Karen Busenbark

Weight Change and Body Composition in Patients With Parkinson's Disease

OBJECTIVE To compare reports of weight loss and actual measures of body composition to predict nutritional risk in patients with Parkinsons disease and matched control subjects. DESIGN Patients and control subjects were asked to record prior changes in weight and activity. Body composition was then compared in both groups using percentage ideal body weight (IBW), body mass index (BMI), triceps skinfold (TSF) thickness, midarm muscle circumference, and percentage body fat (BF) as determined by bioelectrical impedance. SUBJECTS Fifty-one free-living patients with Parkinsons disease and 49 matched control subjects were recruited from the neurology clinic and the surrounding area. MAIN OUTCOME MEASURES We anticipated that reported weight loss would be greater and actual measures of body composition would show greater nutritional risk in the patients with Parkinsons disease. STATISTICAL ANALYSES PERFORMED chi 2 Analysis was used to determine differences in the ratio of patients and control subjects who lost weight. Paired t tests were used to compare amount of weight change and measures of body composition. Correlations were performed among measures of weight change, body composition, and associated disease factors. RESULTS Patients with Parkinsons disease were four times more likely to report weight loss greater than 10 lb than the matched control subjects (odds ratio > 4.2). Patients reported a mean (+/- standard deviation) weight loss of 7.2 +/- 2.9 lb and control subjects reported a mean weight gain of 2.1 +/- 1.6 lb (P < .01). Percentage IBW (P < .02), BMI (P < .009), TSF thickness (P < .005), and percentage BF (P < .022) were lower in patients. Significant correlations (P < .01) were found between reported weight change and percentage IBW, BMI, TSF, percentage BF, and stage of the disease. CONCLUSIONS/APPLICATION: Patients with Parkinsons disease appear to be at greater nutritional risk than a matched population. Simple screening and assessment tools can be used to detect nutritional risk.

Deep brain stimulation for essential tremor

We examined the effects and safety of deep brain stimulation (DBS) as a treatment for essential tremor (ET).Ten ET patients with disabling medication-refractory tremor underwent stereotactic implantation of a DBS lead in the left Vim thalamic nucleus and completed a 6-month follow-up. The Clinical Tremor Rating Scale and disability assessments were performed at baseline, 1-, 3-, and 6-month follow-up. There were significant improvements in dressing, drinking, eating, bathing, and handwriting as reported by the subjects. Tremor severity, writing, pouring, and spiral and line drawing were significantly improved as rated by the examiner. Improvements persisted through the 6-month follow-up period. Although global disability significantly lessened in the group as a whole, one subject with hand-finger tremor accentuated by writing had no change in disability status. In this 6-month open-label study, DBS was effective and safe in reducing tremor and functional disability in ET. NEUROLOGY 1996;46: 1150-1153

Is essential tremor benign

We analyzed the results of the Sickness Impact Profile, a self-reporting measure of sickness-related dysfunction in 753 essential tremor (ET) patients, 87 controls from the general population, and 145 patients with Parkinsons disease (PD). Compared with the general population, ET patients had significantly greater dysfunction in all but one category. Communication, Work, Emotional Behavior, Home Management, and Recreation and Pastimes were particularly impaired in ET. The PD patients had significantly higher dysfunction in all categories as compared with ET patients. We conclude that significant disability can occur in ET and, compared with PD, ET tends to be less severe but causes relatively greater psychosocial dysfunction.

Driving in Parkinson's disease

Altered motor or mental skills in Parkinsons disease (PD) could adversely affect driving ability. We interviewed 150 patients regarding their driving habits and compared them with 100 controls. Thirty patients had stopped driving because of PD. PD patients had no more lifetime accidents than controls. With increased disability, however, there was a smaller percentage of patients still driving with fewer miles traveled and with proportionately more accidents occurring. Though disability scores did not correlate well with driving ability, there were significantly more accidents in subjects with more severe PD. The presence of cognitive impairment was associated with an increased accident rate. We conclude that driving in PD may be a public health problem and that some PD patients should not drive.

Botulinum toxin treatment of essential head tremor

Article abstract-We examined in a double-blind, placebo-controlled study the effects of botulinum toxin in 10 patients with essential head tremor. Each subject received two treatments approximately 3 months apart, one with botulinum toxin injections and another with normal saline injections into the sternocleidomastoid and splenius capitis muscles. The subjects were assessed before each treatment and at 2, 4, and 8 weeks after injections. There was moderate to marked improvement in clinical ratings in five subjects after botulinum toxin injections and in one subject after placebo. There was moderate to marked subjective improvement in five patients with botulinum toxin as compared with three subjects with placebo. Side effects were mild and transient. We conclude that botulinum toxin may be useful for patients with essential head tremor who have failed to benefit from oral medications. NEUROLOGY 1995;45: 822-824

Benztropine versus clozapine for the treatment of tremor in Parkinson's disease

Four open-label studies have reported beneficial effects of clozapine on the tremor of idiopathic Parkinsons disease (PD). We performed a double-blind crossover trial with a 2-week washout, comparing low-dose clozapine to benztropine for the treatment of tremor in PD. Twenty-two subjects enrolled and 19 completed the study. Benztropine and clozapine were equally effective in improving tremor and the motor score of the United Parkinsons Disease Rating Scale at mean doses of 3.0 and 39 mglday, respectively. Significant adverse events were experienced with each drug, but leukopenia was not encountered. We conclude that the atypical antipsychotic drug clozapine is helpful in the treatment of tremor in PD and should be considered when all other drug therapies fail.

Olfactory function in essential tremor

Olfactory function, assessed by the University of Pennsylvania Smell Identification Test, was normal in essential tremor (ET) patients and significantly reduced in patients with Parkinsons disease (PD). This finding further supports a lack of association between ET and PD.

Sexual Dysfunction in Parkinson's Disease

Sexual functioning was investigated in 50 parkinsonian male and female patients using a questionnaire. A loss of sexual interest and functioning was reported in a high percentage of patients. Depression was not prevalent but 70% had some evidence of autonomic nervous system dysfunction that may be related to sexual dysfunction. It is concluded that the sexual function is frequently impaired in Parkinsons disease.

Time course of loss of clinical benefit following withdrawal of levodopa/carbidopa and bromocriptine in early Parkinson's disease

Putative neuroprotective agents for Parkinsons disease can be assessed in untreated patients using progression of clinical disability as an index of disease progression. To avoid the confound associated with symptomatic therapy, progression of the underlying disease can be assessed by evaluating the progression of clinical disability from an untreated baseline to a final visit following wash‐out of symptomatic medication. In this type of analysis it is critical to use a wash‐out of sufficient duration to ensure elimination of symptomatic effects. To assess the time course of resolution of symptomatic effects, we evaluated 31 patients at days 1, 8, and 15 following discontinuation of levodopa/carbidopa and bromocriptine. Mean total Unified Parkinsons Disease Rating Scale scores (± standard error) increased (worsened) by 7.4 ± 1.5 from day 1 to day 15 (p <0.0001), 4.5 ± 1.2 from day 1 to day 8 (p = 0.0009), and 2.9 ± 1.0 from day 8 to day 15 (p = 0.01). We conclude that a wash‐out of at least 2 weeks is required to eliminate the symptomatic effects of levodopa/carbidopa and bromocriptine in patients with early Parkinsons disease.

Clinical experience with controlled‐release carbidopa/levodopa in Parkinson's disease

We converted 158 Parkinsons disease (PD) patients on stable doses of standard carbidopa/levodopa (Std-L) to controlled-release carbidopa/levodopa (L-CR). Of the 141 patients who completed the study, 103 (73%) preferred L-CR, 26 (18.5%) preferred Std-L, and 12 (8.5%) had no preference. One hundred fourteen patients elected to continue L-CR, and we performed the primary data analysis on this group. Following conversion to L-CR, patients reported an increase in length of benefit from each dose and an increased “kick-in” time. There was a decrease in the total number of doses, “off periods, sleep interruptions per night, dose failures, and sleep disturbances. Conversion to L-CR resulted in a significant increase in total levodopa dose. There was no significant change in the dyskinesias. However, early-morning dystonia resolved in eight of 14 patients. Our findings suggest that L-CR is particularly effective in decreasing motor fluctuations, reducing nocturnal problems, and minimizing levodopa dose failures in PD.