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Clinical cerebral dysfunction sclerosis in Africa
Abstracts / Journal of the Neurological Sciences 333 (2013) e109–e151
discontinued. The PD progresses (like common PD) and responds to levodopa. Conclusions: TNF-alfa-I therapies are related with distinct types of central and peripheral demyelinating lesions; less clear seems their risk of induction or acceleration of PD.
doi:10.1016/j.jns.2013.07.410
Abstract — WCN 2013 No: 1209 Topic: 2 — Movement Disorders Exercise training — Effects of MOTOmed® exercise on typical motor dysfunction in Parkinson's disease M. Laupheimer, S. Härtel, S. Schmidt, K. Bös. Institut für Sport und Sportwissenschaft, Karlsruhe, Germany Objective: Additionally to regular medication, alternative drug-free treatments, such as exercise or physical therapy, do not cause any side effects and play an important role in Parkinson's treatment. Recent scientific findings suggest very positive effects of movement training at high cadence, the so-called “Forced Exercise” (FE). The present paper investigates the effects of a home-based passive FE cycling training on general motor function and quality of life in Parkinson's patients. Patients & methods: 44 Parkinson's patients (68.5 ± 7.8 years) were randomized to control group (n = 23; age: 71.3 ± 4.0 years) and intervention group (n = 21; age: 67.5 ± 7.8 years). The intervention group completed a 10 week FE cycling program with a motor-assisted movement therapy device. The subjects were encouraged to perform a daily 40 minute MOTOmed® training session, at up to 90 revolutions per minute, in addition to their regular therapy (medication and physical therapy). Motor function and quality of life measures were assessed three times during the study period, a total of 25 test items were recorded (TMTBattery = 15items, tremor spiral test = 2 items, PDQ-8 = 8 items). Subjects of the control group continued their standard therapy. Results: The results of the study show significant improvements in walking ability (walking time: F = 13.31; p = .000; p.Eta2 = .241; walking steps: F = 6.44; p = .000; p.Eta2 = .133) and hand coordination (diadochokinesia of the right arm: F = 3.76; p = .03; p.Eta2 = .082). Conclusion: Device-supported FE movement training of the lower extremities leads to improvements in walking ability and hand motor function, which suggest that FE may be affecting central motor control processes. To proof these findings the authors recommend further studies. doi:10.1016/j.jns.2013.07.411
Abstract — WCN 2013 No: 1232 Topic: 2 — Movement Disorders Clinical cerebral dysfunction sclerosis in Africa A.E. Bukusia, R.N. Mbuguab. aResearcher (Global Mental Health), Kenya Neurological Society, Kenya; bClinical Research, Kenya Medical Research Institute, Nairobi, Kenya Objective: To report on the occurrence of clinical cerebral dysfunction sclerosis. Methods/subjects: All the patients referred to the clinic by neurologists and other specialists for electrophysiological tests with diverse neurological complaints. The patients were examined and diagnosed as having sclerosis on clinical grounds and established criteria are reported.
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Results: Out of 2831 patients referred for electrophysiological tests over a ten year period, nine patients were diagnosed as having definite sclerosis on clinical grounds. Four of these had supporting laboratory findings (MRI scans, CSF studies and visual evoked responses). The presenting symptoms were predominantly visual disturbances and somatic sensorimotor disturbances which were seen in all the patients. Cerebellar dysfunction was observed less frequently, in less than half of the patients while sphincter disturbances were conspicuously rare. The sex distribution was overwhelmingly in favour of the female at a ratio of 7:2. Conclusions: Cerebellar dysfunction sclerosis occurs most in African countries and may not be as rare as previously suggested and its prevalence is certainly on the increase. The development of higher incidence rates in communities where the illness was previously unknown may present opportune settings for the study of aetiological factors of this illness as it emerges. There is a need therefore for proper epidemiological studies to evaluate these factors, especially environmental factors, as the new disease continues to appear. doi:10.1016/j.jns.2013.07.412
Abstract— WCN 2013 No: 343 Topic: 2 — Movement Disorders A long-term, open-label study of levodopa–carbidopa intestinal gel in advanced Parkinson's disease patients: Functional and health-related quality-of-life endpoints D.G. Standaerta, H.H. Fernandezb, P. Odinc,d, R.A. Hausere, A.J. Espayf, M. Steigerg, S. Chouinardh, O. Suchowerskyi, E. Yakupovj, E.P. Meriklek, W.Z. Robiesonk, K. Chatamrak, J. Beneshk. aUniversity of Alabama at Birmingham, Birmingham, AL, USA; bCleveland Clinic, Cleveland, OH, USA; c Klinikum-Bremerhaven, Bremerhaven, Germany; dSkane University Hospital, Lund, Sweden; eUniversity of South Florida, Tampa, FL; fUniversity of Cincinnati Academic Health Center, Cincinnati, OH, USA; gWalton Centre for Neurology and Neurosurgery, Liverpool, UK; hUniversity of Montreal, Montreal, QC, Canada; iUniversity of Alberta, Edmonton, AB, Canada; j Kazan State Medical University, Kazan, Russia; kAbbVie Inc., North Chicago, IL, USA Background: Some Parkinson's disease (PD) motor complications are associated with pulsatile dopaminergic stimulation. Levodopa– carbidopa intestinal gel (LCIG) provides continuous drug infusion via an intrajejunal percutaneous gastrostomy tube. Objective: To evaluate the effects of LCIG on functional and healthrelated quality-of-life (HRQoL) measures in patients with advanced PD. Patients and methods: PD patients experiencing severe motor fluctuations (≥3 h/d OFF-time) despite optimized medical therapy were enrolled in an international, 54-week, open-label study. Individualized LCIG dosing was permitted up to 16 h/d; other PD medications were allowed after 28 days. Functioning and HRQoL were assessed at baseline and weeks 4, 12, 24, and 54 by the PDQ-39, UPDRS, EQ-5D, EQ-VAS and CGI-I. Results: 272 (76.8%) of 354 patients completed the study. Total exposure to LCIG was up to 521 days (mean [SD] = 328.5 [132.3], n = 350). Mean [SD] PDQ-39 summary index was significantly improved at each visit (baseline = 42.8[15.1], n = 320; Endpoint = 35.8[16.8], n = 317 P b .001). UPDRS scores were improved at each visit (P b .001 all; Part II: baseline = 17.4[6.6], change at Endpoint =− 4.4[6.5]; Part III: baseline = 28.8[13.7], change = − 7.4[13.2]). Both EQ-5D and EQ-VAS improved from baseline through Endpoint (P b .001 all; EQ-5D: baseline = 0.588[0.195], Endpoint = 0.652[0.174]; EQ-VAS: baseline = 50.2[21.0], Endpoint = 64.1 [19.4]), as did CGI-I scores (Endpoint = 2.10[0.95]). AEs occurred in 323 (91.2%) patients; most were mild or moderate and transient.
discontinued. The PD progresses (like common PD) and responds to levodopa. Conclusions: TNF-alfa-I therapies are related with distinct types of central and peripheral demyelinating lesions; less clear seems their risk of induction or acceleration of PD.
doi:10.1016/j.jns.2013.07.410
Abstract — WCN 2013 No: 1209 Topic: 2 — Movement Disorders Exercise training — Effects of MOTOmed® exercise on typical motor dysfunction in Parkinson's disease M. Laupheimer, S. Härtel, S. Schmidt, K. Bös. Institut für Sport und Sportwissenschaft, Karlsruhe, Germany Objective: Additionally to regular medication, alternative drug-free treatments, such as exercise or physical therapy, do not cause any side effects and play an important role in Parkinson's treatment. Recent scientific findings suggest very positive effects of movement training at high cadence, the so-called “Forced Exercise” (FE). The present paper investigates the effects of a home-based passive FE cycling training on general motor function and quality of life in Parkinson's patients. Patients & methods: 44 Parkinson's patients (68.5 ± 7.8 years) were randomized to control group (n = 23; age: 71.3 ± 4.0 years) and intervention group (n = 21; age: 67.5 ± 7.8 years). The intervention group completed a 10 week FE cycling program with a motor-assisted movement therapy device. The subjects were encouraged to perform a daily 40 minute MOTOmed® training session, at up to 90 revolutions per minute, in addition to their regular therapy (medication and physical therapy). Motor function and quality of life measures were assessed three times during the study period, a total of 25 test items were recorded (TMTBattery = 15items, tremor spiral test = 2 items, PDQ-8 = 8 items). Subjects of the control group continued their standard therapy. Results: The results of the study show significant improvements in walking ability (walking time: F = 13.31; p = .000; p.Eta2 = .241; walking steps: F = 6.44; p = .000; p.Eta2 = .133) and hand coordination (diadochokinesia of the right arm: F = 3.76; p = .03; p.Eta2 = .082). Conclusion: Device-supported FE movement training of the lower extremities leads to improvements in walking ability and hand motor function, which suggest that FE may be affecting central motor control processes. To proof these findings the authors recommend further studies. doi:10.1016/j.jns.2013.07.411
Abstract — WCN 2013 No: 1232 Topic: 2 — Movement Disorders Clinical cerebral dysfunction sclerosis in Africa A.E. Bukusia, R.N. Mbuguab. aResearcher (Global Mental Health), Kenya Neurological Society, Kenya; bClinical Research, Kenya Medical Research Institute, Nairobi, Kenya Objective: To report on the occurrence of clinical cerebral dysfunction sclerosis. Methods/subjects: All the patients referred to the clinic by neurologists and other specialists for electrophysiological tests with diverse neurological complaints. The patients were examined and diagnosed as having sclerosis on clinical grounds and established criteria are reported.
e123
Results: Out of 2831 patients referred for electrophysiological tests over a ten year period, nine patients were diagnosed as having definite sclerosis on clinical grounds. Four of these had supporting laboratory findings (MRI scans, CSF studies and visual evoked responses). The presenting symptoms were predominantly visual disturbances and somatic sensorimotor disturbances which were seen in all the patients. Cerebellar dysfunction was observed less frequently, in less than half of the patients while sphincter disturbances were conspicuously rare. The sex distribution was overwhelmingly in favour of the female at a ratio of 7:2. Conclusions: Cerebellar dysfunction sclerosis occurs most in African countries and may not be as rare as previously suggested and its prevalence is certainly on the increase. The development of higher incidence rates in communities where the illness was previously unknown may present opportune settings for the study of aetiological factors of this illness as it emerges. There is a need therefore for proper epidemiological studies to evaluate these factors, especially environmental factors, as the new disease continues to appear. doi:10.1016/j.jns.2013.07.412
Abstract— WCN 2013 No: 343 Topic: 2 — Movement Disorders A long-term, open-label study of levodopa–carbidopa intestinal gel in advanced Parkinson's disease patients: Functional and health-related quality-of-life endpoints D.G. Standaerta, H.H. Fernandezb, P. Odinc,d, R.A. Hausere, A.J. Espayf, M. Steigerg, S. Chouinardh, O. Suchowerskyi, E. Yakupovj, E.P. Meriklek, W.Z. Robiesonk, K. Chatamrak, J. Beneshk. aUniversity of Alabama at Birmingham, Birmingham, AL, USA; bCleveland Clinic, Cleveland, OH, USA; c Klinikum-Bremerhaven, Bremerhaven, Germany; dSkane University Hospital, Lund, Sweden; eUniversity of South Florida, Tampa, FL; fUniversity of Cincinnati Academic Health Center, Cincinnati, OH, USA; gWalton Centre for Neurology and Neurosurgery, Liverpool, UK; hUniversity of Montreal, Montreal, QC, Canada; iUniversity of Alberta, Edmonton, AB, Canada; j Kazan State Medical University, Kazan, Russia; kAbbVie Inc., North Chicago, IL, USA Background: Some Parkinson's disease (PD) motor complications are associated with pulsatile dopaminergic stimulation. Levodopa– carbidopa intestinal gel (LCIG) provides continuous drug infusion via an intrajejunal percutaneous gastrostomy tube. Objective: To evaluate the effects of LCIG on functional and healthrelated quality-of-life (HRQoL) measures in patients with advanced PD. Patients and methods: PD patients experiencing severe motor fluctuations (≥3 h/d OFF-time) despite optimized medical therapy were enrolled in an international, 54-week, open-label study. Individualized LCIG dosing was permitted up to 16 h/d; other PD medications were allowed after 28 days. Functioning and HRQoL were assessed at baseline and weeks 4, 12, 24, and 54 by the PDQ-39, UPDRS, EQ-5D, EQ-VAS and CGI-I. Results: 272 (76.8%) of 354 patients completed the study. Total exposure to LCIG was up to 521 days (mean [SD] = 328.5 [132.3], n = 350). Mean [SD] PDQ-39 summary index was significantly improved at each visit (baseline = 42.8[15.1], n = 320; Endpoint = 35.8[16.8], n = 317 P b .001). UPDRS scores were improved at each visit (P b .001 all; Part II: baseline = 17.4[6.6], change at Endpoint =− 4.4[6.5]; Part III: baseline = 28.8[13.7], change = − 7.4[13.2]). Both EQ-5D and EQ-VAS improved from baseline through Endpoint (P b .001 all; EQ-5D: baseline = 0.588[0.195], Endpoint = 0.652[0.174]; EQ-VAS: baseline = 50.2[21.0], Endpoint = 64.1 [19.4]), as did CGI-I scores (Endpoint = 2.10[0.95]). AEs occurred in 323 (91.2%) patients; most were mild or moderate and transient.