Restorative Therapies in Parkinson's Disease


Book Description

In this exciting and timely book new approaches to repairing the parkinsonian brain are described by leading experts. Never in history has there been greater hope that novel experimental therapies can support significant restoration of brain function. This book gives an overview of the current state-of-the-art research for brain repair, what the challenges are and an indication of what research can provide for the next generation of people with Parkinson’s disease. The comprehensive chapters are geared to an audience of neuroscientists, neurologists, neurosurgeons and anyone interested in how findings in the research laboratory can effectively be transferred to the clinic.




Principles and Practice of Restorative Neurology


Book Description

Principles and Practice of Restorative Neurology is a collection of topics in clinical neurology where progress through research has brought concepts of patient management. The collection emphasizes research done clinically and in experimental laboratories and attempts to discuss restorative neurology in the larger context, encompassing biology, neurobiology, and rehabilitative engineering. The book discusses the concept that neurology should be more therapeutic instead of being just diagnostic because of advances in techniques and drugs. An epidemiology of disability and the evaluation of re ...




Neurotherapy


Book Description

This book focuses on the exciting recent progress in restorative neurology and neuroscience. The book includes chapters on major neurodegenerative disorders of the brain and the visual system, including Parkinson's disease, Alzheimer's disease, amyotrophic lateral sclerosis, Huntington's disease, macular degeneration, retinitis pigmentosa, glaucoma, spinal cord trauma, and multiple sclerosis. The primary goal of the book is to give an overview of new developments in translational research and in potential therapeutic strategies, including stem cell therapy, immunotherapy, gene therapy, pharmacotherapy, neuroprostheses and deep brain stimulation. - Provides the reader with a unique overview over all aspects of new advances in the therapy of neurological and psychiatric disorders - Covers all levels of biological organization including novel molecular and cellular targets, electrophysiological, anatomical and behavioural substrates of neurodegeneration and the application of whole brain in vivo imaging - Broad focus with contributions by the top scientists worldwide in the respective disciplines




Occupational Therapy for People with Parkinson's Disease


Book Description

These practice guidelines draw upon the widest relevant knowledge and evidence available to describe and inform contemporary best practice occupational therapy for people with Parkinson's disease. They include practical examples of interventions to allow occupational therapists to apply new treatments to their practice.




Levodopa pharmacokinetics -from stomach to brain


Book Description

Parkinson’s disease (PD) is one of the most common neurodegenerative disorders and it is caused by a loss of dopamine (DA) producing neurons in the basal ganglia in the brain. The PD patient suffers from motor symptoms such as tremor, bradykinesia and rigidity and treatment with levodopa (LD), the precursor of DA, has positive effects on these symptoms. Several factors affect the availability of orally given LD. Gastric emptying (GE) is one factor and it has been shown to be delayed in PD patients resulting in impaired levodopa uptake. Different enzymes metabolize LD on its way from the gut to the brain resulting in less LD available in the brain and more side effects from the metabolites. By adding dopa decarboxylase inhibitors (carbidopa or benserazide) or COMT-inhibitors (e.g. entacapone) the bioavailability of LD increases significantly and more LD can pass the blood-brain-barrier and be converted to DA in the brain. It has been considered of importance to avoid high levodopa peaks in the brain because this seems to induce changes in postsynaptic dopaminergic neurons causing disabling motor complications in PD patients. More continuously given LD, e.g. duodenal or intravenous (IV) infusions, has been shown to improve these motor complications. Deep brain stimulation of the subthalamic nucleus (STN DBS) has also been proven to improve motor complications and to make it possible to reduce the LD dosage in PD patients. In this doctoral thesis the main purpose is to study the pharmacokinetics of LD in patients with PD and motor complications; in blood and subcutaneous tissue and study the effect of GE and PD stage on LD uptake and the effect of continuously given LD (CDS) on LD uptake and GE; in blood and cerebrospinal fluid (CSF) when adding the peripheral enzyme inhibitors entacapone and carbidopa to LD infusion IV; in brain during STN DBSand during oral or IV LD treatment. To conclude, LD uptake is more favorable in PD patients with less severe disease and GE is delayed in PD patients. No obvious relation between LD uptake and GE or between GE and PD stage is seen and CDS decreases the LD levels. Entacapone increases the maximal concentration of LD in blood and CSF. This is more evident with additional carbidopa and important to consider in avoiding high LD peaks in brain during PD treatment. LD in brain increases during both oral and IV LD treatment and the DA levels follows LD well indicating that PD patients still have capacity to metabolize LD to DA despite probable pronounced nigral degeneration. STN DBS seems to increase putaminal DA levels and together with IV LD treatment also increases LD in brain possibly explaining why it is possible to decrease LD medication after STN DBS surgery. Parkinsons sjukdom (PS) är en av de vanligaste s.k. neurodegenerativasjukdomarna och orsakas av förlust av dopamin(DA)producerande nervceller i hjärnan. Detta orsakar motoriska symptom såsom skakningar, stelhet och förlångsammade rörelser. Levodopa (LD) är ett ämne, som kan omvandlas till DA i hjärnan och ge symptomlindring och det är oftast förstahandsval vid behandling av patienter med PS. Flera faktorer påverkar tillgängligheten av LD, bl.a. den hastighet som magsäcken tömmer sig med och denna verkar förlångsammad hos personer med PS vilket ger sämre tillgänglighet av LD i blodet och därmed i hjärnan. LD bryts även ner i hög grad av olika enzym ute i kroppen vilket leder till mindre mängd LD som hamnar i hjärnan och till fler nedbrytningsprodukter som orsakar biverkningar. Tillägg av enzymhämmare leder till ökad mängd LD som kan nå hjärnan och omvandlas till DA. Det anses viktigt att undvika höga toppar av LD i hjärnan då dessa verkar bidra till utvecklandet av besvärliga motoriska komplikationer hos patienter med PS. Om LD ges mer kontinuerligt, exempelvis som en kontinuerlig infusion in i tarmen eller i blodet, så minskar dessa motoriska komplikationer. Inopererande av stimulatorer i vissa delar av hjärnan (DBS) har också visat sig minska dessa motoriska komplikationer och även resultera i att man kan minska LD-dosen. Huvudsyftet med den här avhandlingen är att studera LD hos patienter med PS; i blod och fettvävnad då LD ges i tablettform och se om det finns något samband med LD-upptag och hastigheten på magsäckstömningen (MT) och om kontinuerligt given LD påverkar LD-upptaget eller MT; i blod och i ryggmärgsvätska då enzymhämmarna entakapon och karbidopa tillsätts LD; i hjärna vid behandling med DBS och då LD ges både som tablett och som infusion i blodet. Sammanfattningsvis kan vi se att LD-upptaget är mer gynnsamt hos patienter med PS i tidigare skede av sjukdomens komplikationsfas. MT är förlångsammad hos patienter med PS och det är inget tydligt samband mellan LD-upptag och MT eller mellan MT och sjukdomsgrad. Kontinuerligt given LD minskar LDnivåerna. Enzymhämmaren entakapon ökar den maximala koncentrationen av LD i blod och ryggmärgsvätska och effekten är mer tydlig vid tillägg av karbidopa vilket är viktigt att ta i beaktande vid behandling av PS för att undvika höga toppar av LD i hjärnan. LD ökar i hjärnan då man behandlar med LD i tablettform och som infusion i blodet och DA-nivåerna i hjärnan följer LD väl vilket visar på att patienter med PS fortfarande kan omvandla LD till DA trots trolig uttalad brist av de DA-producerande nervcellerna i hjärnan. DBS verkar öka DA i vissa områden i hjärnan och tillsammans med LD-infusion i blodet verkar det även öka LD i hjärnan och det kan förklara varför man kan sänka LDdosen efter DBS-operation.




Non-Motor Symptoms of Parkinson's Disease


Book Description

Patients with Parkinson's disease (PD) are known to suffer from motor symptoms of the disease, but they also experience non-motor symptoms (NMS) that are often present before diagnosis or that inevitably emerge with disease progression. The motor symptoms of Parkinson's disease have been extensively researched, and effective clinical tools for their assessment and treatment have been developed and are readily available. In contrast, researchers have only recently begun to focus on the NMS of Parkinson's Disease, which are poorly recognized and inadequately treated by clinicians. The NMS of PD have a significant impact on patient quality of life and mortality and include neuropsychiatric, sleep-related, autonomic, gastrointestinal, and sensory symptoms. While some NMS can be improved with currently available treatments, others may be more refractory and will require research into novel (non-dopaminergic) drug therapies for the future. Edited by members of the UK Parkinson's Disease Non-Motor Group (PD-NMG) and with contributions from international experts, this new edition summarizes the current understanding of NMS symptoms in Parkinson's disease and points the way towards future research.




Human Embryonic Stem Cells


Book Description

Since the first successful isolation and cultivation of human embryonic stem cells at the University of Wisconsin, Madison in 1998, there has been high levels of both interest and controversy in this area of research. This book provides a concise overview of an exciting field, covering the characteristics of both human embryonic stem cells and pluripotent stem cells from other human cell lineages. The following chapters describe state-of-the-art differentiation and characterization of specific ectoderm, mesoderm and endoderm-derived lineages from human embryonic stem cells, emphasizing how these can be used to study human developmental mechanisms. A further chapter discusses genetic manipulation of human ES cells. The concluding section covers therapeutic applications of human ES cells, as well as addressing the ethical and legal issues that this research have raised.




Parkinsons's Disease


Book Description

With the general population becoming increasingly aware of new developments for the diagnosis and treatment of certain neurological disorders throught increased media coverage in the popular press and on television and with celebrities being affected, the clinician must be aware of all the latest developments inthe diagnosis and treatment of disease. Parkinson's disease is no different. Peter LeWitt and Wolfgang Oertel have assembled an international team of contributors to write on their particular areas of expertise to produce a work which will help the practising clinician. This book captures all the latest information: the most important developments in the research of Parkinson's disease in recent years and the many different approaches to the treatment of the disease. These are exciting times for the study of Parkinson's disease, and this book condenses the wealth of available information into a practical text.




Human Embryonic Stem Cells


Book Description

A discussion of all the key issues in the use of human pluripotent stem cells for treating degenerative diseases or for replacing tissues lost from trauma. On the practical side, the topics range from the problems of deriving human embryonic stem cells and driving their differentiation along specific lineages, regulating their development into mature cells, and bringing stem cell therapy to clinical trials. Regulatory issues are addressed in discussions of the ethical debate surrounding the derivation of human embryonic stem cells and the current policies governing their use in the United States and abroad, including the rules and conditions regulating federal funding and questions of intellectual property.




Deep Brain Stimulation for Parkinson's Disease


Book Description

Considered the largest breakthrough in the treatment of Parkinson's disease in the past 40 years, Deep Brain Stimulation (DBS) is a pioneering procedure of neurology and functional neurosurgery, forging enormous change and growth within the field. The first comprehensive text devoted to this surgical therapy, Deep Brain Stimulation for Parkinson's