A public health perspective for neurological disorders. Fresh and updated estimates and predictions of the global burden borne by neurological disorders:

• Dementia
• Epilepsy
• Headache disorders
• Multiple sclerosis
• Neuroinfections
• Neurological disorders associated with malnutrition
• Pain associated with neurological disorders
• Parkinson’s disease
• Stroke
• Traumatic brain injuries.

Information and advice on public health interventions that may be applied to reduce the occurrence and consequences of most neurological disorders and offers health professionals and planners the opportunity to assess the burden caused by these disorders in their country and to take appropriate action.

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The issue of when to start treatment in Parkinson’s disease (PD) remains controversial. Some favour treatment at diagnosis while others opt for a ‘‘wait and watch’’ policy. The effect of the latter policy on the self reported health status of people with PD is unknown.

The aim of this study was to record self reported health status through longitudinal use of a validated PD specific questionnaire (PDQ-39) in untreated PD patients in multiple centres in the UK. To compare patients who were left untreated with those who were offered treatment during follow-up.

This study addresses for the first time self reported health status, an indicator of health related quality of life, in untreated PD. The findings may strengthen the call for re-evaluation of the policy to delay treatment in newly diagnosed patients with PD.

Neurostimulation of the subthalamic nucleus reduces levodopa-related motor complications in advanced Parkinson’s disease.

This study was an unblinded trial with a randomized- pairs design comparing deep-brain stimulation of the subthalamic nucleus with best medical management. The trial was conducted at 10 academic centers in Germany and Austria over six-months of patients under 75 years of age with severe motor complications of Parkinson’s disease.

Italian Society of Neurology's working group on Bioethics and Palliative care together with FIAN, Italian Federation Neurological Associations

Published by the Journal of Neurological Sciences and prepared by the Italian Society of Neurology's working group on Bioethics and Palliative care together with FIAN, Italian Federation Neurological Associations

In April 2006, medical professionals from 28 countries came together in Cannes to attend a symposium on rasagiline – a new option for the treatment of Parkinson’s disease (PD). During the event, experts in the field of PD discussed their opinions on the unmet needs of living with and managing PD, presented scientific data, discussed future perspectives in PD treatment and, most specifically, the emergence of clinical data supporting the use of rasagiline as a symptomatic and potentially diseasemodifying PD therapy.

A recent survey found that the administration of dopamine agonists in the treatment of Parkinson’s disease (PD) has been associated with use in young patients only. In this roundtable discussion, chaired by Dr Doug MacMahon, Drs Donald Grosset and Graeme MacPhee and Kirsten Turner discuss the difference between current and best practice in managing new PD patients and the role of biological versus chronological age in PD prescribing.

This article is from a Geriatric Medicine supplement which contains details of the original discussion.

An analysis was undertaken of clinic-based questionnaires that asked people with Parkinson's disease and a control group of older people without a known neurological condition about their experiences of constipation.

People with Parkinson's disease report higher constipation on a validated objective measure, the Rome criterion (59% vs. 20.9%); a behavioral indicator, laxative-taking (38.4% vs. 14.2%); and subjective self-report of being always or often concerned by it (33.4% vs. 6.1%). Many people with Parkinson's disease experience constipation problems but they may not bring these to the attention of their healthcare providers. More research is required to understand the causes and management options.

Long-term benefits in quality of life provided by bilateral subthalamic stimulation in patients with Parkinson disease

Quality-of-life improvements from STN DBS are maintained for at least 24 months after surgery, according to this study. Seventy-one patients who underwent bilateral STN DBS completed at least 12 months of follow-up; of these, 43 completed at least 24 months of follow-up.

Evaluations included UPDRS and PDQ-39. Off-medication UPDRS motor score declined (improved) from 41 to 24 in the 12-month follow-up group, and from 43 to 28 in the 24-month group. PDQ-39 total score declined (improved) from 42 to 28 in the 12-month group, and from 41 to 33 in the 24-month group (all changes significant at p<0.01).

Deep brain stimulation of either the subthalamic nucleus or the globus pallidus continues to provide significant benefit after 4 years of treatment, according to the study. Long-term follow-up was conducted at 8 centers in Europe and Canada, of patients originally enrolled in a multicenter trial of deep brain stimulation. Patients were enrolled if they had been treated for a minimum of 3 years and less than 5 years. Forty-nine of 68 DBS-STN patients were available for follow-up, and 20 of 37 DBS-GPi patients. Compared to GPi patients, STN patients at baseline were slightly older, had slightly higher UPDRS off-medication scores, and slightly higher daily levodopa equivalent doses.

Results showed:

• for STN, at baseline the percent of waking time spent off, on with dyskinesias, and on without dyskinesias was 53%, 23%, and 24%, respectively. At 3-4 years, it was 23%, 13%, and 64%.
• For GPi, these same percentages were 37%, 37%, and 26% at baseline, and 21%, 10%, and 69% at 3-4 years.
• for STN, UPDRS off-medication motor scores were 56.7 at baseline and 28.6 at 3-4 years (with stimulation on). For GPi, the scores were 51.7 and 31.7.
• for STN, levodopa equivalent dose intake fell from 1309 mg/day to 859 mg/day (p<0.001). For GPi, it rose from 1074 to 1418 (difference not significant).

Major adverse events present at 3-4 years included:

• memory decline and/or psychiatric disturbance in 12 STN patients (4 mild, 7 moderate, 1 severe) and 1 GPi patient (mild).
• moderate depression in 3 STN patients
• speech difficulties in 9 STN patients (2 mild, 3 moderate, 4 severe) and 1 GPi patient (severe)
• falls and/or balance disturbances in 8 STN patients (2 mild, 5 moderate, 1 severe)
• gait disorders in 9 STN patients (2 mild, 3 moderate, 4 severe)

The severity of adverse events did not warrant suspension of DBS in any case.

The challenges facing patient organisations in Europe are unique only in part, but that part is both critical and daunting. The core problem involves what "Europe" is and is not. It is a collection of nation states. It is not a nation. Consequently, people are "Europeans" after they are Danish, German, French, or whatever their nationality, and their healthcare and policy is National (with a deliberate capital), not European. Their access to treatment differs with their nationality. Where they exist, their patient organisations are National, not European.

At the European level, there is need for dialogue to inform the decisions of policy makers and to use patients as a resource to define societal and service needs. Organisations such as the European Parkinson’s Disease Association (EPDA), the European Federation of Neurological Societies (EFNS), and the European Brain Council (EBC) have an important role in initiating and sustaining a dialogue between medical science and society to improve the quality of life of patients and families living with Parkinson's disease and other brain diseases.

• Physiotherapy in The management of Parkinson’s disease
  M. Graziano, physiotherapist
• Electromyographic profiles of Gait prior to onsetof freezing
• Episodes in patients with Parkinson's disease
• Dimensions of sexual Dysfunction in Parkinson’s disease
• Use and interpretation of ‘on–off’ diaries in Parkinson's disease

Reprinted with permission of Excerpta Medica Medical Communications B.V.
Focus on Parkinson's Disease 2004; volume 16 (issue 1)
Published by Excerpta Medica Publications
ISSN 0924-2015

Supported by an unrestricted educational grant from
F. Hoffmann-La Roche Ltd, Basel, Switzerland

• Depression in PD, Clinical features and Treatment
• Treatment of PD in Spain
• The Impact of Comorbid Disease and Injuries on Resource use and Expenditures in Parkinsonism
• Cognitive and Behavioral Effects of Chronic Stimulation of the Subthalamic Nucleus in Patients with PD
• Does This Patient Have PD?

Reprinted with permission of Excerpta Medica Medical Communications B.V.
Focus on Parkinson's Disease 2003; volume 15 (issue 1)
Published by Excerpta Medica Publications
ISSN 0924-2015

Supported by an unrestricted educational grant from
F. Hoffmann-La Roche Ltd, Basel, Switzerland.

• L-Dopa Therapy in PD
• Predictors of Rapid Progression in PD
• Assessment of Plasma Lactoferrin in PD
• Twelve Months Safety of Entacapone in Patients with PD

"Reprinted with permission of Excerpta Medica Medical Communications B.V.
Focus on Parkinson's Disease 2002; volume 14 (issue 1) Published by Excerpta Medica Publications
ISSN 0924-2015

Supported by an unrestricted educational grant from
F. Hoffmann-La Roche Ltd, Basel, Switzerland