Parkinson Disease: Marras C

Marras C, Lang AE. · No affiliation provided · J Neurol Neurosurg Psychiatry. · Pubmed #12531932 links to  free full text

This publication has no abstract.

Marras C, Lang A. · Toronto Western Hospital, University Health Network and University of Toronto, Ontario, Canada. · Neurology. · Pubmed #18490620 No free full text.

Abstract: Recent years have seen major changes in our understanding of Parkinson disease (PD), challenging conventional wisdom, much of which was established during the Decade of the Brain. In this article, we highlight important changes in our understanding of PD in six general categories: definition, etiology, pathology, pathogenesis, clinical features, and therapeutics.

Marras C, Lang AE. · Toronto Western Hospital, Movement Disorders Centre, 7 McLaughlin, 399 Bathurst Street, Toronto, ON M5T 2S8, Canada. · Expert Rev Neurother. · Pubmed #15853525 No free full text.

Abstract: Three areas of intense investigation in Parkinson's disease clinical trials include symptomatic treatment of Parkinsonism, disease-modifying therapy (or neuroprotection), and the prevention and treatment of motor complications of dopaminergic therapy. Difficulty interpreting the results of many studies in recent years has been attributed to problems with the chosen outcome measures. This article reviews the most common outcome measures used, assesses their positive attributes and proposes needs for future research. The Unified Parkinson's disease Rating Scale has been extensively validated and is by far the most common outcome measure used in trials of symptomatic therapy. Ambiguities in the response scale descriptors, poor inter-rater reliability of some items and a lack of items addressing nonmotor features of the disease are being addressed in a revision of the scale. Quality of life outcomes are being used in the minority of clinical trials, and no single generic or disease-specific quality of life measure is being used most frequently. Additional work validating several of the disease-specific instruments is needed. When a generic measure is used, its validity for use in Parkinson's disease must be critically assessed despite its previously established validity in other diseases. With respect to measuring motor complications, significant unmet needs include a consensus as to the best way to define the first motor complication and validating time to the first occurrence of motor complications as a surrogate of future disability and quality of life. Measuring the effectiveness of a potential neuroprotective agent presents unique challenges, particularly since symptomatic effects of the experimental agent or concomitant treatment can obscure any neuroprotective effects. Study designs and biomarkers are being developed that may overcome this problem. Currently, neuroimaging techniques that reflect function of the dopaminergic system are the most promising biomarkers but still require additional validation.

Broggi G, Franzini A, Marras C, Romito L, Albanese A. · Department of Neurosurgery, Istituto Nazionale Neurologico C. Besta, Milan, Italy. · Neurol Sci. · Pubmed #12774212 No free full text.

Abstract: Parkinson's disease (PD) is a progressive disturbances of movement that affects mainly the motor system. Prolonged pharmacological administration may result in insufficient control of symptoms and significant side effects. Deep brain stimulation (DBS), targeted at the STN, is a recent surgical procedure that, according to the symptoms response, allows modification of stimulation parameters; its effects are also reversible. In this paper management of surgical patients is reported. It includes patient selection, inclusion and exclusion criteria, postoperative clinical protocol. The evaluation rating scale such as UPDRS, Dyskinesias Rating Scale and Self-Reporting Questionnaire usually administrated on PD patients are analyzed. Surgical inclusion criteria are (1) idiopathic PD, (2) IV or V Hoehn-Yahr stage, (3) severe motor disability, and (4) no dementia or psychiatric abnormalities. Postoperative clinical protocol is analyzed and parameter of stimulation after surgery and at the follow up are reported. Generally DBS allows an improvement of rigidity and tremor; bradykinesia also improves with high frequency stimulation. Results obtained by continuous stimulation show a mean improvement of UPDRS of about 60% and a significant reduction in the drug intake.

Marras C, Rochon P, Lang AE. · Morton and Gloria Shulman Movement Disorders Center, Toronto Western Hospital, University Health Network, University of Toronto, Ontario, Canada. · Arch Neurol. · Pubmed #12433259 links to  free full text

Abstract: CONTEXT: The clinical course of Parkinson disease (PD) varies from patient to patient. A number of studies investigating predictors of prognosis in patients with PD have been performed. OBJECTIVE: To summarize evidence on predicting the rate of motor decline and increasing disability in early PD. DATA SOURCES: English-language and French-language literature cited in the MEDLINE database (1966-2002). STUDY SELECTION: Cohort and case-control studies investigating associations between clinical features and subsequent motor impairment or disability were selected. DATA EXTRACTION: Study methods and results were abstracted by a single reviewer. DATA SYNTHESIS: The results of 13 studies were summarized qualitatively. Study methods were highly variable, particularly regarding the choice of outcome measure. Baseline motor impairment and cognitive impairment are probable predictors of more rapid motor decline and disability. A lack of tremor at onset and older age both appear to be predictive of increasing disability, but conflicting results exist for their association with the rate of change of motor impairment. Family history of PD does not appear to be prognostically important. The prognostic value of many other factors studied is uncertain owing to conflicting or unconfirmed results. CONCLUSIONS: Uncertainty remains about the prognostic importance of many baseline clinical features in PD. Greater baseline impairment, early cognitive disturbance, older age, and lack of tremor at onset appear to be adverse prognostic factors.

Marras C, Lang A, Krahn M, Tomlinson G, Naglie G, Anonymous00241. · Division of Neurology, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada. · Mov Disord. · Pubmed #14743356 No free full text.

Abstract: The impact of dyskinesias and motor fluctuations on quality of life (QOL) at various stages in the course of Parkinson's disease (PD) is not well understood. In 301 subjects with early PD enrolled in a clinical trial (CALM-PD), we quantified the impact of motor complications on QOL and investigated how this changes over time. We also compared QOL related to demographic and treatment characteristics. The presence of dyskinesias was associated with visual analogue scale (VAS) scores 3.0 of 100 points higher (better) than those without dyskinesias in years 1 to 2, even when adjusting for Unified Parkinson's Disease Rating Scale (UPDRS) motor scores. The positive association between dyskinesias and QOL scores was more marked in older patients. In years 3 to 4, dyskinesias no longer had a significant relationship with QOL. Younger subjects had higher VAS scores. Gender, motor fluctuations, and treatment regimen had no significant association with QOL, although a trend was found toward a small negative effect of motor fluctuations on QOL. We conclude that motor complications that occur within the first 4 years of treatment of PD do not have a significant negative effect on quality of life as measured by a visual analogue scale for most patients.

Marras C, Lang AE, Ang LC, Zijlmans J, Wenning GK. · Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada. · Mov Disord. · Pubmed #11391758 No free full text.

This publication has no abstract.

Zadikoff C, Duong-Hua M, Sykora K, Marras C, Lang A, Rochon P. · Morton and Gloria Shulman Movement Disorders Center, Toronto Western Hospital, Department of Neurology, Toronto, Ontario, Canada. · Can J Neurol Sci. · Pubmed #18574930 No free full text.

Abstract: INTRODUCTION: Pergolide is an ergot derived dopamine agonist that is widely used for the treatment of Parkinson's disease. Studies have found an association between pergolide and valvular heart abnormalities although there is still much to be learned about the clinical significance of the valvular changes, who is at risk, and whether there is duration of exposure effect. OBJECTIVE: To assess the long term risk of hospital admissions for valvular heart disease (VHD) or congestive heart failure (CHF, a clinically overt outcome of VHD) in new users of pergolide compared to new users of levodopa. The secondary objective was to assess whether there are any characteristics that can predict who is at higher risk of developing this outcome. DESIGN: Retrospective, population-based cohort study. Setting: Ontario, Canada. SUBJECTS: Ontario residents aged 66 and older, newly started on treatment with either pergolide or levodopa. Outcomes: Admission to hospital with the most responsible diagnosis of congestive heart failure or valvular heart disease. RESULTS: The risk for admission for valvular heart disease or congestive heart failure were higher in those with 1-4 years exposure to pergolide compared with no exposure to pergolide (VHD: hazard ratio 2.4, p = 0.04; CHF: hazard ratio 1.6, p = 0.02). No such pattern was found with exposure to levodopa. CONCLUSION: Our study demonstrates that treatment with pergolide is associated with a higher risk of hospital admission for valvular heart disease or congestive heart failure and that this risk is greater in those with 1-4 years exposure than in those with less exposure. We did not find an increased risk beyond four years.

Healy DG, Falchi M, O'Sullivan SS, Bonifati V, Durr A, Bressman S, Brice A, Aasly J, Zabetian CP, Goldwurm S, Ferreira JJ, Tolosa E, Kay DM, Klein C, Williams DR, Marras C, Lang AE, Wszolek ZK, Berciano J, Schapira AH, Lynch T, Bhatia KP, Gasser T, Lees AJ, Wood NW, Anonymous00013. · Department of Clinical Neurosciences, Institute of Neurology, University College London, London, UK. · Lancet Neurol. · Pubmed #18539534 No free full text.

Abstract: BACKGROUND: Mutations in LRRK2, the gene that encodes leucine-rich repeat kinase 2, are a cause of Parkinson's disease (PD). The International LRRK2 Consortium was established to answer three key clinical questions: can LRRK2-associated PD be distinguished from idiopathic PD; which mutations in LRRK2 are pathogenic; and what is the age-specific cumulative risk of PD for individuals who inherit or are at risk of inheriting a deleterious mutation in LRRK2? METHODS: Researchers from 21 centres across the world collaborated on this study. The frequency of the common LRRK2 Gly2019Ser mutation was estimated on the basis of data from 24 populations worldwide, and the penetrance of the mutation was defined in 1045 people with mutations in LRRK2 from 133 families. The LRRK2 phenotype was defined on the basis of 59 motor and non-motor symptoms in 356 patients with LRRK2-associated PD and compared with the symptoms of 543 patients with pathologically proven idiopathic PD. FINDINGS: Six mutations met the consortium's criteria for being proven pathogenic. The frequency of the common LRRK2 Gly2019Ser mutation was 1% of patients with sporadic PD and 4% of patients with hereditary PD; the frequency was highest in the middle east and higher in southern Europe than in northern Europe. The risk of PD for a person who inherits the LRRK2 Gly2019Ser mutation was 28% at age 59 years, 51% at 69 years, and 74% at 79 years. The motor symptoms (eg, disease severity, rate of progression, occurrence of falls, and dyskinesia) and non-motor symptoms (eg, cognition and olfaction) of LRRK2-associated PD were more benign than those of idiopathic PD. INTERPRETATION: Mutations in LRRK2 are a clinically relevant cause of PD that merit testing in patients with hereditary PD and in subgroups of patients with PD. However, this knowledge should be applied with caution in the diagnosis and counselling of patients. FUNDING: UK Medical Research Council; UK Parkinson's Disease Society; UK Brain Research Trust; Internationaal Parkinson Fonds; Volkswagen Foundation; National Institutes of Health: National Institute of Neurological Disorders and Stroke and National Institute of Aging; Udall Parkinson's Disease Centre of Excellence; Pacific Alzheimer Research Foundation Centre; Italian Telethon Foundation; Fondazione Grigioni per il Morbo di Parkinson; Michael J Fox Foundation for Parkinson's Research; Safra Global Genetics Consortium; US Department of Veterans Affairs; French Agence Nationale de la Recherche.

Marras C, McDermott MP, Rochon PA, Tanner CM, Naglie G, Lang AE, Anonymous00028. · Division of Neurology, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada. · Mov Disord. · Pubmed #18076084 No free full text.

Abstract: The aim of this study was to investigate factors associated with decline in health-related quality of life in Parkinson's disease, by a retrospective cohort study from referral centers in Canada and the United States. Subjects were patients with early Parkinson's disease (N = 362) enrolled in a clinical trial of deprenyl (selegiline) and tocopherol (DATATOP) and followed prospectively. The main outcome measure was change in health-related quality of life using SF-36 Mental and Physical Component Summary scores. The mean interval between SF-36 measurements was 1.7 +/- 0.1 years, beginning 5 to 6 years after enrolment into the trial. In multivariable analysis, baseline Hamilton Depression Scale scores and self-rated cognitive function were associated with subsequent decline in Physical Component Summary scores, while older age and Schwab and England activities of daily living scores were associated with decline in Mental Component Summary scores. The Postural Instability Gait Disorder score was the only variable found to decline concurrently with HRQOL. Our results suggest that depression, self-rated cognitive function, and one's degree of functional independence are predictors of subsequent changes in HRQOL. Our focus in clinical care needs to be broadened beyond assessing and treating Parkinsonism, recognizing the impact of mood, cognition and function on HRQOL.

Zadikoff C, Fox SH, Tang-Wai DF, Thomsen T, de Bie RM, Wadia P, Miyasaki J, Duff-Canning S, Lang AE, Marras C. · Department of Neurology, Northwestern University, Parkinson's Disease and Movement Disorders Center, Chicago, Illinois, USA. · Mov Disord. · Pubmed #18044697 No free full text.

Abstract: Dementia is an important and increasingly recognized problem in Parkinson's disease (PD). The mini-mental state examination (MMSE) often fails to detect early cognitive decline. The Montreal cognitive assessment (MoCA) is a brief tool developed to detect mild cognitive impairment that assesses a broader range of domains frequently affected in PD. The scores on the MMSE and the MoCA were compared in 88 patients with PD. A pronounced ceiling effect was observed with the MMSE but not with the MoCA. The range and standard deviation of scores was larger with the MoCA(7-30, 4.26) than with the MMSE(16-30, 2.55). The percentage of subjects scoring below a cutoff of 26/30 (used by others to detect mild cognitive impairment) was higher on the MoCA (32%) than on the MMSE (11%) (P < 0.000002). Compared to the MMSE, the MoCA may be a more sensitive tool to identify early cognitive impairment in PD.

Munhoz RP, Wakutani Y, Marras C, Teive HA, Raskin S, Werneck LC, Moreno D, Sato C, Lang AE, Rogaeva E. · Movement Disorders Unit, Neurology Service, Hospital de Clínicas, Federal University of Paraná, Curitiba, PR, Brazil. · Mov Disord. · Pubmed #17999435 No free full text.

Abstract: Mutations in the Leucine-Rich Repeat Kinase 2 gene (LRRK2) are mainly responsible for idiopathic Parkinson's disease (PD) with either a dominant pattern of transmission or a sporadic occurrence due to the reduced penetrance. A majority of LRRK2 kindreds demonstrate an extremely variable age-at-onset in affected members of the same family. The G2019S is the most common LRRK2 mutation, which accounts for 1-5% PD patients in North America, and up to 40% of patients from an isolated Arab population. We assessed the frequency of the G2019S mutation in 83 Brazilian PD patients originally preselected for having an early age-at-onset (<50 years) and/or a positive family history. The mutation was detected in three probands (3.5%). Our clinical findings in these kindreds include the first description of the phenotype in identical twins discordant for handedness (a general phenomenon found in approximately 25% monozygotic twins). However, both twins developed right asymmetric PD. The clinical presentation of twins was strikingly similar including an identical PD onset at age 60. This observation may suggest that genetic factors predominantly determine age-at-onset.

Postuma RB, Wolfson C, Rajput A, Stoessl AJ, Martin WR, Suchowersky O, Chouinard S, Panisset M, Jog MS, Grimes DA, Marras C, Lang AE. · Department of Neurology, McGill University, Montreal General Hospital, Montreal, Quebec, Canada. · Mov Disord. · Pubmed #17486603 No free full text.

Abstract: Recent studies suggest that, for many adult-onset neurological diseases, persons born at a certain time of year are at higher risk of the disease. Small-scale studies have suggested that persons born in the spring may be at higher risk of developing Parkinson's disease (PD) late in life. There have also been suggestions that there are clusters of PD birth dates in the years of major influenza pandemics. To determine whether there is any seasonal variation in the birth dates of PD patients, we examined birth dates of 8,168 PD patients collected from subspecialty movement disorder clinics across Canada. Patterns of seasonality of birth were examined and compared with the general Canadian population. In addition, we compared counts of patients born in the years of major influenza pandemics with the number born in the surrounding years. We found no evidence of systematic seasonal variation in PD incidence by birth date, or of clustering of birth dates during influenza pandemic years in PD patients.

Broggi G, Franzini A, Tringali G, Ferroli P, Marras C, Romito L, Maccagnano E. · Department of Neurosurgery, Istituto Nazionale Neurologico C. Besta, Milano, Italy. · Acta Neurochir Suppl. · Pubmed #17370756 No free full text.

Abstract: Since 1995, at the Istituto Nazionale Neurologico "Carlo Besta" in Milan (INNCB,) 401 deep brain electrodes were implanted to treat several drug-resistant neurological syndromes (Fig. 1). More than 200 patients are still available for follow-up and therapeutical considerations. In this paper our experience is reviewed and pioneered fields are highlighted. The reported series of patients extends the use of deep brain stimulation beyond the field of Parkinson's disease to new fields such as cluster headache, disruptive behaviour, SUNCt, epilepsy and tardive dystonia. The low complication rate, the reversibility of the procedure and the available image guided surgery tools will further increase the therapeutic applications of DBS. New therapeutical applications are expected for this functional scalpel.

Kishore A, Espay AJ, Marras C, Al-Khairalla T, Arenovich T, Asante A, Miyasaki J, Lang AE. · Division of Neurology, Department of Medicine, Toronto Western Hospital, Toronto, Ontario, Canada. · Mov Disord. · Pubmed #17216641 No free full text.

Abstract: Patients with Parkinson's disease (PD) have an impaired ability to perform two different simultaneous bimanual tasks. The differential effects of unilateral versus bilateral identical tasks on the bradykinesia scores of the more and less affected limbs in PD have not been examined. Twenty-seven patients with early and asymmetric PD underwent blinded, videotaped assessment, independently for each limb, using the bradykinesia items of the Unified Parkinson's Disease Rating Part III, Motor subscale (mUPDRS) and a Modified Bradykinesia Rating Scale (MBRS), which assessed amplitude, speed, and rhythm of movements. We found that the score for finger tapping in mUPDRS and MBRS, the score of amplitude of finger tapping in MBRS, and the lateralized scores of mUPDRS (sum of Items 23 to 25) of the most affected side significantly improved during the bimanual task. The improvement was associated with longer duration of illness, higher total scores in mUPDRS, and higher lateralized bradykinesia scores of the most affected side. There was a simultaneous deterioration of the lateralized bradykinesia scores in MBRS (sum of Items 23 to 25) and Item 25 of mUPDRS (rapid alternating movements) of the least affected side in bimanual tasks. In conclusion, identical bimanual tasks facilitate movement of the most affected side in early asymmetric PD at the cost of motor degradation in the least affected side. This observation also highlights the need to perform tasks of bradykinesia in one limb at a time for best accuracy.

Marras C, Kopp A, Qiu F, Lang AE, Sykora K, Shulman KI, Rochon PA. · Morton and Gloria Shulman Movement Disorders Centre, Toronto Western Hospital, University Health Network, Toronto, Canada. · Mov Disord. · Pubmed #17149718 No free full text.

Abstract: The choice of agents to treat psychotic symptoms in Parkinson's disease is important given the potential for antipsychotics to worsen Parkinsonism. The purpose of this study was to estimate the incidence of psychotic symptoms requiring treatment in individuals with Parkinson's disease after starting dopaminergic medications, and to describe the agents being selected as initial antipsychotic therapy. Using the administrative health care databases of Ontario, Canada, individuals 66 years of age or older with Parkinson's disease who were newly treated with dopaminergic agents were identified. Subsequent prescriptions for antipsychotic medications were then identified. A total of 10,347 older adults were newly started on dopaminergic agents between 1998 and 2003. The Kaplan-Meier estimate for the cumulative probability of requiring an antipsychotic at 7 years was 35%; 499 individuals (4.8%; 5.2/100 person-years) were prescribed an antipsychotic within 1 year of starting dopaminergic therapy. The proportion of initial antipsychotic prescriptions for typical antipsychotics decreased from 56% (42 of 75) in 1998 to 9% (8 of 88) in 2002. Antipsychotic use is common in individuals with Parkinsonism newly treated with dopaminergic medication. Typical antipsychotics are still commonly being chosen as first-line agents for older patients, indicating a need for interventions to improve practice.

Rochon PA, Stukel TA, Sykora K, Gill S, Garfinkel S, Anderson GM, Normand SL, Mamdani M, Lee PE, Li P, Bronskill SE, Marras C, Gurwitz JH. · Institute for Clinical Evaluative Sciences, Kunin-Lunenfeld Applied Research Unit, Baycrest Centre for Geriatric Care, Department of Medicine, University of Toronto, Toronto, Ontario, Canada. · Arch Intern Med. · Pubmed #16157833 links to  free full text

Abstract: BACKGROUND: Atypical antipsychotic agents are thought to be less likely than older typical agents to produce parkinsonism. This has not been well documented. We compared the risk of development of incident parkinsonism among older adults dispensed atypical relative to typical antipsychotics. METHODS: Retrospective cohort study of all adults 66 years and older in Ontario. We used Cox proportional hazards models to study the association between the type, potency, and dose of antipsychotic dispensed and the development of parkinsonism during 1 year of follow-up. RESULTS: All 25,769 older adults prescribed antipsychotics were observed for 11,573 person-years, and 449 events of parkinsonism were identified. Relative to individuals dispensed an atypical antipsychotic, those dispensed a typical agent were 30% more likely (adjusted hazard ratio [HR], 1.30; 95% confidence interval [CI], 1.04-1.58) and those exposed to neither agent were 60% less likely (HR, 0.40; 95% CI, 0.29-0.43) to experience development of parkinsonism. Furthermore, those dispensed lower-potency typical agents were no different (HR, 0.75; 95% CI, 0.48-1.15), and those dispensed higher-potency typical antipsychotics were at close to a 50% greater risk (HR, 1.44; 95% CI, 1.13-1.84) of development of parkinsonism relative to atypical antipsychotics. Relative to those dispensed a high-dose atypical antipsychotic, those dispensed a typical antipsychotic were at similar risk for parkinsonism (Wald chi(2) = 0.14, P = .7). CONCLUSIONS: The risk of development of parkinsonism associated with the use of high-dose atypical antipsychotics was similar to that associated with the use of typical antipsychotics. Caution should be used when prescribing atypical antipsychotic therapy at high doses.

Marras C, Goldman S, Smith A, Barney P, Aston D, Comyns K, Korell M, Langston JW, Ross GW, Tanner CM. · The Parkinson's Institute, Sunnyvale, California, USA. · Mov Disord. · Pubmed #15719425 No free full text.

Abstract: Olfactory dysfunction has been proposed to be a sign that may precede the motor features of Parkinson's disease (PD). To determine whether smell identification deficits predict subsequent PD, we studied smell identification ability using the University of Pennsylvania Smell Identification Test (UPSIT) in 62 members of male twin pairs discordant for PD at baseline. Smell identification ability was reduced at baseline in the twins with PD compared to their unaffected brothers (23 vs. 31 of 40; P = 0.001). UPSIT scores were not reduced in the twins without PD when compared to age- and gender-specific normal values. After a mean interval of 7.3 years, 28 unaffected twins were still alive and 19 agreed to a second evaluation. Two had newly developed PD. Neither twin had impaired smell identification at baseline. The average decline in UPSIT percentile scores in these 2 twins was greater than in the 17 twins who did not develop PD (-68% vs. -24%; P = 0.01). In subjects who did not meet Core Assessment Program for Intracerebral Transplantations diagnostic criteria for PD at baseline, the presence of cardinal signs of parkinsonism was not associated with lower baseline UPSIT scores nor with a subsequent decline. Smell identification ability may not be a sensitive indicator of future PD 7 or more years before the development of motor signs, even in a theoretically at-risk population.

Marras C, McDermott MP, Rochon PA, Tanner CM, Naglie G, Rudolph A, Lang AE, Anonymous00131. · Division of Neurology, Toronto Western Hospital, University Health Network, University of Toronto, Ontario, Canada M5T 2S8. · Neurology. · Pubmed #15642909 No free full text.

Abstract: OBJECTIVE: To investigate predictors of survival in Parkinson disease (PD). METHODS: Vital status was determined in 800 subjects enrolled in a clinical trial of deprenyl (selegiline) and tocopherol 13 years earlier. RESULTS: Two hundred ninety-six deaths were recorded. There was no difference in the standardized mortality ratios across gender or age group. In univariate analyses, PD-specific variables associated with mortality were increased symmetry of parkinsonism, gait dysfunction as an initial symptom, severity of parkinsonism, and rate of worsening of parkinsonism prior to study enrollment. Cumulative exposure to deprenyl was not associated with mortality. In multivariable analysis, severity of parkinsonism and rate of worsening of parkinsonism remained associated with mortality. A poorer response to levodopa was associated with increased mortality independent of disease severity or dosage of levodopa. Results were unchanged when the analysis was restricted to 747 subjects maintaining a most likely diagnosis of PD throughout 6 years of active follow-up. CONCLUSIONS: Parkinson disease did not affect survival differently across gender or age groups in this selected group of otherwise healthy clinical trial participants. Severity and rate of worsening of parkinsonism and response to levodopa are strongly related to survival.

Marras C. · No affiliation provided · Mov Disord. · Pubmed #15197726 No free full text.

This publication has no abstract.

Ferroli P, Franzini A, Marras C, Broggi G. · No affiliation provided · J Neurosurg. · Pubmed #11883859 No free full text.

This publication has no abstract.