory to medical treatment met inclusion criteria for the study. 9 patients were randomized to 5,000 U of BTX-B treatment and 5 patients to placebo. Our cohort had a mean age of 74 years, and average PD duration of 10 years. Based on the CGIS, 1 patient was much improved, 2 patients had minimal improvement, 9 were unchanged from baseline and 2 were minimally worse. There was no significant difference between the treatment and placebo arms in the number of patients improved versus unchanged. There were no significant differences between the treatment and placebo arms in the UPDRS II and III, VAS, or Modified Webster Step-Seconds scores between the treatment and placebo arms, at baseline and after treatment. CONCLUSIONS: 5,000 U of BTX-B injected in one leg did not significantly improve FOG. However, since the power of the study was low, a small beneficial effect may have been missed.
Aged↗
Genetic markers and the majority's right not to know.
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Ethics, Medical↗
Long-term outcome of clozapine use for psychosis in parkinsonian patients.
A retrospective analysis was carried out on 39 parkinsonian patients on clozapine treatment >/=24 months for psychosis. The cohort had a mean age of 76 years and an average clozapine dose of 47 mg/day over 60 months of clozapine use. Of 39 patients, 13 (33%) patients were eventually admitted to nursing homes, 6 (46%) of whom died over a period of 5 years. The overall 5-year mortality rate in this cohort was 44% (17/39). Of 39 patients, 33 (85%) had continued partial/good response and 5 (13%) had complete resolution of psychosis. None discontinued clozapine due to motor worsening. Among patients who responded early on, the long-term efficacy of clozapine for psychosis was sustained. The risk of nursing home placement and mortality among parkinsonian patients treated with clozapine for psychosis in this geriatric cohort was better than that reported previously. Our data are more consistent with recently published long-term outcome data suggesting an improvement in the prognosis of parkinsonian patients with psychosis with the use of atypical antipsychotic agents such as clozapine.
Aged↗
Hemiballismus from a parietal stroke in a Parkinson patient.
Stroke-induced hemiballismus (HB) has been reported to improve motor function in people with Parkinson's disease (PD). We report on a patient who developed HB from a parietal infarct. The HB was improved by very low-dose clozapine but the HB did not improve the parkinsonism. This suggests that HB itself, whether from a lesion in the subthalamic nucleus or elsewhere, is not what improves motor function in PD; instead, the physiological function of the damaged structure is the determining factor.
Aged↗
Sleep and fatigue in Parkinson's disease.
Sleep disorders and fatigue are common problems in Parkinson's disease (PD). Although they frequently appear together, they are often distinct symptoms that must be understood separately. Fatigue has been reported to be the most bothersome aspect of PD in about one-third of patients, yet it is poorly understood and not clearly treatable. Sleep disorders, while more common, are less bothersome to the patients and often responsive to therapy. An overview of sleep disorders in PD and an approach to therapy will also be outlined. The little that is known about fatigue in PD will be reviewed.
Animals↗
Diabetes mellitus among parkinsonian patients treated chronically with clozapine.
Clozapine is the gold standard treatment for Parkinson's disease (PD) psychosis based on double blinded, placebo controlled trials, and has also been shown to alleviate tremor and dyskinesia. There is accumulating data suggesting that clozapine may be associated with increased frequency of diabetes mellitus (DM) compared to conventional neuroleptic drugs in treating schizophrenia. Forty-four predominantly geriatric parkinsonian subjects on clozapine for psychosis, tremor or dyskinesia, on an average dose of 50.6 mg/d for a mean duration of 41 months were reviewed. The prevalence of DM in this cohort was 18.1% (8/44). This rate was similar to that reported in the aged-matched general population (prevalence = 19.3% for ages > or = 60 years). In this small study, parkinsonian patients on long-term, low dose clozapine were not at increased risk for developing DM. Larger controlled prospective studies are needed to confirm this.
Adult↗
Parkinsonism in a nursing home: underrecognition.
Parkinsonism is a very common condition in the elderly, particularly the elderly demented. The authors' experience in both the in-and outpatient settings suggested that parkinsonism was generally underdiagnosed in the elderly. They evaluated the residents at a local nursing home to assess for parkinsonian signs. They then compared the findings to those noted in the charts. Blinded assessment of all nursing home residents for signs of parkinsonism was performed. A standardized evaluation instrument was used, followed by a chart review to determine if patients were taking medications that might induce the parkinsonism and whether the parkinsonism had been recognized. The authors looked separately at those patients receiving antipsychotics because of their increased risk. Twenty-seven out of 100 residents had "probable" parkinsonism, 12 of whom were severe, and 33 had "possible" parkinsonism. Of 27 residents on antipsychotics, 23 showed parkinsonian features versus 43 of 73 not on such drugs (P<.02). Only 1 patient with drug-induced parkinsonism and 3 residents with previously diagnosed Parkinson's disease had chart notes indicating that parkinsonism had been recognized.
Accidental Falls↗
It's all in your head.
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Dystonic Disorders↗
Historical perspective on movement disorders.
Before atypical antipsychotics were developed, neuroleptics given to patients for the treatment of psychosis often caused movement disorders. Although the role of neuroleptics in the development of tardive dyskinesia was never certain, this adverse effect was of great concern to physicians because its effects could be irreversible and devastating to the patient. It is important to understand whether involuntary movement disorders are an intrinsic part of schizophrenia, because if so, then a certain percentage of patients will develop the dyskinetic syndromes whether they are treated or not. To uncover the role of antipsychotic medications in tardive dyskinesia, it is necessary to examine the descriptions of abnormal movements made by those who were first researching schizophrenia, as well as modern descriptions of neuroleptic-naïve individuals with schizophrenia. The physicians who initially described the syndrome of tardive dyskinesia had observed pre-neuroleptic schizophrenia first hand and saw a difference in the movements of treated and untreated patients. Nevertheless, the idea of a chronic movement disorder caused by treatment with neuroleptics would become controversial for many years. With the development of the atypical antipsychotics, the incidence and prevalence of tardive dyskinesia have dropped remarkably, suggesting that psychosis, its treatment, and dyskinesias are not inextricably linked.
Antipsychotic Agents↗
Ignorance is bliss? An ethical question.
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Age of Onset↗