Baciu Diana, MG, VIScientific Advisor: Lecturer: Dr. Szász József-Attila UMF Târgu Mureș, Neurology II, Târgu Mureș

Introduction-Pathophysiology-Diagnostic-Treatment-Material and Methods-Results-Conclusion

• Hypo-kinetic hypertonic, extrapyramidal motor syndrome

• Progressive, neurodegenerative disease

• Heterogenous etiology• Rather affects middle-

age people• The onset-age plays an

important role in further evolution of the disease

Introduction-Pathophysiology-Diagnostic-Treatment-Material and Methods-Results-Conclusion

Introduction-Pathophysiology-Diagnostic-Treatment-Material and Methods-Results-Conclusion

Two major pathological mechanism:

•Loss of pigmented dopamine neurons•The presence of Lewy bodies and Lewy neurites

Introduction-Pathophysiology-Diagnostic-Treatment-Material and Methods-Results-Conclusion

Introduction-Pathophysiology-Diagnostic-Treatment-Material and Methods-Results-Conclusion

I. Clinical:Hoehn and Yahr Staging Scale: motor symptoms quantificationSchwab and England activities of daily living (ADL)-scaleUnified Parkinson´s Disease Rating Scale (MDS-UPDRS) : Therapy monitoring I: non-motor experiences of daily living

II: motor experiences of daily livingIII: motor examinationIV: motor complications

Introduction-Pathophysiology-Diagnostic-Treatment-Material and Methods-Results-Conclusion

II. Imaging:

SPECT/PET

CT/MRI for Diff. Dg.

Transcranial Doppler- Sonography

Parkinson’s Disease: Diagnostic

Introduction-Pathophysiology-Diagnostic-Treatment-Material and Methods-Results-Conclusion

Monotherapy

Introduction-Pathophysiology-Diagnostic-Treatment-Material and Methods-Results-Conclusion

Complications of treatment with L-DOPA

http://www.cnsspectrums/Volkmann_BigSlide_1.jpgChorea, Benign Hereditary; Chorea, Chronic Progressive; Chorea, Rheumatic; Chorea, Senile; Chorea, Sydenham; Dyskinesias, Paroxysmal; Neuroacanthocytosis; Paroxysmal Dyskinesias; Senile Chorea; Sydenham Chorea)

Introduction-Pathophysiology-Diagnostic-Treatment-Material and Methods-Results-Conclusion

Hypokinetic symptoms:1.“wearing off ” end of dose akinesia1.“sudden off” 2.“delayed on”3.“no on”4.“early morning akinesia”5.“peak-dose akinesia”6.“on-off”

7.“freezing”

Motor Fluctuations:

Introduction-Pathophysiology-Diagnostic-Treatment-Material and Methods-Results-Conclusion

The follow-up of the patients who suffer motor fluctuations , with advanced Parkinson’s disease

Which person requires treatment with intestinal gelPatients monitoring before and after Duodopa-medicationComparing performance of motor fluctuations

Material and Methods

The therapeutic method with intestinal gel Levodopa/Carbidopa has been firstly used in the Neurology Clinic II Tg. Mures in June 2011

Until December 2013 , 21 patients with advanced P.D and hypokinetic motor fluctuations were assesed with Duodopa-treatment

Aim of the Study

Introduction-Pathophysiology-Diagnostic-Treatment-Material and Methods-Results-Conclusion

Results I. Distribution according to risc factors

Introduction-Pathophysiology-Diagnostic-Treatment-Material and Methods-Results-Conclusion

Introduction-Pathophysiology-Diagnostic-Treatment-Material and Methods-Results-Conclusion

Introduction-Pathophysiology-Diagnostic-Treatment-Material and Methods-Results-Conclusion

ResultsIII. Patient distribution of oral medications

Introduction-Pathophysiology-Diagnostic-Treatment-Material and Methods-Results-Conclusion

Treatment with Duodopa: Intestinal Gel

Introduction-Pathophysiology-Diagnostic-Treatment-Material and Methods-Results-Conclusion

Generally, most of the patients presented a decrease in the number of “off-hours”

Results: Treatment with Duodopa

Introduction-Pathophysiology-Diagnostic-Treatment-Material and Methods-Results-Conclusion

Daily activities of patients and motor symptoms were measured using international scalesHoehn-Yahr Scale Before and UPDRS II+III After

Introduction-Pathophysiology-Diagnostic-Treatment-Material and Methods-Results-Conclusion

UPDRS II (Daily Activity): The amount of the grade scale for measuring daily activity before treatment was compared with the one after treatment.

Introduction-Pathophysiology-Diagnostic-Treatment-Material and Methods-Results-Conclusion

UPDRS III (Motor System):The total amount of the grade scale for measuring motor performance during “ON” before treatment was compared with the one after treatment

Introduction-Pathophysiology-Diagnostic-Treatment-Material and Methods-Results-Conclusion

Main causes in the occurrence of M.F are:Progressive degeneration of dopamine terminalsShort Half-Life of L-Dopa, which produces a discontinous

dopamine stimulationGastric inactivation of L-Dopa or low absorbtionDuodopa – Intestinal Gel Administration can solve this issues - maintaining a constant level of dopamine in the blood Objectively, all 21 patients experienced a significant reduction

in the fluctuations, while achieving a better gait function

Introduction-Pathophysiology-Diagnostic-Treatment-Material and Methods-Results-Conclusion

Introduction-Pathophysiology-Diagnostic-Treatment-Material and Methods-Results-Conclusion