baciu diana, mg, vi scientific advisor: lecturer: dr. szász józsef-attila umf târgu mure,...
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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
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• 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
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Introduction-Pathophysiology-Diagnostic-Treatment-Material and Methods-Results-Conclusion
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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
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Introduction-Pathophysiology-Diagnostic-Treatment-Material and Methods-Results-Conclusion
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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
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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
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Monotherapy
Introduction-Pathophysiology-Diagnostic-Treatment-Material and Methods-Results-Conclusion
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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
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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
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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
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Results I. Distribution according to risc factors
Introduction-Pathophysiology-Diagnostic-Treatment-Material and Methods-Results-Conclusion
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Introduction-Pathophysiology-Diagnostic-Treatment-Material and Methods-Results-Conclusion
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Introduction-Pathophysiology-Diagnostic-Treatment-Material and Methods-Results-Conclusion
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ResultsIII. Patient distribution of oral medications
Introduction-Pathophysiology-Diagnostic-Treatment-Material and Methods-Results-Conclusion
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Treatment with Duodopa: Intestinal Gel
Introduction-Pathophysiology-Diagnostic-Treatment-Material and Methods-Results-Conclusion
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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
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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
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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
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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
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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
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Introduction-Pathophysiology-Diagnostic-Treatment-Material and Methods-Results-Conclusion