Amdore Guescel Asano

Quality of Life Related to Swallowing in Parkinson’s Disease

Swallowing difficulties in Parkinson’s disease can result in decreased quality of life. The swallowing quality of life questionnaire (SWAL-QOL) is an instrument for specifically assessing quality of life with respect to swallowing, which has been little explored in patients with Parkinson’s disease (PD). The goal of this study was to evaluate the quality of life with respect to swallowing in persons with PD compared to controls and at several stages of the disease using the SWAL-QOL. The experimental group was composed of 62 persons with PD at stages 1–4. Forty-one age-matched healthy subjects constituted the control group. The SWAL-QOL scores were significantly lower for the patients with PD than for the controls in all SWAL-QOL domains. Eating duration had the largest difference in score between persons with PD and the controls and the lowest mean score, followed by communication, fatigue, fear, sleep, and food selection. The scores of most domains were lower at later stages of the disease. The scores for eating duration, symptom frequency, and sleep were significantly lower at stage 4 than stages 1 and 2. In conclusion, patients with PD have significantly lower scores in all domains of the SWAL-QOL than normal controls. This means swallowing difficulties occurring in patients with PD negatively affect their QOL. Progression of the disease worsens swallowing QOL, more specifically in the domains of eating duration, symptom frequency, and sleep. This occurs mostly at later stages of the disease.

Monitorando a deglutição através da eletromiografia de superfície

OBJETIVO: descrever o metodo de registro da eletromiografia de superficie atraves da utilizacao de um protocolo desenvolvido para o estudo da degluticao e demonstrar a degluticao de um paciente com doenca de Parkinson e de um sujeito normal atraves do registro da eletromiografia de superficie (EMGs). METODOS: para ilustrar os parâmetros eletrofisiologicos registrados apos execucao do protocolo foram utilizados dois voluntarios do sexo feminino, sendo um sem doenca e outro apresentando doenca de Parkinson (DP) no estagio III de acordo com a escala de Hoehn e Yahr. Os parâmetros analisados pelo foram: a duracao da atividade eletrica durante a degluticao, a amplitude (rms) e o limite de disfagia. RESULTADOS: os resultados mostram diferencas entre os eletromiogramas ilustrativos. CONCLUSAO: a EMGs pode ser utilizada como metodo de avaliacao e monitorizacao da degluticao de sujeitos sem doenca e com DP.

Acupuncture as Adjuvant Therapy for Sleep Disorders in Parkinson's Disease.

There are few studies which attest the efficacy of acupuncture on treatment of sleep disturbs in Parkinson disease. The aimed of this randomized clinical trial was to evaluate the effects of acupuncture on sleep disturbs of 22 patients with diagnosis of idiopathic Parkinson disease (Hoehn-Yahr 1 to 3) who have assistance on the Pro-Parkinson Program of Clinical Hospital at Federal University of Pernambuco in Brazil. All participants were evaluated by Parkinson Disease Sleep Scale (PDSS) before and after 8 weeks. The experimental group was submitted to 8 sections (once a week) which had duration of 30 minutes. The control group had no intervention. The intervention was executed using the acupuncture points LR3 (Taichong), SP6 (Sanyinjiao), LI4 (Hegu), TE5 (Wai-Guan), HT7 (Shenmen), PC6 (Neiguan), LI11 (Quchi), GB20 (Fengchi). Paired analyses were obtained by Wilcoxon test and independent analyses were made according to Mann-Whitney test. This study presented a potential therapeutic benefit of acupuncture on sleep disturbs of Parkinsons disease patients. This study showed a possible therapeutic benefit through acupuncture in sleep disorders in patients with PD. However, we propose new studies related to the effects of acupuncture on the clinical symptoms and evolution of the disease.

MAO‐B and COMT Genetic Variations Associated With Levodopa Treatment Response in Patients With Parkinson's Disease

The most commonly used Parkinsons disease (PD) treatment is the replacement of dopamine by its levodopa precursor (l‐dopa). Monoamine oxidase‐B (MAO‐B) and catechol‐o‐methyl transferase (COMT) are enzymes involved in the metabolism and regulation of dopamine availability. In our study we investigated the possible relation among selected single‐nucleotide polymorphisms (SNPs) in the MAO‐B (rs1799836) and COMT (rs4680) genes and the therapeutic response to levodopa (l‐dopa). A total of 162 Brazilian patients from the Pro‐Parkinson service of Clinics Hospital of Pernambuco diagnosed with sporadic PD and treated with levodopa were enrolled. PD patients were stratified into 2 groups according to the daily levodopa dose. MAO‐B and COMT SNP genotyping was conducted by polymerase chain reaction–restriction fragment length polymorphism. After multivariate analysis, we observed a significant difference between PD groups for the following variables: sex (P = .02), longer duration of disease (P = .02), longer levodopa therapy duration (P = .01), younger onset of PD (P = .01), and use of COMT inhibitor (P = .02). We observed that patients carrying MAO‐B (rs1799836) A and AA genotypes and COMT (rs4680) LL genotype suffered more frequently from levodopa‐induced‐dyskinesia. In addition, we found an increased risk of 2.84‐fold for male individuals carrying the MAO‐B G allele to be treated with higher doses of levodopa (P = .04). We concluded that before beginning PD pharmacological treatment, it is important to consider the genetic variants of the MAO‐B and COMT genes and the sex, reinforcing the evidence that sexual dimorphism in the genes related to dopamine metabolism might affect PD treatment.

Verificação dos efeitos da Levodopa na deglutição de pacientes com doença de Parkinson

Purpose : To evaluate the effects of Levodopa on the swallowing of patients with Parkinson’s Disease (PD). Methods : The study was carried out in the Pro-Parkinson Program of the Hospital das Clinicas of the Federal University of Pernambuco. Twenty patients with idiopathic PD and 12 normal subjects (control group) were studied. The surface Electromyography (sEMG) was recorded over the suprahyoid musculature during swallowing of 3 ml and 10 ml of water and yogurt. Each volume was repeated five times. This protocol was carried out on the group with PD before and after the medication, off and on periods, and on the control group, a single time. Results : The amplitude of the sEMG was significantly greater for subjects of the control group than for the patients with PD (off), regarding swallowing of each volume of water. The duration of the sEMG was significantly greater for the swallowing of 3 ml of water and yogurt in patients with PD (off). During the on phase, no significant differences were noted. Conclusion : The administration of Levodopa on patients with PD seems to influence the amplitude and duration of the sEMG of suprahyoid muscles, approximating the variables to the values of normalcy.

The influence of SLC6A3 and DRD2 polymorphisms on levodopa-therapy in patients with sporadic Parkinson's disease

The aim of this study was to evaluate a possible relationship between DRD2/ANKK1 (rs1800497) and SLC6A3/DAT1 (rs28363170) gene polymorphisms with the response to levodopa (L‐DOPA)‐therapy in patients with Parkinsons disease (PD).

Qualidade de vida de pessoas com doença de Parkinson após o tratamento com realidade virtual não imersiva

Objective: To analyze the influence of treatment with non-immersive virtual reality games (VR) on the quality of life (QOL) of people with Parkinson’s disease (PD). Methods: Uncontrolled clinical trial using 14 people with PD between stages I and IV of PD. Treatment with NIVR occurred for 6 months, 1 initial assessment and 2 quarterly re-evaluations. The instruments to measure the results were the Parkinson’s Disease Questionnaire (PDQ-39) and a Self-Perception of Performance Questionnaire. The treatment protocol used was Kinect® for Xbox 360, and the following games: Kinect Advenctures®, Your Shape: Fitness Evolved®, and Kinect Sports®. Statistical analysis of the PDQ-39 used the Wilcoxon test (p ≤ 0.05) while the Self-Perception of Performance Questionnaire was analyzed qualitatively for thematic content, identifying six categories. Results: There was a statistically significant difference after 3 months of treatment with the NIVR games in terms of mobility, emotional well-being, stigma, cognition, and total score of the PDQ-39. After 6 months of treatment the results were maintained, but no further gains. However, for a neurodegenerative disease this maintenance of gains is favorable for the functional prognosis of the patients. In the thematic categories, what stood out was an improvement of reports on mobility, activities of daily living, emotional well-being, stigma, and bodily discomfort. Conclusion: Treatment with NIVR benefits QOL of people with PD, especially including mobility, emotional well-being, stigma, and cognition

AVALIAÇÃO ELETROMIOGRÁFICA DA DEGLUTIÇÃO DOS DIFERENTES TIPOS CLÍNICOS DA DOENÇA DE PARKINSON NAS FASES ON E OFF

PURPOSE:to evaluate the electromyographic parameters of swallowing different types of clinical of idiopathic Parkinson disease on and off phases.METHODS:the study was performed at the Clinic of Neurology, Hospital of the Federal University of Pernambuco. The population of the study were 20 patients with Parkinson disease, divided by Unified Scale for Assessment of Parkinsons disease in three groups: tremor, akinetic-rigid and mixed. The surface electromyography examination was collected on suprahyoid muscles during swallowing and 3 ml water and 10 ml of yoghurt, which was repeated 5 times for each volume and consistency. This protocol was carried out before and after the medication period off and on.RESULTS:it was found that the phase off, akinetic-rigid group had the highest average in parts of swallows and duration of surface electromyography, while the mixed group had the lowest average amplitude. In phase on the three groups tended to improve or maintain the averages of the variables, but there was no significant difference between the clinical types, before or after Levodopa.CONCLUSION:drug therapy through Levodopa shows no consistent differences in surface electromyography of swallowing the clinical types of Parkinson disease.

Pain characterization in patients with Parkinson's disease

JUSTIFICATIVA E OBJETIVOS:A dor na doenca de Parkinson e uma queixa muito frequente, podendo preceder o diagnostico da doenca. O objetivo deste estudo foi avaliar a dor num grupo de pacientes com doenca de Parkinson de um servico de atendimento especializado.METODOS:Trata-se de um estudo observacional da dor em pacientes com doenca de Parkinson no Hospital das Clinicas da Universidade Federal de Pernambuco. A amostra de conveniencia, obtida entre julho e agosto de 2011, foi composta por 24 sujeitos, sendo 17 do genero masculino e 7 do genero feminino, com idades que variaram de 42 a 50 (media=64,3) anos e 48 a 66 (media=58,7) anos, respectivamente. Utilizou-se a sessao III da Escala Unificada de Avaliacao da Doenca de Parkinson, a classificacao segundo o estagio da doenca de Hoehn e Yahr (HY), o questionario de dor McGill e o Mini-Exame do Estado Mental.RESULTADOS:A regiao especifica do corpo com dor mais frequente foi coluna lombar (50%). As regioes categorizadas com maior percentual de queixas foram: tronco (66,7%) e membros (37,5% - superiores; 37,5% - inferiores). A maioria dos pacientes referiu dor em apenas uma regiao do corpo, independentemente de se analisar as regioes especificas ou categorizadas (37,5%). Nao houve diferenca significativa na pontuacao proporcional atingida por cada componente da pontuacao do questionario McGill. Pacientes com doenca de Parkinson do grupo rigido-acinetico apresentaram maior numero de regioes do corpo com dor. A comparacao entre as pontuacoes dos indices de McGill, segundo o sintoma predominante e segundo o estagio da doenca de Parkinson (HY) nao apresentou diferenca significativa.CONCLUSAO:No presente estudo, todos os pacientes com doenca de Parkinson referiram dor. Apesar de a dor representar um dos sintomas nao motores mais frequentes, muitos aspectos da dor relacionada a doenca de Parkinson necessitam de investigacao, tais como qual seria a melhor categorizacao da dor e que metodologia poderia distinguir melhor os diferentes mecanismos dos varios tipos de dor.