Parkinson Disease: Friedman A

Horstink M, Tolosa E, Bonuccelli U, Deuschl G, Friedman A, Kanovsky P, Larsen JP, Lees A, Oertel W, Poewe W, Rascol O, Sampaio C, Anonymous00036, Anonymous00037. · Department of Neurology, Radboud University Medical Centre, Nijmegen, The Netherlands. · Eur J Neurol. · Pubmed #17038032 No free full text.

Abstract: To provide evidence-based recommendations for the management of late (complicated) Parkinson's disease (PD), based on a review of the literature. Complicated PD refers to patients suffering from the classical motor syndrome of PD along with other motor or non-motor complications, either disease-related (e.g. freezing) or treatment-related (e.g. dyskinesias or hallucinations). MEDLINE, Cochrane Library and INAHTA database literature searches were conducted. National guidelines were requested from all EFNS societies. Non-European guidelines were searched for using MEDLINE. Part II of the guidelines deals with treatment of motor and neuropsychiatric complications and autonomic disturbances. For each topic, a list of therapeutic interventions is provided, including classification of evidence. Following this, recommendations for management are given, alongside ratings of efficacy. Classifications of evidence and ratings of efficacy are made according to EFNS guidance. In cases where there is insufficient scientific evidence, a consensus statement ('good practice point') is made.

Horstink M, Tolosa E, Bonuccelli U, Deuschl G, Friedman A, Kanovsky P, Larsen JP, Lees A, Oertel W, Poewe W, Rascol O, Sampaio C, Anonymous00034, Anonymous00035. · Department of Neurology, Radboud University Medical Centre, Nijmegen, The Netherlands. · Eur J Neurol. · Pubmed #17038031 No free full text.

Abstract: The aim of the study was to provide evidence-based recommendations for the management of early (uncomplicated) Parkinson's disease (PD), based on a review of the literature. Uncomplicated PD refers to patients suffering from the classical motor syndrome of PD only, without treatment-induced motor complications and without neuropsychiatric or autonomic problems. MEDLINE, Cochrane Library and International Network of Agencies for Health Technology Assessment (INAHTA) database literature searches were conducted. National guidelines were requested from all European Federation of Neurological Societies (EFNS) societies. Non-European guidelines were searched for using MEDLINE. Part I of the guidelines deals with prevention of disease progression, symptomatic treatment of motor features (parkinsonism), and prevention of motor and neuropsychiatric complications of therapy. For each topic, a list of therapeutic interventions is provided, including classification of evidence. Following this, recommendations for management are given, alongside ratings of efficacy. Classifications of evidence and ratings of efficacy are made according to EFNS guidance. In cases where there is insufficient scientific evidence, a consensus statement (good practice point) is made.

Zabek M, Sławek J, Harat M, Koszewski W, Opala G, Friedman A. · Oddział Neurochirurgii Czynnościowej i Chorób Układu Pozapiramidowego, Klinika Neurochirurgii, Akademia Medyczna, ul Debinki 7, 80-211 Gdańsk. · Neurol Neurochir Pol. · Pubmed #16463215 links to  free full text

Abstract: The authors present the current views on the use of electrical stimulation in selected movement disorders (Parkinson's disease, dystonia) and pain syndromes (central and neuropathic pain) refractory to pharmacological therapy. Stimulation should be applied in cases with an established diagnosis (especially Parkinson's disease and dystonia) and with a lack of efficacy despite the best available medical therapy. Therefore it should be the last treatment option, except of generalized dystonia, where it seems to be nowadays the treatment of choice. Suggested selection criteria are based on experience of different centers and on current medical literature. They are published to make the procedure more rational and more available in Poland.

Friedman A. · Katedra i Klinika Neurologii Wydziału Nauki o Zdrowiu, Akademia Medyczna w Warszawie. · Neurol Neurochir Pol. · Pubmed #17941453 No free full text.

Abstract: There is a long lasting discussion in the literature how should we begin the treatment of Parkinson's disease. The author presents the arguments, why the treatment should not be started with agonists of dopamine receptors but with levodopa. The clinical efficacy of levodopa is certainly much higher than that of agonists. It is probably related to the fact that levodopa leads to the production of natural neurotransmitter in the striatum - the dopamine. Even the best artificial agonist cannot fully mimic the function of dopamine. And there are no doubts that levodopa does not hasten the parkinsonian neurodegeneration. Starting the treatment with an agonist one does not achieve as good results as with levodopa, and later when the addition of levodopa becomes a necessity, there is already such a destruction of substantia nigra that the effect is unsatisfactory for patients. Therefore the treatment of Parkinson's disease should be started with levodopa.

Friedman A, Galazka-Friedman J. · Department of Neurology, Medical University of Warsaw, 02-097 Warsaw, Poland. · Adv Neurol. · Pubmed #11553971 No free full text.

This publication has no abstract.

Friedman A. · Kliniki Neurologicznej Akademii Medycznej w Warszawie. · Neurol Neurochir Pol. · Pubmed #11107568 No free full text.

Abstract: The symptomatic treatment of Parkinson's disease is based on assumption that its symptoms are a consequence of damage to the dopaminergic system at the level of substantia nigra. However, not all symptoms can be explained by this damage, moreover, substitution therapy /with preparations containing dopamine precursor--levodopa and agonists of the dopaminergic receptor /not only fails to remove all disease symptoms but can even produce adverse effects. Theoretical bases of treatment are discussed, including the non-motor signs /dementia, depression, autonomic system disturbances/ with the analysis of how these theoretical assumptions come true in practise, including the author's practice. a schema is proposed of diagnosis establishing and decision taking of treatment with stress laid on the most frequent diagnostic and therapeutic errors. Expectations and hopes are discussed also concerning the search for the cause and better therapeutic methods in the future.

Koziorowski D, Friedman A. · Department of Neurology, The Medical University of Warsaw, Warsaw, Poland. · Mov Disord. · Pubmed #17370308 No free full text.

Abstract: The loss of beneficial effect of levodopa due to progression of the disease and alteration of receptor sensitivity makes the treatment of the advanced stadium of Parkinson's disease (PD) very difficult. In the past "drug holidays" was used in attempt to resensitize dopamine receptors in the striatum to make the treatment easier. However possible serious complications like neuroleptical malignant-like syndrome discouraged the use of this procedure. Intravenous administration of amantadine, another antiparkinsonian medication during "drug holidays," procedure could be a solution for this problem. We studied 12 patients with PD suffering from complication of the therapy. Daily dose of Levodopa used as monotherapy before amantadine infusions ranged between 700 and 2,000 mg. Levodopa was discontinued for 3 days and during that time amantadine sulfate intravenous was administrated. After "drug holidays" levodopa in the same dose as before treatment was resumed. An assessment of the parkinsonian condition was performed with Unified Parkinson's Disease Rating Scale before "drug holidays" 2 days after and 1, 2, 3, 4, 5, 6 months later. The follow-up study demonstrated a significant improvement both in the motor condition and complication of therapy. The improvement after therapy was maintained up to 4 month. The levodopa "drug holidays" with amantadine infusion is a valuable option in the therapy of advanced stages of PD.

Gawrys L, Szatkowska I, Jamrozik Z, Janik P, Friedman A, Kaczmarek L. · Laboratory for Molecular Neurobiology, Nencki Institute of Experimental Biology, Pasteura 3, 02-093 Warsaw, Poland. · Acta Neurobiol Exp (Wars). · Pubmed #18389016 links to  free full text

Abstract: This study examined verbal and nonverbal aspects of explicit and implicit memory in a sample of 19 Parkinson's disease (PD) patients and 21 control subjects. For implicit memory evaluation, we used a Mirror Reading (MR) task employing verbal material as well as a nonverbal Serial Reaction Time (SRT) task. For explicit memory measurement we applied a word pairs task (verbal) and pairs of a Japanese ideograms task (nonverbal). The PD patients displayed impairments in the nonverbal tasks only, namely, in the SRT task and the pairs of Japanese ideograms task. No correlation between Wisconsin Card Sorting Test (WCST) scores and the results of tasks in which PD patients displayed deficits (SRT and pairs of Japanese ideograms) were discovered. Interestingly, such a correlation was found in the case of MR and words pairs tasks, which did not distinguish PD patients from control group.

Koziorowski D, Friedman A, Arosio P, Santambrogio P, Dziewulska D. · Department of Neurology, The Medical University in Warsaw, ul. Kondratowicza 8, 03-242 Warsaw, Poland. · Parkinsonism Relat Disord. · Pubmed #17275395 No free full text.

Abstract: Iron released from ferritin may trigger oxidative stress leading to progressive neurodegeneration of substantia nigra resulting in Parkinson's disease (PD). Change in the structure of ferritin may allow an easier efflux of iron. We compared with the use of ELISA the structure of ferritin (concentrations of H and L ferritins) in substantia nigra (SN) in ten cases of PD, six of incidental Lewy body (ILB) cases and 20 controls. SN concentration of L ferritin in ILB (50.6+/-11.5 ng/mg) and in PD (52.5+/-26.0) was lower than in control (97.9+/-54.9). H ferritin in PD (534.2+/-223.1) was higher than in ILB (336.9+/-87.7) and control (374.8+/-169.3). The decrease of L ferritin in SN in PD and ILB may suggest that the whole process of neurodegeneration starts with a higher availability of free iron, which is released from the ferritin shell.

Benmoyal-Segal L, Vander T, Shifman S, Bryk B, Ebstein RP, Marcus EL, Stessman J, Darvasi A, Herishanu Y, Friedman A, Soreq H. · The Life Sciences Institute, The Hebrew University of Jerusalem, Israel. · FASEB J. · Pubmed #15629887 links to  free full text

Abstract: Exposure to agricultural insecticides, together with yet incompletely understood predisposing genotype/phenotype elements, notably increase the risk of Parkinson's disease. Here, we report findings attributing the increased risk in an insecticide-exposed rural area in Israel to interacting debilitating polymorphisms in the ACHE/PON1 locus and corresponding expression variations. Polymorphisms that debilitate PON1 activity and cause impaired AChE overproduction under anticholinesterase exposure were strongly overrepresented in patients from agriculturally exposed areas, indicating that they confer risk of Parkinson's disease. Supporting this notion, serum AChE and PON1 activities were both selectively and significantly lower in patients than in healthy individuals and in carriers of the risky polymorphisms as compared with other Parkinsonian patients. Our findings suggest that inherited interactive weakness of AChE and PON1 expression increases the insecticide-induced occurrence of Parkinson's disease.

Zach M, Friedman A, Sławek J, Derejko M. · Department of Neurology, Medical University of Warsaw, Warsaw, Poland. · Mov Disord. · Pubmed #15197705 No free full text.

Abstract: The objective of this study was to evaluate possible relationships between quality of life (QoL) of Polish patients with long-lasting Parkinson's disease and various demographic and clinical factors. The study comprised 141 patients of Movement Disorders outpatient clinics in Warsaw and Gdansk with at least 5 years of the disease duration. Mean age of patients was 68.09 +/- 8.51 years, mean duration of disease was 11.87 +/- 5.14 years. To assess the quality of life, the Parkinson's Disease Questionnaire (PDQ-39) was used. Additional questions concerned duration of disease, initial and current treatment and expenses associated with therapy. Self-perceived symptoms of depression were in our study the most important factor determining QoL. Duration of the disease and expenses related to the treatment also have a significant impact on the QoL. Patient's age and presence of dyskinesia seem to be irrelevant to the quality of life.

Friedman A, Harat M, Opala G, Sławek J, Zabek M. · Klinika Neurochirurgii-Oddział Neurochirurgii Czynnościowej i Chorób Układu Pozapiramidowego Akademia Medyczna w Gdańsku ul. Debinki 7, 80-211 Gdańsk. · Neurol Neurochir Pol. · Pubmed #15098326 No free full text.

Abstract: Renewed interest (also in Poland) in the neurosurgical treatment of Parkinson's Disease is the main cause of referring patients to stereotactic surgery. It is the result of our improved understanding of functional anatomy of basal ganglia and development of neurophysiological, neuroimaging and neurosurgical techniques. Various surgical options and possible targets offer different functional benefits, but due to almost 10 years experience we are aware of limited results and possible complications as well. There is a need of minimal standard of patient's evaluation before selection to surgery. The selection criteria include: good diagnosis of Parkinson's Disease, at least 5 years from the onset of symptoms, good responsiveness to L-dopa or apomorphine, exclusion of severe depression and dementia, neuroimaging (MRI) before surgery and optimal (but ineffective) pharmacological therapy before surgery.

Galazka-Friedman J, Bauminger ER, Koziorowski D, Friedman A. · Faculty of Physics, Warsaw University of Technology, 00-662 Warsaw, Koszykowa 75, Poland. · Biochim Biophys Acta. · Pubmed #14990343 No free full text.

Abstract: The possible role of iron in the degeneration of nervous cells in Parkinson's disease (PD) was studied with the use of Mössbauer spectroscopy (MS) and enzyme-linked immunoabsorbent assay (ELISA). Mössbauer data were obtained at 90 and 4.1 K from 21 samples of control and 9 samples of parkinsonian substantia nigra (SN). Mössbauer spectra were very similar to those observed in ferritin. Small differences were detected between the spectra obtained from PD and from control SN, and could be due to a slight difference in the composition of the ferritin-like iron cores or due to the presence of about 8% of non-ferritin-like iron in parkinsonian SN. ELISA studies from 11 controls and 6 parkinsonian SN showed a decrease in the concentration of L-chains in wet tissues of PD-SN compared to control SN. The decrease in the amount of L subunits may correspond to a decreased ability of this ferritin to keep iron in a safe form. Iron released from ferritin or neuromelanin (NM) may be the source of such iron, which may cause the difference in the Mössbauer spectra and may trigger oxidative stress leading to cell death.

Potulska A, Friedman A, Królicki L, Spychala A. · Department of Neurology, Medical University of Warsaw, ul. Banacha 1a, 02-097 Warsaw, Poland. · Parkinsonism Relat Disord. · Pubmed #12853234 No free full text.

Abstract: The aim of this study was to assess the reflex and oral, pharyngeal, esophageal phase of swallowing in patients with Parkinson's disease (PD). Eighteen patients with PD and 22 healthy control subjects were investigated using electromyography (EMG) and esophageal scintigraphy. This study demonstrated delayed triggering of the swallowing reflex (443+/-84 ms in patients with PD vs. 230+/-96 ms in controls, p<0.05) and prolongation of laryngeal movement (980+/-140 vs. 649+/-145 ms, p<0.05). We found prolongation of the esophageal phase of swallowing (14.46+/-5.30 vs. 7.45+/-1.64 s, p<0.001) in PD patients. The dysphagia limit i.e. the maximum amount of water swallowed at once was smaller in PD patients than in controls (6.23+/-3.67 vs. >20 ml). Dysphagia was observed in all patients studied although only 13 of them complained about it. In the remaining five cases swallowing impairment was subclinical and it consisted of decreased dysphagia limit and prolongation of the esophageal phase. Dysphagia at the subclinical level may be one of the early symptoms of PD.

Potulska A, Friedman A, Królicki L, Jedrzejowski M, Spychała A. · Klinika Neurologii Akademii Medycznej w Warszawie. · Neurol Neurochir Pol. · Pubmed #12185801 No free full text.

Abstract: Impairment of swallowing is a common symptom in advanced stage of Parkinson's disease and severe defect of this function may cause aspiration pneumonia, problems with food intake and cachexy. The aim of this study was to assess the reflex and oral, pharyngeal, oesophageal phase of swallowing. Eleven patients with Parkinson's disease and 9 healthy subjects were investigated by electromyography (EMG) and oesophageal scintigraphy. The study demonstrates delayed triggering of swallowing reflex (543 +/- 84 ms in patients with PD vs. 230 +/- 66 ms in controls, p < 0.05) and prolongation of laryngeal movement (1880 +/- 140 ms vs. 1349 +/- 154 ms, p < 0.05). The prolongation of the oesophageal phase of swallowing with predilection to retention of water in lower one/third part of esophagus (12.45 +/- 2.45 s vs. 6.45 +/- 1.18 s, p < 0.001) was observed. The dysphagia limit, that is the maximum amount of water swallowed at once, was also evaluated (all normal subjects are able to swallow 20 ml water or more at once). In the studied patients with Parkinson's disease it was 4.5 +/- 0.86 ml. These results evidently and objectively indicate the presence of swallowing disorders in Parkinson's disease. Dysphagia was observed in all studied patients, although only 8 of them complained about it. In other 3 cases the impairment of swallowing was subclinical and it was connected with prolongation of oesophageal phase.

Friedman A, Potulska A. · Department of Neurology, Medical University of Warsaw, Warsaw, Poland. · Neurol Neurochir Pol. · Pubmed #12001650 No free full text.

Abstract: AIM: Sialorrhea is one of the main problems of patients with Parkinson's disease (PD). Most of the medications used for the treatment of it are ineffective. We decided to try in such patients local injections of botulinum toxin, type A, into both parotid glands. MATERIAL: 11 patients with clinical diagnosis of idiopathic PD and drooling assessed as at least 2 point on the UPDRS part II and 14 control subjects. METHODS: Salivation was measured by weighting dental rolls before and 2 minutes after insertion at 6 places of highest secretion of saliva in mouth (buccal vestibule, and sublingual area). PD patients were assessed before and one week after injections of 5 units of BOTOX into each parotid salivary gland and the results were compared to the salivation of controls. RESULTS: Average excretion of saliva in PD patients was significantly higher than in controls -0.39 +/- 0.4 g/2 min. (range: 0.02-1.82) vs. 0.19 +/- 0.16 g/2 min. (range: 0.02-0.98) (p = 0.03). After the treatment the average excretion of saliva in PD patients decreased to 0.25 +/- 0.26 g/2 min. (range: 0.004-0.99) and did not differ significantly from controls. All patients improved also according to UPDRS. No side-effects were observed in any of the patients injected. CONCLUSION: Botulinum toxin may be an effective and safe treatment of parkinsonian sialorrhea.