Parkinson Disease: Okuma Y

Miziuno Y, Okuma Y, Kikuchi S, Kuno S, Hashimoto T, Hasegawa K, Mano Y, Miwa H, Murata M, Yamamoto M, Yokochi F, Okiyama R, Kanazawa A, Shinpo K, Chuma T, Higashi T, Maruyama T, Mizuta E, Yamazaki S, Anonymous00188. · Department of Neurology, Juntendo University School of Medicine, Tokyo, Japan · Rinsho Shinkeigaku. · Pubmed #12708433 No free full text.

This publication has no abstract.

Okuma Y, Yanagisawa N. · Department of Neurology, Juntendo University Shizuoka Hospital, Shizuoka, Japan. · Mov Disord. · Pubmed #18668623 No free full text.

Abstract: Freezing of gait (FOG) is a common and very disabling symptom in Parkinson's disease (PD). It is usually observed in the advanced stage of the disease, although a mild form can be seen in the early stage. Although some studies have suggested that longer duration of dopaminergic treatment is associated with FOG, the disease progression alone may be responsible for the development of FOG. FOG can be experienced on turning, in narrow spaces, while reaching a destination, and in stressful situations. In PD, FOG is strongly associated with motor fluctuation. FOG is commonly observed in the "off" state and is observed less frequently in the "on" state. Dual tasking (cognitive load) aggravates FOG. Visual or auditory cues often resolve FOG. Analysis of gait revealed that the stepping rhythm suddenly jumps into high frequency (4-5 Hz) in FOG (hastening), and that floor reaction forces are disregulated. Since the hastening phenomenon was also reported in patients with lesions in the striatum and/or the frontal lobe, fronto-basal ganglia projections are considered essential for FOG. Careful observation and gait pattern analysis may lead to a successful management of individual PD patients with FOG.

Okuma Y. · Department of Neurology, Juntendo University Shizuoka Hospital, 1129 Nagaoka, Izunokuni, Shizuoka 410-2295, Japan. · J Neurol. · Pubmed #17131225 No free full text.

Abstract: Freezing of Gait (FOG) is one of the most disabling and least understood symptoms in Parkinson's disease (PD), and is usually observed in the advanced stage of the disease. FOG can be experienced on turning, in narrow spaces, whilst reaching a destination, and in stressful situations. FOG is commonly observed in the "off" state, but it can also be observed in the "on" state. Dual tasking (cognitive load) aggravates FOG. Visual or auditory cues often resolve FOG. Analysis of gait revealed that the rhythm of stepping suddenly jumps into high frequency (4-5 Hz) in FOG (hastening), and that floor reaction forces are disregulated. Stride-to-stride variability is increased in FOG. Hastening phenomenon was reported not only in PD patients but also in patients with striatal lesions. The basal ganglia and its frontal projections may be one of the essential lesion sites for FOG.A recent study using single-photon emission tomography (SPECT) revealed enhanced lateral premotor cortex (PMC) activity during paradoxical gait in PD, suggesting that PMC can compensate for the impaired function of the medial frontal cortex when cued by visual input. Treatment of FOG includes behavioural, medical, and surgical approaches. Tricks of all kinds (including external cues) are effective therapeutic approaches. If FOG occurs predominantly in the "off" state, dopaminergic therapy can be increased. For "on" freezing or if "on" response is otherwise optimised, the dose of the dopaminergic agent may be manipulated, but it could lead to the deterioration of parkinsonism. Deep brain stimulation of the STN often alleviates FOG in the "off" state.

Suzuki K, Miyamoto T, Miyamoto M, Okuma Y, Hattori N, Kamei S, Yoshii F, Utsumi H, Iwasaki Y, Iijima M, Hirata K. · Department of Neurology, Dokkyo Medical University, 880-Kitakobayashi, Mibu, Tochigi 321-0293, Japan. · J Neurol Sci. · Pubmed #18436241 No free full text.

Abstract: In Parkinson's disease (PD), sudden unexpected sleep episodes and excessive daytime sleepiness (EDS) while driving and engaging in social activities are important problems. We conducted a multi-center study to clarify the prevalence and contributing factor of EDS and sleep episodes in Japanese patients with PD. We evaluated 188 patients with PD (85 men, 103 women) and 144 age-matched controls for sleepiness. EDS was defined as an Epworth sleepiness scale (ESS) score of >or=10. ESS score was significantly higher (6.6+/-4.2 vs. 5.6+/-3.8) and prevalence of sleep episodes was higher in PD than in controls (6.4% vs. 0.7%). PD patients with EDS were more likely to have sleep episodes (22.5% vs. 2.0%), higher score for disease severity and depressive symptoms, and on higher dose of dopaminergic agents than those without EDS. However, there were no differences in nocturnal disturbances between the two groups. ESS score was not different between patients taking ergot and non-ergot dopamine agonists. Logistic regression analysis demonstrated that mental state, total dose of dopaminergic agents, and ESS score were significant predictors of sleep episodes. ESS score of >or=10 had 75% sensitivity and 82.4% specificity for sleep episodes. These results suggest that sleepiness in PD is dependent on disease itself and dopaminergic treatment rather than nocturnal disturbances.

Suzuki K, Miyamoto M, Miyamoto T, Okuma Y, Hattori N, Kamei S, Yoshii F, Utsumi H, Iwasaki Y, Iijima M, Hirata K. · Department of Neurology, Dokkyo Medical University, 880-Kitakobayashi, Mibu, Tochigi 321-0293, Japan. · Parkinsonism Relat Disord. · Pubmed #18359262 No free full text.

Abstract: Depression and nocturnal disturbances are frequent in patients with Parkinson's disease (PD). The aim of this study was to determine the correlation between depressive symptoms and nocturnal disturbances in patients with PD in Japan. The subjects of this multi-center cross-sectional study were 188 patients with PD and 144 age-matched controls who were assessed for nocturnal disturbances by the Parkinson's disease sleep scale (PDSS) and for depressive symptoms by Zung Self-Rating Depression Scale (SDS). Depressive symptoms (SDS score of > or =40) were identified in 122 patients (64.9%). The SDS was significantly higher in PD patients than control subjects. The stepwise regression model identified PDSS (p<0.001) and Unified Parkinson's Disease Rating Scale I (mental state) (p=0.002) as significant determinants of SDS. Stepwise regression analysis identified item 15 (daytime sleepiness) (p=0.002), item 13 (early morning tremor) (p=0.008), item 12 (nocturnal dystonia) (p=0.015), and item 3 (sleep maintenance insomnia) (p=0.026) as significant predictors of SDS. Our results indicated that depressive symptoms in PD correlate significantly with nocturnal disturbances, and that daytime sleepiness, dystonia, tremor and sleep fragmentation are the most common nocturnal disturbances in depressed patients with PD.

Suzuki K, Okuma Y, Hattori N, Kamei S, Yoshii F, Utsumi H, Iwasaki Y, Iijima M, Miyamoto T, Miyamoto M, Hirata K. · Department of Neurology, Dokkyo Medical University, Tochigi, Japan. · Mov Disord. · Pubmed #17557325 No free full text.

Abstract: The present multicenter cross-sectional study was performed using semistructured questionnaires to determine the contributing factors of sleep disturbances in Japanese patients with Parkinson's disease (PD). We used the Parkinson's disease sleep scale (PDSS, Japanese version). All data were obtained by means of interviewed questionnaire and physical examination by neurologists. The study was carried out between April 2005 and December 2005 at eight university hospitals and affiliated facilities in the Kanto area of Japan. A total of 188 (85 men and 103 women) PD patients and 144 controls (64 men and 80 women) were included. Stepwise regression analysis identified complications of treatment, depression, age, and disease duration as significant risk factors of sleep disturbances in PD. Significant differences in total PDSS score were observed between Hoehn & Yahr (H&Y) Stages 1 and 4, between H&Y Stages 2 and 4, and between H&Y stages 3 and 4 (Bonferroni test). The results of this survey suggested that complications due to treatment (dyskinesia, wearing off, on-off), depressive state, and disease stage are significant determinants of sleep disorders in Japanese patients with PD. We speculate that the reduction of neurotransmitters involved in the sleep-wakefulness mechanism and degeneration of neurons progress together in parallel with deterioration of motor function.

Kondo T, Takubo H, Yokochi F, Okuma Y, Mizuno Y. · Department of Neurology, Juntendo University School of Medicine, Japan. · No To Shinkei. · Pubmed #12599519 No free full text.

Abstract: We herein report on the outcome of 5 year-treatment of Parkinson's disease patients with selegiline hydrochloride. The subjects participated in this study were 10 patients whose treatment had been maintained consecutively by administration of this agent even after completion of the Phase II trial (all cases under adjunct therapy with L-DOPA/DCI). The daily dose of selegiline hydrochloride was 6.6 +/- 2.5 mg in average at the end and/or termination of the study. As for L-DOPA, its daily dose decreased from 410 +/- 160 mg to 365 +/- 133 mg at the 6th month, but the dose reduction level after 9 months was not determinable due to an increase in dropouts. Regarding alteration in the scores for individual symptoms, improvement in wearing-off symptom was pronounced during the treatment period of 3 to 51 months. The Global Improvement Rate and Usefulness Rate remained stable during the period of 18 to 30 months treatment although these rates declined after 36 months probably because of exacerbation in disease conditions. This study may assure tolerability of selegiline hydrochloride in a long-term treatment of Parkinson's disease patients.

Okuma Y, Mizuno Y. · No affiliation provided · Mov Disord. · Pubmed #11295804 No free full text.

This publication has no abstract.