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Poster Abstracts Wednesday, November 9, 2005 $357 speech revealed that PP did not use the full capacity of their motor speech abilities when expressing emotions. Our data suggest that perception and expression of emotional conmmnication is impaired in PP already in an early stage of the disease. These changes are non-motor and point to all impairment of processing of emotions. The findings may have are relevance for the therapeutic strategies in Parkinson's disease. I011 A Prospective Study Of Falls In 113 Patients With Parkinson's Disease Fung, VSC l, Latt, MD ~, Lord, SR a, Morris, JGL a. 1Movement Disorders Unit, Department of Neurology, Westmead Hospital, Sydney, Australia; 2Falls & Balance Group, Prince of Wales Medical Research Institute, Sydney, Australia Background: Falls are a major cause of morbidity in patients with Parkinson's disease (PD). There have been few prospective studies exanffrfing the risk factors that predict falls in PD. Methods: Baseline data were obtained fi'om 113 conmmnity-dwelling subjects with PD (age 66 ± 95%CI 1.6 years, 66 male, height 171 ± 1.4 cm and weight 72 ± 2.9 kg), including clinical history, general medical and neurological examination, UPDRS, Hoehn and Yahr Staging, Timed Get-Up and Go test, MMSE, and the Frontal Assessment Battery. The number and nature of any falls and subse- quent injuries sustained over a twelve month follow-up period were detemrined prospectively using a falls diary recorded daily by patients and monthly telephone call perfonlled by one of the investigators (ML). Multivariate logistic regression analysis (backward stepwise method) was used to identify factors that independently predicted Falls. Results: Independent predictors of falls were a fall in the previous year (OR 3.9, CI 1.4 11.4, p -- 0.010), freezing of gait (FOG) (OR 3.5, CI 1.~9.8, p -- 0.017), frontal lobe intpaimtent (OR 4.3, CI 1.4 13.5, p - 0.009), higher levodopa dose (p - 0.020) and abnormal mxial posture (p -- 0.022). This model predicted 38/51 railers (sensitivity 75%) and 45/62 non-railers (specificity 73%). Conclusion: Falls in PD can be predicted by a history of falls, FOG, frontal lobe impairment, high levodopa dose and abnormal posture. These data are important in desigtffng therapeutic interventions that might prevent falls in patients with PD. 1012 Multiple coiling of subcutaneous leads in deep brain stimulation in Partdnson's disease: A rare Coulplieafion for lead nmltimetion Goyal, V, Vaishya, S, Behari, M. AIIMS, New Delhi, India Subthalamic deep brain stimulation (St DBS) is the treatment of choice in patients with Parkinson's disease, who develops uncontrolled levodopa induced dyskinesias. Tiffs 55 year old lady underwent bilateral St DBS for uncontrolled peak dose levodopa induced dyskinesias. On 2nd postoperative day she had serous collection in the pacemaker subcutaneous pocket, which was drained. At 3 months post operative period her head tremors during off period were not controlled and she had vigorous head tremors. Electrode impedance was very lffgh on left side, wlffch suggested lead malfunctioning, and lead replacement was planned. Intraoperatively on exploration of the subcutaneous lead track, both the lead were found coiled overreach other more then 15-20 times. Mechanism of such a rare complication will be discussed by disgrams. 1013 The role of G196A polymorptfisul in the brain-derived neurotroplfie factor (BDNF) gene in the cause of Parkinson's disease: a meta-analysis Georgios M. Hadjigeorgioul, Elias Zintzaras 2. 1Department Neurology, Neurogeneties Unit, University Hospital of Larissa, University of Thessaly School of Medicine, Papakyriazi 22, Larissa 41222, Greece; 2Department of Biomathematics, University of Thessaly School of Medicine, Papakyriazi 22, Larissa 41222, Greece The association between Parkinson's disease (PD) and the G196A polymorphism in the brain-derived neurotrophic factor (BDNF) gene has been investigated in several case-control studies, producing contradictory results one study indicated that homozygocity of AA is associated with PD, another study produced the opposite result, whereas other studies urged there is no association. In order to investigate these contradicted findings, a meta-analysis of all available association studies between the G196A polymorphism and the risk of developing PD was conducted. Four out of six identified studies included populations of East Asian descent, and two included population of European descent (Whites). Overall, the meta-analysis of the allele contrast (A vs G) suggested large heterogeneity between studies (p - 0.07, I z - 51%) and no association between G196A and the risk of developing PD: random effects odds ratio OR -- 1.00 [95%ci (0.85, 1.18)]. The sensitivity analysis (exclusion of two studies (one East Asian and one White) with the controls not in HWE showed large heterogeneity (p -- 0.10, 12 - 52"/o) and no significant association: random effects OR -- 0.94 [95%d (10.77, 1.15)]. The subgroup analyses for East Asians and Whites produced no significant association. In addition, the contrast of homozygotes, and the dominant and recessive models for allele 196A did not support a major role for the polymorptffsm in the pathogenesis of PD. There were no source of bias in the selected studies, and the differential magnitude of effect in large versus snmll studies was not significant. The meta-analysis results, suggested further exploration of the involvement of the BDNF gene in the susceptibility to PD with larger and more rigorous population association studies. 1014 How to treat hallucinous patients with Parkinson's disease Kazuko Hasegawa, Elmko Horiuchi, Hisayuki Kowa. Department of Neurology, National Hospital Organization, National Sagamihara Hospital, Sagamihara, )'apart Background and Aim: Hallucination is one of the major non-motor problems in advanced Parkinson's disease (PD). There are many medical procedures concenffng haw to manage PD hallucination in various treatment manuals. In many of them, first procedure is reduced dopanrinergic agents such as dopanffne agonist, anmtantadine, seregelin and so on. However, reduced dopaminergic agents produced to both deterioration of motor performance and diminished of self- efficacy. So that, these deterioration problems would tend PD patients to fall into a vicious cycle. We tried to manage to control of hallucinous PD patients without reducing dopanffnergic agents through a trial and error process. The purpose of tiffs report was to introduce our procedures concerning how to treat for hallucination in the patients with PD. Subjects and Methods: Out-and in-patients with PD in our hospital were about 250 cases. Several cases showed hallucination. Out-patients with PD who showed mild hallucination such as visual hallucina- tion were controlled with donebezil or quetiapine, rn case of moderate to severe hallucination, we added quefiapnie up to 200rag/day. However hallucination could not controlled with quetiapine, we added olanzapiene or risperidone without reduction of dopaminergic agents. Results anti Conclusions: We could control hallucinous patients without deterioration in motor performance. 1015 Urinary 8-hydroxydeoxyguanosine levels as a bioularker ior progression of earldnson's disease

1011 A prospective study of falls in 113 patients with Parkinson's disease

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Poster Abstracts Wednesday, November 9, 2005 $357

speech revealed that PP did not use the full capacity of their motor speech abilities when expressing emotions.

Our data suggest that perception and expression of emotional conmmnication is impaired in PP already in an early stage of the disease. These changes are non-motor and point to all impairment of processing of emotions. The findings may have are relevance for the therapeutic strategies in Parkinson's disease.

I011 A Prospective Study Of Falls In 113 Patients With Parkinson's Disease

Fung, VSC l, Latt, MD ~, Lord, SR a, Morris, JGL a. 1Movement Disorders Unit, Department of Neurology, Westmead Hospital, Sydney, Australia; 2Falls & Balance Group, Prince of Wales Medical Research Institute, Sydney, Australia

Background: Falls are a major cause of morbidity in patients with Parkinson's disease (PD). There have been few prospective studies exanffrfing the risk factors that predict falls in PD. Methods: Baseline data were obtained fi'om 113 conmmnity-dwelling subjects with PD (age 66 ± 95%CI 1.6 years, 66 male, height 171 ± 1.4 cm and weight 72 ± 2.9 kg), including clinical history, general medical and neurological examination, UPDRS, Hoehn and Yahr Staging, Timed Get-Up and Go test, MMSE, and the Frontal Assessment Battery. The number and nature of any falls and subse- quent injuries sustained over a twelve month follow-up period were detemrined prospectively using a falls diary recorded daily by patients and monthly telephone call perfonlled by one of the investigators (ML). Multivariate logistic regression analysis (backward stepwise method) was used to identify factors that independently predicted Falls. Results: Independent predictors of falls were a fall in the previous year (OR 3.9, CI 1.4 11.4, p -- 0.010), freezing of gait (FOG) (OR 3.5, CI 1.~9.8, p -- 0.017), frontal lobe intpaimtent (OR 4.3, CI 1.4 13.5, p - 0.009), higher levodopa dose (p - 0.020) and abnormal mxial posture (p -- 0.022). This model predicted 38/51 railers (sensitivity 75%) and 45/62 non-railers (specificity 73%). Conclusion: Falls in PD can be predicted by a history of falls, FOG, frontal lobe impairment, high levodopa dose and abnormal posture. These data are important in desigtffng therapeutic interventions that might prevent falls in patients with PD.

1012 Multiple coiling of subcutaneous leads in deep brain stimulation in Partdnson's disease: A rare Coulplieafion for lead nmltimetion

Goyal, V, Vaishya, S, Behari, M. AIIMS, New Delhi, India

Subthalamic deep brain stimulation (St DBS) is the treatment of choice in patients with Parkinson's disease, who develops uncontrolled levodopa induced dyskinesias. Tiffs 55 year old lady underwent bilateral St DBS for uncontrolled peak dose levodopa induced dyskinesias. On 2nd postoperative day she had serous collection in the pacemaker subcutaneous pocket, which was drained. At 3 months post operative period her head tremors during off period were not controlled and she had vigorous head tremors. Electrode impedance was very lffgh on left side, wlffch suggested lead malfunctioning, and lead replacement was planned. Intraoperatively on exploration of the subcutaneous lead track, both the lead were found coiled overreach other more then 15-20 times. Mechanism of such a rare complication will be discussed by disgrams.

1013 The role of G196A polymorptfisul in the brain-derived neurotroplfie factor (BDNF) gene in the cause of Parkinson's disease: a meta-analysis

Georgios M. Hadjigeorgiou l, Elias Zintzaras 2. 1Department Neurology, Neurogeneties Unit, University Hospital of Larissa, University of Thessaly School of Medicine, Papakyriazi 22, Larissa 41222, Greece; 2Department of Biomathematics, University of Thessaly School of Medicine, Papakyriazi 22, Larissa 41222, Greece

The association between Parkinson's disease (PD) and the G196A polymorphism in the brain-derived neurotrophic factor (BDNF) gene has been investigated in several case-control studies, producing contradictory results one study indicated that homozygocity of AA is associated with PD, another study produced the opposite result, whereas other studies urged there is no association. In order to investigate these contradicted findings, a meta-analysis of all available association studies between the G196A polymorphism and the risk of developing PD was conducted. Four out o f six identified studies included populations of East Asian descent, and two included population of European descent (Whites). Overall, the meta-analysis of the allele contrast (A vs G) suggested large heterogeneity between studies (p - 0.07, I z - 51%) and no association between G196A and the risk of developing PD: random effects odds ratio OR -- 1.00 [95%ci (0.85, 1.18)]. The sensitivity analysis (exclusion of two studies (one East Asian and one White) with the controls not in HWE showed large heterogeneity (p -- 0.10, 12 - 52"/o) and no significant association: random effects OR -- 0.94 [95%d (10.77, 1.15)]. The subgroup analyses for East Asians and Whites produced no significant association. In addition, the contrast of homozygotes, and the dominant and recessive models for allele 196A did not support a major role for the polymorptffsm in the pathogenesis of PD. There were no source of bias in the selected studies, and the differential magnitude of effect in large versus snmll studies was not significant. The meta-analysis results, suggested further exploration of the involvement of the BDNF gene in the susceptibility to PD with larger and more rigorous population association studies.

1014 How to treat hallucinous patients with Parkinson's disease

Kazuko Hasegawa, Elmko Horiuchi, Hisayuki Kowa. Department of Neurology, National Hospital Organization, National Sagamihara Hospital, Sagamihara, )'apart

Background and Aim: Hallucination is one of the major non-motor problems in advanced Parkinson's disease (PD). There are many medical procedures concenffng haw to manage PD hallucination in various treatment manuals. In many of them, first procedure is reduced dopanrinergic agents such as dopanffne agonist, anmtantadine, seregelin and so on. However, reduced dopaminergic agents produced to both deterioration of motor performance and diminished of self- efficacy. So that, these deterioration problems would tend PD patients to fall into a vicious cycle. We tried to manage to control of hallucinous PD patients without reducing dopanffnergic agents through a trial and error process. The purpose of tiffs report was to introduce our procedures concerning how to treat for hallucination in the patients with PD. Subjects and Methods: Out-and in-patients with PD in our hospital were about 250 cases. Several cases showed hallucination. Out-patients with PD who showed mild hallucination such as visual hallucina- tion were controlled with donebezil or quetiapine, rn case of moderate to severe hallucination, we added quefiapnie up to 200rag/day. However hallucination could not controlled with quetiapine, we added olanzapiene or risperidone without reduction of dopaminergic agents. Results anti Conclusions: We could control hallucinous patients without deterioration in motor performance.

1015 Urinary 8-hydroxydeoxyguanosine levels as a bioularker ior progression of earldnson's disease