Consider Restless Genital Syndrome in Parkinson's

the Neurology Advisor take:

Parkinson’s disease (PD) is rarely associated with discomfort in the genital region; however, researchers suggest that restless genital syndrome should be a part of the differential diagnosis in PD patients, according to a study published in JAMA Neurology. 

Restless genital syndrome, sometimes also referred to as persistent genital arousal disorder (PGAD), causes feelings of pain, discomfort, tingling and burning sensations in the genital region and can be disabling and very distressing to patients. 

A woman aged 65 years with PD complaining of severe and persistent discomfort in the genital region. Symptoms occurred at night and were often triggered by sitting or lying down for periods of time. During examination, no gynecological abnormalities were observed. She was treated with a low dose of a dopamine agonist and reported improvement.

Although the disorder is rare, researchers suggest that restless genital syndrome be included in the differential diagnosis of genital symptoms and restlessness, as well as nonmotor wearing off and akathisia. Treatment with dopamine agonists can improve symptoms. 

In PD, Restless Genital Syndrome Should Be Considered

In this case study, Camila C. Aquino, MD, MSc, of the Morton and Gloria Shulman Movement Disorders Center at Toronto Western Hospital in Ontario, Canada, and colleagues observed a female Parkinson's disease patient complaining of severe and disabling symptoms in the genital region, including burning sensations, tingling and pain. Previous rare cases were attributed to nonmotor off symptoms.

While restless genital syndrome is rare, researchers suggest that it be included in the differential diagnosis of genital symptoms and restlessness, and recommend treatment with a dopamine agonist. 

http://www.neurologyadvisor.com/restless-genital-syndrome-in-parkinsons-disease/article/376826/

Weight, eating habits in Parkinson's disease

November 20, 2014

 Source:

Sissa Medialab

A review of the scientific literature on Parkinson's disease, conducted by SISSA research scientists, shows that even the non-motor symptoms associated with the disease can contribute to the changes in body weight seen in patients (including those subjected to deep brain stimulation). Among the factors affecting eating habits and body weight there could be, for example, an impaired ability to derive pleasure from food and changes in motivation. These are important findings which can help to understand how to reduce these effects of Parkinson's that exacerbate an already negative clinical situation

Patients affected by Parkinson's disease often show marked changes in body weight: they may gain or lose a lot of weight depending on the stage of the disease, or they may put on up to ten kilos after deep brain stimulation (a treatment to alleviate the symptoms). This situation considerably worsens the quality of life of a person who is already suffering from heavily disabling motor disorders, so it is important to understand what are the factors that cause it.

"The body weight and eating habits of Parkinson's patients change as the disease progresses," explains Marilena Aiello, SISSA researcher and first author of the study published in the journal Appetite. "In our paper, we reviewed studies on Parkinson's that provided data on the association between non-motor symptoms and dietary habits and body weight. This way, we were able to evaluate some factors which, beyond the motor symptoms and drug treatments, might play a role in this problem."

Depression, cognitive impairment, sensory disturbances -- chiefly smell and taste -, impaired ability to feel pleasure: all these aspects contribute to incorrect eating habits. "The possible role of the ability to feel pleasure and motivation towards food consumption is particularly interesting. Parkinson's patients may be somewhat lacking in this respect and therefore eat less and lose weight, whereas the weight gain exhibited after deep brain stimulation seems to point to an increase in pleasure and motivation associated with food. Specific studies are required to confirm or refute this finding emerging from the literature review."

"Studies like ours can help those working with these patients: awareness of the roles played by the different factors is in fact crucial for devising interventions aiming to minimise the effect of the deficits and restore normal weight levels in individuals who are already suffering because of the disease."

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Story Source:

The above story is based on materials provided by Sissa Medialab. Note: Materials may be edited for content and length.

end story_source

Journal Reference:

1  Marilena Aiello, Roberto Eleopra, Raffella I. Rumiati. Body weight and food intake in Parkinson's disease. A review of the association to non-motor symptoms. Appetite, 2015; 84: 204 DOI: 10.1016/j.appet.2014.10.011

end journal_references

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Sissa Medialab. "Weight, eating habits in Parkinson's disease." ScienceDaily. ScienceDaily, 20 November 2014. <www.sciencedaily.com/releases/2014/11/141120082138.htm>.

Video games, Parkinson's 'therapy'

Computer consoles can help improve the lives of people with the neurological disease Parkinson's, researchers have found.

A patient testing a mini golf game (Lancaster University/PA)

Scientists said games with sensors - used in consoles like the Nintendo Wii and accessories such as the Xbox Kinect - were found to aid symptoms of those with the degenerative brain condition taking part in the study.

An in-depth study with Parkinson's sufferers at Lancaster University found that video games involving the movement of players acted as a form of physical therapy.

Researcher Dr Emmanuel Tsekleves said: "Muscles and joints tend to become stiff and rigid, which is why exercise is crucial in managing some of the symptoms.

"However, physiotherapy exercises are very repetitive in nature leading to boredom and de-motivation and hence lack of adherence.

"Computer games have the potential to motivate people to keep active by implicitly incorporating repetitive exercises into the games."

Parkinson's disease affects more than 120,000 people in the UK, and six million across the globe.

Sufferers include former boxing champion Muhammad Ali, comedian Billy Connolly , and actor Michael J Fox.

Researchers have been adapting and testing computer games to be used as physical therapy and believe people with Parkinson's should be involved in the design of these games.

Dr Tsekleves said: "Our research involved participants with Parkinson's using commercially available gaming sensors like the Nintendo Wii and computer games designed specifically for people with Parkinson's disease.

"The key was in taking physiotherapy exercises and translating them into game play movements.

"The games help at improving the player's speed and arm movement, improving flexibility and reducing rigidity.

"One involved the control of a two-paddled row boat, while the second, the steam mini-golf game, asked the player to rotate a valve to release steam to push a ball into a hole."

The researchers, who also included teams from Brunel University and Queen's Belfast, found that the more familiar games based on simple exercises worked best.

Commenting on the study, Professor David Burn, Parkinson's UK clinical director, said: "Studying the effects of exercise on Parkinson's is an underexplored but exciting area of research.

"We know that games like those on Nintendo Wii can be a great way to help people with Parkinson's improve their stiff movement, as well as their general fitness levels.

"This study is only in a handful of people, and needs to be replicated in larger numbers, but the results are promising."

Earlier this year, e xperts at Newcastle University began investigating the benefits that Google Glass could have on Parkinson's sufferers.

The technology works like a hands-free smartphone displaying information on the lens of the glass.

http://jerseyeveningpost.com/news/uk-news/2014/11/20/video-games-parkinsons-therapy/

A medium amount of physical activity can lower the risk of Parkinson's disease

November 19, 2014 - 12:31am

A new study, published online in Brain: A Journal of Neurology today, followed 43,368 

individuals in Sweden for an average of 12.6 years to examine the impact of physical 

activity on Parkinson's disease risk. It was found that "a medium amount" of physical 

activity lowers the risk of Parkinson's disease.

Karin Wirdefeldt of the Karolinska Institutet in Stockholm and her colleagues used the 

Swedish National March Cohort to analyse comprehensive information on physical 

activity of all kinds. They assessed household and commuting activity, occupational 

activity, leisure time exercise, and total daily physical activity according to data 

provided by 27,863 females and 15,505 males as part of an extensive questionnaire. 

For the purpose of this study, physical activity was quantified into metabolic equivalent 

(MET) hours per day, based on estimated oxygen consumption associated with those

 activities.

All participants were free of Parkinson's disease on 1 October 1997, the start of the 

follow-up period. Study participants were followed from this baseline until date of 

diagnosis with Parkinson's disease, date of death, date of emigration, or the end of 

the follow-up period on 31 December 2010, whichever came first. In that time 286 

cases of Parkinson's disease were identified.

In the study's multivariable-adjusted model, compared with participants who spent 

less than two hours per week on household and commuting activity, those who spent 

more than six hours per week on the same types of activities had a 43% lower risk of 

developing Parkinson's disease. Compared with a low level of total physical activity, a 

medium level of total physical activity (a mean of 39.1 MET hours per day) was 

associated with a 45% lower Parkinson's disease risk in males. Leisure time exercise 

was not associated with Parkinson's disease risk when analysed alone. 

Karin Wirdefeldt, researcher at the Department of Medical Epidemiology and 

Biostatistics and Department of Clinical Neuroscience, who headed the study, said: 

"Our study has a number of strengths. This was a prospective study including both 

males and females, and all information on physical activity was assessed before the 

disease occurrence, making recall bias and reverse causation less likely." 

"Another major strength of this study is that we considered the entire spectrum of daily 

energy output, rather than purely focusing on dedicated exercising. Further, we 

conducted a rich set of sensitivity analyses to test the robustness of our findings."

"We found that a medium level of daily total physical activity is associated with a lower 

risk of Parkinson's disease. The protective effect of physical activity was further 

supported when we summarized all available evidence from published prospective 

cohort studies. These findings are important for both the general population and for 

the healthcare of patients with Parkinson's disease."

Source: Oxford University Press

http://www.sciencecodex.com/a_medium_amount_of_physical_activity_can_lower_the_risk_of_parkinsons_disease-145915

Computer model of nerve cells provides insights into communication problems

Nerve cells communicate with each other via intricate projections. In brain diseases such as Alzheimer's and Parkinson's these extensions atrophy, thereby causing connectivity problems.

Credit: DZNE/Detlef Friedrich

November 14, 2014

Source:

DZNE - German Center for Neurodegenerative Diseases

Summary:

In diseases of the brain, such as Alzheimer's and Parkinson's, the neurons fail to communicate correctly with each other. Researchers now report that these connectivity problems can be ascribed to alterations in the structure of the nerve cells.

In diseases of the brain, such as Alzheimer's and Parkinson's, the neurons fail to communicate correctly with each other. As Bonn-based researchers of the German Center for Neurodegenerative Diseases (DZNE) now report in the journal "Neuron," these connectivity problems can be ascribed to alterations in the structure of the nerve cells. For their study, the scientists investigated diseased nerve cells using high precision methods and subsequently simulated their electrical properties on the computer. In their view, medical interventions that preserve the structural integrity of neurons may constitute an innovative strategy for the treatment of neurodegenerative diseases

Inside the brain, the nerve cells, which are also called "neurons," are woven into a network in which they relay signals to one another. Thus, neurons form intricate projections that enable them to transmit electrical stimuli and synchronize their activity. "However, in Alzheimer's, Parkinson's and in other diseases of the brain, the nerve cells tend to atrophy. This is a typical symptom of neurodegenerative processes," explains Professor Stefan Remy, who leads a research group at the Bonn site of the DZNE and also works for the Department of Epileptology at the University Hospital Bonn. "In general, diseased cells have smaller as well as fewer extensions than healthy cells."

Troubles in Communication

It is also known that the signal transmission between neurons is disturbed. The nerve cells are hyper-excitable. As a result, they fire electrical impulses in a succession that could best be described as hectic. "This activity is somewhat reminiscent of epileptic activity. However, to date it was unclear how changes in cell morphology and abnormal function are related," remarks Remy. "We have now found that if the form changes, this has a direct impact on the cell's electrical properties. It's just like in an electrical power cord. A thin cord that is also short has different electrical properties than a cord that's thick and longer. We were able to show that the hyper-excitability can be explained by changes in the structure of the neurons."

The neuroscientist emphasizes that this finding does not rule out other factors, such as alterations in cell metabolism. "However, our results demonstrate that the dysfunctions and the shape of the neurons are closely connected. Up until now we were not aware of this relationship."

Precise Measurements and Computer Simulations

For their study, the scientists combined experimental research with computer simulations. At first, they examined the electrical activities of individual neurons as well as those of larger cell groups. For this purpose, they studied mice, whose brains exhibited Alzheimer-typical hallmarks. Furthermore, using high-precision microscope techniques, the scientists determined the dimensions of healthy and diseased nerve cells. Based upon this structural data, Remy's team created a three-dimensional model of a single neuron and computed its electrical properties. In this way the researchers were able to relate cellular dysfunction to changes in cell morphology.

A General Effect

"Our study focused on Alzheimer's. However, alterations in cell morphology are typical for all neurodegenerative diseases. Hence, we assume that the dysfunctions in cellular communication that manifest in other brain diseases are also resulting from structural changes. We think that this is a general effect shared by different diseases."

In the opinion of the Bonn-based researcher, these findings cast a new light on pathological hallmarks. On the other hand, they could possibly also help with options for treatment. "Our results indicate that if one protects the structure of nerve cells, one also protects their functions. Pharmaceuticals aiming specifically at safeguarding the shape of neurons could potentially have a positive impact on disease progression. Cell morphology would be a novel approach for therapy," says Remy. "Moreover, our computer model might prove helpful in studying the effects of these treatment options and in predicting their outcome."

end text

Story Source:

The above story is based on materials provided by DZNE - German Center for Neurodegenerative Diseases. Note: Materials may be edited for content and length.

end story_source

Journal Reference:

1 Zuzana Šišková, Daniel Justus, Hiroshi Kaneko, Detlef Friedrichs, Niklas Henneberg, Tatjana Beutel, Julika Pitsch, Susanne Schoch, Albert Becker, Heinz von der Kammer, Stefan Remy. Dendritic Structural Degeneration Is Functionally Linked to Cellular Hyperexcitability in a Mouse Model of Alzheimer’s Disease. Neuron, 2014; DOI: 10.1016/j.neuron.2014.10.024

end journal_references

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DZNE - German Center for Neurodegenerative Diseases. "Computer model of nerve cells provides insights into communication problems." ScienceDaily. ScienceDaily, 14 November 2014.

Understanding a Complicated Condition

Parkinson’s Disease
Understanding a Complicated Condition

We rely on our brains for every movement we make, whether writing, walking, talking, or even sleeping. But a serious brain disorder like Parkinson’s disease can rob a person of the ability to do everyday tasks that many of us take for granted. There’s no cure, but treatment can help. And researchers continue to seek new understanding to improve medical care. 

Parkinson’s disease evolves gradually over time. The early signs may be barely noticeable. A person’s movements may change slightly. You might notice slowness, rigidity, or difficulty balancing or walking. The person’s face may lack expression, or handwriting may become small and cramped. Eventually, these changes can become more severe and interfere with daily life. It might become harder to sleep, think, eat, speak, smell, and make decisions. As the disease worsens, symptoms may become difficult to control.

Parkinson’s disease usually arises after age 50, but can also appear earlier in life. It affects about 600,000 people nationwide. As Americans age, the number of people with Parkinson’s disease is expected to rise dramatically. 

Parkinson’s disease is a neurodegenerative disorder, which means that brain cells gradually malfunction and die. The disease damages brain cells that make a chemical called dopamine. The resulting dopamine shortage causes the movement problems that mark Parkinson’s disease. 

Although researchers don’t yet understand what causes Parkinson’s disease, the body’s genes likely play some role. A number of genes have been linked to the risk of developing Parkinson’s. “Diving deeper into the genetics of the disease is providing us with hints about the underlying biology,” says Dr. Beth-Anne Sieber, an NIH expert on Parkinson’s disease. 

But genes are only part of the picture. NIH-funded scientists are searching for other factors that might lead to the disease. One goal of this research is to discover new targets for drugs that can slow disease progression. 

If you notice any of the common signs of Parkinson’s disease, see a health care provider. Your doctor may refer you to a neurologist, a physician specializing in the nervous system. A careful exam and certain tests can help with diagnosis. 

To treat Parkinson’s, doctors prescribe combinations of medicines that work to regulate dopamine in the brain. “This helps free up people to move better and lessens the troubling movement problems of Parkinson’s,” Sieber says. 

A surgical procedure called deep brain stimulation is an option for some patients. In this approach, a small pacemaker-like system is placed in areas of the brain that control movement. 

Research suggests that eating right and exercising may help reduce or delay symptoms. Scientists are studying how much and what kinds of exercise can most help improve patient health and quality of life.

Many potential new treatments for Parkinson’s disease are now being studied in NIH-funded clinical trials. “There’s a great need for people with Parkinson’s and their families to participate in clinical research,” says Sieber. “Participation is key.”

To learn more about participating in NIH research on Parkinson’s disease, or to find a clinical trial, visit www.nih.gov/health/clinicaltrials.

 Know the Signs of Parkinson’s Disease

Parkinson’s disease affects everyone differently. Common symptoms include: 

• Movement problems such as shaking or tremor, especially in the fingers, hand, arm, or face
• Rigidity, stiffness, or slowness
• Fatigue or problems sleeping
• Problems standing or balancing
• Trouble speaking or choosing words
• Changes in handwriting
• Difficulty completing simple tasks or making decisions
• Inability to detect odors

NIH News in Health, November 2014