Parkinson Disease: Opala G

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.

Jasińska-Myga B, Opala G. · Katedra i Klinika Neurologii Wieku Podeszłego, Slaska Akademia Medyczno w Katowicach. · Neurol Neurochir Pol. · Pubmed #17941459 No free full text.

Abstract: In this review we focus on and summarize the effects of dopamine agonists as well as their recent and future place in Parkinson's disease (PD) therapy in view of the results of clinical trials. Currently, the research is focused mainly on agents influencing the underlying neurodegenerative process or with efficacy in slowing progression of PD. Simultaneously, there is increasing interest in providing more continuous dopaminergic stimulation as an attempt at preventing and/or reducing motor complications. Strong efforts are underway to develop therapies that provide effective parkinsonian symptoms control but without motor fluctuations and dyskinesias. There are some new drugs as well as more efficacious, safe and comfortable formulations (e.g. controlled release) or routes of administration (e.g. transdermal, subcutaneous, intranasal) of dopamine agonists under development in clinical trials. According to recently reported results of clinical trials with dopamine agonists we conclude that they are effective in both monotherapy and combination therapy of idiopathic PD, and that there is a place for dopamine agonists in modern therapy of both early and late PD.

Boczarska-Jedynak M, Opala G. · Katedra i Klinika Neurologii Wieku Podeszłego, Slaska Akademia Medyczna, SP CSK, ul. Medyków 14, 40-752 Katowice. · Neurol Neurochir Pol. · Pubmed #16273462 links to  free full text

Abstract: Parkinson's disease is a progressive disorder of the central nervous system. Degeneration of the dopaminergic neurons is the main cause of the disease. The basic symptoms of Parkinson's disease are bradykinesia, rigidity and resting tremor. Disturbances of the autonomous nervous system, depression, dementia and sleep disorders are common, too. People with Parkinson's disease suffer from insomnia, excessive daytime sleepiness, "sleep attacks", nightmares, REM sleep behaviour disorder, periodic limb movement in sleep, restless legs syndrome and sleep apnea syndrome. The main cause of sleep disorders in Parkinson's disease are age-connected changes in sleep architecture, disturbances of neurotransmission, movement disturbances in sleep, medications and concomitant diseases. The authors present the current state of knowledge on sleep disorders in Parkinson's disease, especially, the role of dopaminergic therapy, methods of diagnostics and treatment as well as the influence of sleep disturbances on patient's quality of life.

Bialecka M, Hui S, Klodowska-Duda G, Opala G, Tan EK, Drozdzik M. · Department of Pharmacology, Pomeranian Medical University, Powstancow Wlkp 72, 70-111 Szczecin, Poland. · Neurosci Lett. · Pubmed #16115731 No free full text.

Abstract: Mutations in the leucine-rich repeat kinase 2 (LRRK 2), encoding dardarin protein, have been demonstrated to be linked to autosomal dominant Parkinson's disease (PD). In the present study the entire exon 41 of LRRK 2 gene was evaluated in a series of 174 PD patients recruited from Polish population, aged at the time of diagnosis 54.0+/-39.1 years, 21 of them had positive family history of PD with mean onset of the disease of 51.9+/-11.7 years as well as in 190 healthy controls aged 73.7+/-6.0 years. The mutations were evaluated by direct sequencing for mutations in exon 41 of LRRK 2 gene. In the studied patients no known mutations in exon 41 of LRRK 2 gene, including G 2019 S and I 2020 T were found, both in PD patients as well as in the controls. It can be concluded that the G 2019 S and I 2020 T mutations in exon 41 of LRRK 2 gene are rare causes of Parkinson disease in a Polish population.

Gaweda-Walerych K, Maruszak A, Safranow K, Bialecka M, Klodowska-Duda G, Czyzewski K, Slawek J, Rudzinska M, Styczynska M, Opala G, Drozdzik M, Canter JA, Barcikowska M, Zekanowski C. · Department of Neurodegenerative Disorders, Medical Research Center Polish Academy of Sciences, Pawińskiego 5, 02-106, Warsaw, Poland. · J Neural Transm. · Pubmed #18810306 No free full text.

Abstract: mtDNA common variation is inconsistently reported to modify the risk of Parkinson's disease (PD). We evaluated the impact of the mitochondrial haplogroups, subhaplogroups, coding and non-coding single-nucleotide polymorphisms on PD risk in 241 PD patients and 277 control subjects. After stratification by gender, we found that haplogroup J (OR 0.19; 95% CI 0.069-0.53; P = 0.0014) was associated with a lower PD risk in males. Unexpectedly, subhaplogroup analysis based on the control region (CR) polymorphisms demonstrated that subcluster K1a was more prevalent in healthy controls, while K1c was more frequent in PD patients (P = 0.025 and P = 0.011, respectively; two-tailed Fisher's exact test). Additionally, we confirmed the hypothesis that sublineages (U4 + U5a1 + K+J1c + J2), previously proposed to partially uncouple oxidative phosphorylation (OXPHOS), decrease PD risk (P = 0.027, chi2 with Yates' correction). The putative protective effect of uncoupling mtDNAs against PD might result from decreased production of reactive oxygen species. We propose that stratification into subhaplogroups or by gender could be necessary to reveal the involvement of specific mtDNA sublineages in PD pathogenesis.

Ross OA, Soto AI, Vilariño-Güell C, Heckman MG, Diehl NN, Hulihan MM, Aasly JO, Sando S, Gibson JM, Lynch T, Krygowska-Wajs A, Opala G, Barcikowska M, Czyzewski K, Uitti RJ, Wszolek ZK, Farrer MJ. · Department of Neuroscience, Mayo Clinic, Jacksonville, Florida 32224, United States. · Parkinsonism Relat Disord. · Pubmed #18790661 No free full text.

Abstract: Variants in the Omi/HtrA2 gene have been nominated as a cause of Parkinson's disease. This sequencing study of Omi/HtrA2 in 95 probands with apparent autosomal dominant inheritance of Parkinson's disease did not identify any pathogenic mutations. In addition, there was no association between common variations in the Omi/HtrA2 gene and susceptibility to Parkinson's disease in any of our four patient-control series (n=2373). Taken together our results do not support a role for Omi/HtrA2 variants in the pathogenesis of Parkinson's disease.

Ross OA, Heckman MG, Soto AI, Diehl NN, Haugarvoll K, Vilariño-Güell C, Aasly JO, Sando S, Gibson JM, Lynch T, Krygowska-Wajs A, Opala G, Barcikowska M, Czyzewski K, Uitti RJ, Wszolek ZK, Farrer MJ. · Department of Neuroscience, Mayo Clinic College of Medicine, Jacksonville, FL 32224, USA. · Parkinsonism Relat Disord. · Pubmed #18722802 No free full text.

Abstract: A single nucleotide polymorphism in the promoter region of the dopamine beta-hydroxylase gene (DBH -1021C>T; rs1611115) is reported to regulate plasma enzyme activity levels. This variant has also been the focus of two large association studies in Parkinson's disease yielding conflicting results. We examined this association in four Caucasian patient-control series (n=2696). A modest protective association was observed in the Norwegian series (OR=0.81, p=0.03; n=1676), however, the effect was in the opposite direction in the Polish series (OR=2.01, p=0.01; n=224). No association was observed for DBH -1021C>T with disease susceptibility in the US and Irish series, or combining all four series (OR=0.91, p=0.16, n=2696). We observed a modest association between DBH -1021C>T and AAO in the combined series (p=0.01). Taken together, these findings indicate that DBH -1021C>T does not play a major role in the pathogenesis of Parkinson's disease.

Bialecka M, Kurzawski M, Klodowska-Duda G, Opala G, Tan EK, Drozdzik M. · Department of Experimental and Clinical Pharmacology, Pomeranian Medical University, Powstancow Wikp. 72, Szczecin, Poland. · Pharmacogenet Genomics. · Pubmed #18698234 No free full text.

Abstract: INTRODUCTION: Differences in catechol-O-methyltransferase (COMT) activity and genotype may determine individual variations in the therapeutic response to levodopa or Parkinson's disease (PD) susceptibility. The role of functional COMT haplotypes in PD susceptibility and treatment response has not been examined. OBJECTIVES: In this case-control study, we investigated the association of the most common COMT gene haplotypes (formed by single nucleotide polymorphisms (SNPs): rs6269:A>G; rs4633C>T; rs4818:C>G; and rs4680:A>G) with PD risk and the association of the COMT haplotypes with the dose and complications of levodopa therapy in PD patients. METHODS: A total of 679 study participants (322 PD and 357 controls) were included. Each participant was genotyped for four SNPs in the COMT gene, located in a common haploblock, that has been shown to influence COMT enzymatic activity. The influence of COMT haplotypes on the dose of levodopa administered during fifth year of treatment, and occurrence of motor complications were examined in PD patients. The EH program (Jurg Ott, Rockefeller University, New York, USA) was used to estimate haplotype frequencies. RESULTS: The estimated frequencies of low (A_C_C_G) and medium (A_T_C_A) activity haplotypes tended to be slightly lower among PD patients when compared with controls (P=0.09, G_C_G_G-high activity haplotype as reference). The frequency of G_C_G_G (high activity) haplotype carriers was higher in late onset PD patients (P=0.04) compared with controls. The mean levodopa dose increased with the activity of the functional haplotypes (low<medium<high). Doses prescribed for G_C_G_G (high activity) haplotype carriers (mean 604.2+/-261.9 mg) were significantly higher than those for the noncarriers (mean 512.2+/-133.5 mg, P<0.05). The COMT haplotype seemed to have little influence on the development of levodopa-induced dyskinesias. CONCLUSION: Our study showed a possible association of functional COMT haplotypes with the risk of PD. Both nonsynonymous and synonymous SNPs within functional COMT haplotype blocks may be more relevant than individual SNPs in conferring PD susceptibility. The doses of levodopa treatment can be influenced by specific COMT haplotypes and this may be useful in instituting individualized therapy for PD patients.

Bialecka M, Klodowska-Duda G, Kurzawski M, Slawek J, Gorzkowska A, Opala G, Bialecki P, Sagan L, Droździk M. · Department of Experimental and Clinical Pharmacology, Pomeranian Medical University, Szczecin, Poland. · Parkinsonism Relat Disord. · Pubmed #18362084 No free full text.

Abstract: Recent studies revealed that inflammatory processes might play an important role in the pathogenesis of Parkinson's disease (PD). We hypothesized that genetically determined differences in the immune response, especially in anti- and pro-inflammatory cytokines production might influence the risk for the development and/or onset of sporadic PD. In the present study, we investigated the genetic polymorphisms of the IL10 (-1082 and -519) and TNF (-308) genes in relation to the risk of PD, and their associations with age of PD onset in a group of 316 patients, divided into two subgroups: Group 1: patients with early onset PD (EOPD), i.e. before 50 years of age (102 patients), and group 2: patients with onset of PD after 50 years of age comprising 214 subjects. Control samples were obtained from 300 randomly selected healthy individuals from the same geographical region with no signs of Parkinsonism as evaluated by a neurologist. PCR-RFLP methods were used for genotyping. No statistically significant differences between PD patients and controls were found in the frequency of a single locus of IL10 promoter. We found TNF -308A allele significantly more frequent in EOPD patients compared to the controls (p=0.007). The overrepresentation of the A allele was reflected by a significant increase in AA homozygous individuals in EOPD patients compared to the controls (p=0.0021). The results from our study revealed that the TNF -308AA genotype might increase the risk of early onset of PD.

Bialecka M, Klodowska-Duda G, Kurzawski M, Slawek J, Opala G, Bialecki P, Safranow K, Droździk M. · Department of Experimental and Clinical Pharmacology, Pomeranian Medical University, Szczecin, Poland. · Arch Med Res. · Pubmed #17923267 No free full text.

Abstract: BACKGROUND: The etiology of sporadic Parkinson's disease (PD) is not well established. Recent studies revealed that inflammatory processes might also play an important role in the pathogenesis of PD. We hypothesized that genetically determined differences in the immune response, especially in anti-inflammatory cytokines production, might influence the risk of sporadic PD development and/or onset. To prove this hypothesis, two DNA polymorphisms at IL-10 promoter (-1082 and -519) were examined in sporadic PD patients. METHODS: The study enrolled 341 patients with diagnosed idiopathic PD. All cases of secondary parkinsonism were excluded from the study. For the purpose of this study the patients were also divided into two subgroups: group 1: patients with onset of Parkinson's disease, i.e., <50 years of age (early onset) included 60 patients, as well as group 2: patients with onset of Parkinson's disease >50 years of age (late onset) comprising 281 subjects. Control samples were from 315 randomly selected healthy individuals from the same geographical region who were free from signs of parkinsonism as evaluated by consultant neurologists. PCR-RFLP methods were used for genotyping. RESULTS: No statistically significant differences between PD patients and controls were found in the frequency of a single locus (-1082, -519) of IL-10 promoter. Likewise, haplotype analysis did not demonstrate any significant differences between evaluated groups. The frequency of the evaluated IL-10 genotypes was also similar in EOPD and LOPD patients. CONCLUSIONS: Results from our study revealed that the IL-10 (-1082G>A, -592C>A) polymorphism is not a risk factor of sporadic Parkinson's disease in a Polish population.

Błaszczyk JW, Orawiec R, Duda-Kłodowska D, Opala G. · Faculty of Physiotherapy, Academy of Physical Education, Katowice, Poland. · Exp Brain Res. · Pubmed #17609881 No free full text.

Abstract: Postural instability is one of the most disabling features of idiopathic Parkinson's disease (PD). In this study, we focused on postural instability as the main factor predisposing parkinsonians to falls. For this purpose, changes in sway characteristics during quiet stance due to visual feedback exclusion were studied. We searched for postural sway measures that could be potential discriminators for an increased fall risk. A group of 110 subjects: 55 parkinsonians (Hoehn and Yahr: 1-3), and 55 age-matched healthy volunteers participated in the experiment. Their spontaneous sway characteristics while standing quiet with eyes open and eyes closed were analyzed. We found that an increased mediolateral sway and sway area while standing with eyes closed are characteristic of parkinsonian postural instability and may serve to quantify well a tendency to fall. These sway indices significantly correlated with disease severity rated both by the Hoehn and Yahr scale as well as by the Motor Section of the UPDRS. A forward shift of a mean COP position in parkinsonians which reflects their flexed posture was also significantly greater to compare with the elderly subjects and exhibited a high sensitivity to visual conditions. Both groups of postural sway abnormalities identified here may be used as accessible and reliable measures which allow for quantitative assessment of postural instability in Parkinson's disease.

Jasinska-Myga B, Opala G, Goetz CG, Tustanowski J, Ochudlo S, Gorzkowska A, Tyrpa J. · Department of Neurology, Ageing, Degenerative and Cerebrovascular Diseases, Medical University of Silesia, Central University Hospital, Medykow 14, Katowice 40-752, Poland. · Arch Neurol. · Pubmed #17296843 links to  free full text

Abstract: BACKGROUND: Apolipoprotein E gene (APOE) polymorphism is an important determinant for the development of various cardiovascular and neurodegenerative disorders. There have been conflicting reports of association of APOE polymorphism with dementia in Parkinson disease (PD). OBJECTIVE: To determine the relationship between APOE polymorphisms and plasma cholesterol concentration, and PD with dementia (PDD). DESIGN: Four-year (1999-2002) case-control study. SETTING: Academic medical center with inpatient and outpatient movement disorders services. Patients Consecutive white patients of the same ethnic background with PD. INTERVENTIONS: Strict clinical, neuropsychological, and neuroimaging criteria were used to exclude dementia with Lewy bodies, Alzheimer disease, and vascular dementia. Findings were compared in 2 clinical groups, including 98 patients (47 men and 51 women; mean age, 71 years) with PDD and 100 patients (52 men and 48 women; mean age, 62 years) with PD without dementia. MAIN OUTCOME MEASURES: Analysis of APOE genotypes and allelic frequency (polymerase chain reaction) and plasma cholesterol concentration (enzymatic assay) were evaluated by a clinician blinded to the clinical diagnosis, and findings were compared between the groups with PDD or PD without dementia. Multiple stepwise regression analysis and the Spearman rank correlation coefficient were used to evaluate relationships between dementia and both APOE polymorphism and cholesterol concentration. Statistical significance was set at P<.05. RESULTS: Epsilon4 allele frequencies were similar in PDD and PD without dementia (16.8% vs 19%, respectively). Cholesterol concentration, APOE genotypes, and allelic frequencies did not relate to PDD. CONCLUSIONS: In contrast to Alzheimer disease, when PDD is carefully defined, it is clearly not associated with APOE polymorphisms or with a distinctive plasma cholesterol profile. Ongoing longitudinal follow-up with emphasis on autopsy recruitment will enable further analyses of biochemical alterations underlying PDD.

Bialecka M, Kurzawski M, Klodowska-Duda G, Opala G, Juzwiak S, Kurzawski G, Tan EK, Drozdzik M. · Department of Experimental and Clinical Pharmacology, Pomeranian Medical University, Szczecin, Poland. · Neurosci Res. · Pubmed #17174426 No free full text.

Abstract: Recent reports have proven the importance of genetic factors and inflammation in the pathogenesis of sporadic Parkinson's disease (PD). In the current study, the frequency of CARD15/NOD2 gene variants (R702W, G908R, L1007fs), previously associated with Crohn's disease--a common inflammatory bowel disease, have been examined in a group of 308 sporadic PD patients and 220 healthy controls. Significantly higher frequency of total CARD15 variant alleles in PD patients (13.0%) compared to the controls (8.0%, p<0.02) was observed. 24.0% of PD patients carried at least one CARD15 variant allele compared to 15.5% of healthy controls (p<0.02, OR=1.73). The results of the study suggest, that the polymorphism in CARD15/NOD2 gene may be a risk factor for sporadic PD development, and support the concept of inflammatory pathogenesis of PD.

Bialecka M, Kurzawski M, Klodowska-Duda G, Opala G, Tan EK, Drozdzik M. · Department of Pharmacology, Pomeranian Medical University, Powstancow Wlkp 72, 70-111 Szczecin, Poland. · Neurosci Lett. · Pubmed #16481103 No free full text.

Abstract: A SNP rs7702187 within the semaphorin 5A gene (Sema5A) has been recently associated with sporadic Parkinson's disease (PD) risk in American Caucasians. In the present study frequencies of rs7702187 was determined in two independent populations involving 427 sporadic PD patients (235 Polish Caucasians and 192 Asians from Singapore) and 412 healthy controls (220 Caucasians and 192 Asians), with the use of PCR-RFLP assay. The frequencies of the minor allele were found to be very similar in PD patients and healthy controls in both populations studied: 0.147 versus 0.143 in Caucasian, and 0.224 versus 0.221 in Asian, respectively. Our research does not confirm the previous observation, as no relationship was found between polymorphism within Sema5A gene and the risk of PD. It can be concluded that rs7702187 SNP in Sema5a gene is not a marker of PD risk in the studied populations.

Kłodowska-Duda G, Jasińska-Myga B, Safranow K, Boczarska-Jedynak M, Opala G. · Klinika Neurologii Wieku Podeszłego, Slaska Akademia Medyczna, ul. Medyków 14, 40-752 Katowice Ligota. · Neurol Neurochir Pol. · Pubmed #16355301 links to  free full text

Abstract: BACKGROUND AND PURPOSE: Various factors are suspected to participate in PD onset and include environment-related factors and workplace exposure to pesticides, metals and hydrocarbons. Nevertheless, results of epidemiological research are inconsistent. Some authors emphasize hydrocarbons exposure to younger patients. Our aim was to compare PD risk factors to onset age. MATERIAL AND METHODS: Of 174 patients with idiopathic PD, without dementia, two subgroups were isolated: 65 patients with early onset PD (EOPD) below 50 (n=65, age 52.8+/-7.6 years, onset 42.8+/-5.3 years) and 109 patients with late onset (LOPD) above 50 (n=109, age 67.8+/-7.0, onset 60.8+/-6.7 years). Various environmental factors reported in literature were analyzed. RESULTS: The univariate analysis showed that factors significantly predisposing to EOPD are vocational education (OR 3.24, 95%CI 1.50-7.00, p<0.003), smoking (OR 1.94, 95%CI 1.02-3.69, p<0.05), well water consumption at 20-40 (OR 2.77, 95%CI 1.31-5.86, p<0.008), and after 40 (OR 4.84, 95%CI 1.95-11.99, p<0.0007), side-effects following exposure to paints (OR 2.26, 95%CI 1.10-4.66, p<0.03) and exposure to solvents (OR 1.98, 95%CI 0.96-4.07, p<0.07) on borderline significance. Drinking well water both between 20-40 and after 40 involved a substantial increase in EOPD (OR 6.57, 95%CI 2.43-17.75, p<0.0002). Education only at a primary level proved to be protective against EOPD (OR 0.20, 95%CI 0.07-0.55, p<0.002). The multivariate logistic regression model demonstrated that independent EOPD risk factors are smoking (OR 2.20, 95%CI 1.07-4.53, p<0.04) and well water consumption both between 20-40 and after 40 (OR 8.29, 95%CI 2.73-25.23, p<0.0002), whilst the independent protective factor is education only at a primary level (OR 0.17, 95%CI 0.05-0.53, p<0.003). CONCLUSIONS: Our research demonstrated that a number of independent environmental factors significantly affect the risk of PD onset at younger ages. Presumably, some of the observed differences in the results of research of various authors into PD risk factors may be caused by ignoring onset age within the researched patients.

Białecka M, Droździk M, Honczarenko K, Gawrońska-Szklarz B, Stankiewicz J, Dabrowska E, Kubisiak M, Kłodowska-Duda G, Opala G. · Department of Experimental and Clinical Pharmacology, Pomeranian Medical University, Szczecin, Poland. · Eur Neurol. · Pubmed #15753616 No free full text.

Abstract: Recent reports have proved that genetic factors play a role in the pathogenesis of sporadic Parkinson's disease (PD). It has been suggested that polymorphisms in monoamine oxidase B (MAOB) and catechol-O-methyltransferase (COMT) might increase the risk of PD. A total of 210 Polish patients with sporadic PD and 152 healthy controls were studied. The MAOB and COMT polymorphisms were identified using the polymerase chain reaction-restriction fragment length polymorphism method. The MAOB allele and genotype frequencies in PD patients did not differ significantly from the controls. A statistically lower frequency of the COMTLL genotype in patients with parkinsonism was found. The combined haplotype of the MAOB G (G/G) and COMTHL genotype showed a fourfold increase (p < 0.05) in the risk of PD in female patients in this Polish population.

Białecka M, Droździk M, Kłodowska-Duda G, Honczarenko K, Gawrońska-Szklarz B, Opala G, Stankiewicz J. · Department of Experimental and Clinical Pharmacology, Pomeranian Medical University, Szczecin. · Acta Neurol Scand. · Pubmed #15355491 No free full text.

Abstract: OBJECTIVES: The etiology of sporadic idiopathic Parkinson's disease (PD) is considered multifactorial with both genetic and environmental factors modifying the disease expression. Recent studies suggest that polymorphism in monoamine oxidase B (MAOB) and catechol-O-methyltransferase (COMT) might influence the risk and treatment of PD. The aim of the study was to evaluate the effect of MAOB and COMT genetic polymorphism on effective daily dose of levodopa applied during the first 5 years of treatment, and to find out if a relationship exists between MAOB and COMT haplotypes and motor disturbances onset in PD patients treated with levodopa preparations. MATERIALS AND METHODS: A total of 95 patients (40 females and 55 males) of Polish origin diagnosed with sporadic PD were enrolled into the study, and were divided into two groups. Group 1 - patients treated with doses of levodopa below 500 mg/day during the first 5 years of treatment. Group 2 - patients requiring levodopa doses exceeding 500 mg/24 h during the first 5 years of treatment. Low activity alleles of MAOB and COMT, i.e. MAOB allele A and COMT(L) as well as high activity ones, i.e. MAOB allele G and COMT(H), were determined using PCR-RFLP method. RESULTS: No statistically significant differences were found in MAOB and COMT allele distribution in the two groups. However, the frequency of COMT(L/L) homozygotes was higher in the group treated with low doses of levodopa when compared with the second group. MAOB and COMT AG-HH haplotype predominated in the group of females treated with high daily doses of levodopa when compared with AG-LL haplotype in the group of females treated with low daily doses of levodopa (<500 mg/24 h). CONCLUSION: The results of the study suggest that patients with COMT(L/L) genotype and possibly MAOB genotype A may benefit from more efficient and safer levodopa therapy.

Jasińska-Myga B, Opala G, Ochudło S, Tustanowski J. · Katedry i Kliniki Neurologii Wieku Podeszłego, Slaskiej Akademii Medycznej w Katowicach. · Wiad Lek. · Pubmed #15181744 No free full text.

Abstract: The aim of our study was evaluation of the relationship between apolipoprotein E (APO E) genotype and the clinical parameters in Parkinson's disease (PD) with and without dementia. 104 PD patients were evaluated and within this group two subgroups were formed: 51 PD patients (25 males, 26 females; mean age: 70.4 +/- 6.03 years) with dementia and 53 (31 males, 22 females; mean age: 62.5 +/- 8.57 years) without dementia. The estimation of APO E genotype was executed by means of Polymerase Chain Reaction. The Unified Parkinson's Disease Rating Scale was used to quantify the severity of PD. Cognitive functions were assessed according to the Mini Mental State Examination. APO E genotype and allele frequencies did not differ between demented and nondemented parkinsonian patients.

Ochudło S, Opala G, Jasińska-Myga B, Siuda J, Nowak S. · Katedra i Klinika Neurologii Wieku Podeszłego SAM SP Centralny Szpital Kliniczny ul. Medyków 14, 40-752 Katowice. · Neurol Neurochir Pol. · Pubmed #15098340 No free full text.

Abstract: INTRODUCTION: Dementia is more frequent in patients suffering from Parkinson's disease (PD) then in general population. The mechanism for mental deterioration in PD remains controversial. The aim of our study was comparison of the regional cerebral perfusion quantified by single photon emission computed tomography in patients suffering from idiopathic Parkinson's disease with and without dementia. MATERIAL AND METHODS: We examined 49 PD patients: 22 PD patients with dementia and 27 PD patients without dementia. Dementia was recognized according to ICD-10 and DSM-IV criteria. Cognitive functions were executed by means of the Mini Mental State Examination (MMSE) and neuropsychological assessment. The Unified Parkinson's Disease Rating Scale (UPDRS) and Modified Hoehn & Yahr Scale was used to quantify the severity of PD. SPECT was performed with Siemens Diacam single--head rotating gamma camera after intravenous application of technetium 99m hexamethylpropylene amine oxime (99mTc-HMPAO). The perfusion values were expressed as cortical or basal ganglia regions of interest (ROIs)/cerebellum activity ratios. RESULTS: In both examined group of patients the lowest uptake was in basal ganglia region, while the highest uptake was in occipital region. In the subgroup of PD patients with dementia significant hypoperfusion affecting the inferior frontal cortices was observed. CONCLUSIONS: In Parkinson's disease with dementia hypoperfusion in inferior frontal region can be found.

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.