Research

Parkinson Disease and the Gut: A Primer for Gastroenterologists

The American Journal of Gastroenterology

This article highlights the emerging role of the gut-brain axis in the pathogenesis and progression of Parkinson’s disease. It suggests that gastrointestinal symptoms may precede motor signs by decades, offering potential for earlier diagnosis and risk stratification. Understanding the gut’s influence on neuroinflammation and treatment response could open new avenues for disease-modifying therapies and more personalized care strategies.

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Parkinson’s disease – genetic cause

Current Opinion in Neurology

This article offers a comprehensive overview of the genetic factors underlying Parkinson's disease (PD). It highlights key mutations in both autosomal dominant and recessive genes that contribute to PD, providing insights into the genetic complexity of the disease. The article also introduces new putative disease-causing genes, which could influence future diagnostic and therapeutic strategies. Understanding these genetic aspects can help healthcare providers predict and manage PD more effectively, paving the way for precision medicine in treating this condition.

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Roles of neuronal lysosomes in the etiology of Parkinson’s disease

Neural Regeneration Research

This article delves into the molecular etiology of Parkinson's disease (PD), focusing on the role of the autophagy-lysosome system. The review highlights how genetic and genomic advancements have identified key proteins and cellular processes involved in PD, particularly those related to lysosome function. Understanding these mechanisms can aid in developing targeted therapies that modify disease progression. Additionally, the article discusses the potential risks of indiscriminately enhancing autophagy, emphasizing the need for precise adjustments in lysosome functionalities to improve neuronal and glial cell functions.

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Imaging-Guided Subthalamic Nucleus Deep Brain Stimulation Programming for Parkinson Disease

Neurology

This article compares two programming methods for deep brain stimulation (DBS) in Parkinson's disease (PD) patients, highlighting their efficacy and patient burden. The study shows that both conventional ring-mode programming (CP-RM) and image-guided volume of tissue activated (IG-VTA) programming provide similar improvements in motor function. However, IG-VTA programming is associated with shorter hospital stays and fewer hospitalizations, reducing the burden on patients and clinicians. These findings can help healthcare providers optimize DBS programming methods to enhance patient outcomes and streamline care.

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OFF-Time

Subcutaneous infusions treat “off” periods in Parkinson disease

AJN, American Journal of Nursing

Onapgo offers movement disorder specialists and neurologists a valuable option for managing “off” episodes in advanced Parkinson’s disease through continuous subcutaneous infusion of apomorphine. It provides nearly two hours less “off” time compared to placebo, helping to stabilize motor and nonmotor symptoms when oral medications fall short. Its non-opioid profile, established efficacy, and flexible titration approach make it a practical and effective addition to personalized Parkinson’s care.

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Off-time Treatment Options for Parkinson’s Disease

Neurology and Therapy

This article offers a comprehensive overview of treatment options for managing motor fluctuations (MF) in Parkinson's disease (PD). It discusses both pharmacological and advanced therapies, including new once-a-daily compounds and on-demand rescue therapies, providing insights into their efficacy and application. The article also addresses complex therapies like deep brain stimulation and device-aided treatments, highlighting their potential benefits when oral/on-demand options are insufficient. Additionally, it emphasizes the importance of personalized treatment decisions based on patient preferences, symptoms, and socio-economic factors, which is crucial for optimizing patient care.

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The Efficacy of Istradefylline for Treating Mild Wearing-Off in Parkinson Disease

Clinical Neuropharmacology

This article examines the efficacy of istradefylline, an adenosine A2A antagonist, in treating mild wearing-off symptoms in Parkinson's disease (PD) patients. The study found that 20 mg/day of istradefylline significantly improved motor functions over 12 weeks, as evidenced by reductions in ON-UPDRS-III scores. The results suggest that istradefylline can be effective for PD patients with shorter daily OFF times, providing valuable insights for healthcare providers on optimizing treatment strategies. Additionally, the article highlights the dose-dependent effects of A2A antagonists in relation to L-DOPA, which is crucial for tailoring treatment regimens.

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Parkinson's Disease

Diagnosis

History

Symptoms are often subtle or attributed to aging.

Physical Exam

Differential Diagnosis

Diagnostic Tests & Interpretation

Initial Tests (lab, imaging)

Follow-Up Tests & Special Considerations

Single-photon emission computerized tomography (SPECT) scan might be helpful to differentiate PD from secondary parkinsonism.

Diagnostic Procedures/Other

PET and MR spectroscopy are not recommended.

Test Interpretation

Diagnosis is clinical and no tests are recommended to confirm diagnosis of PD.

From 5-Minute Clinical Consult, Svitlana Zhukivska, Medical Doctor Reviewed 04/2024