Bastiaan R Bloem

..Interesting new questions have been raised that should fuel studies of pathophysiological mechanisms, which could help in the development of improved treatment strategies to reduce falls in Parkinson's disease...

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..Bilateral GPi stimulation, bilateral STN stimulation, and to a lesser extent, unilateral pallidotomy significantly improved PIGD, and more so during the ON phase than during the OFF phase...

..Instead, Parkinson patients use a "posture second" strategy and treat all elements of a complex task with equal priority, which in daily life may go at the expense of maintaining balance and lead to falls...

..Here, we discuss the latest findings regarding epidemiology, assessment, pathophysiology and treatment of gait and balance impairments in Parkinson's disease...

..Move for Change is a three-part series of pan-European patient surveys based on this Charter...

..In about a quarter of PD patients, drooling appears to be a frequently occurring problem. We recommend to report drooling in future studies with more detailed consideration of severity, frequency and nocturnal versus diurnal complaints...

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..These limitations might become particularly evident during challenging events that require precise regulation of step length and gait timing, such as turning or initiating walking, which are known triggers for freezing of gait...

..In addition, falls pose high costs to the public health service. For these reasons, falls remain a popular topic for research. Here, we review several interesting developments that have been published during the past year...

..Baseline characteristics of participants in the ParkinsonNet and control clusters were comparable. With 699 participating patients, this is the largest allied health study in PD to date...

..These functional cerebral changes open the possibility to use a prospective study to test their relevance as early markers of Parkinson's disease...

..To identify subjects at early stages of the disease, we investigated whether the presence of MPS was dependent on the severity and location of small-vessel disease, including white matter lesions and lacunar infarcts...

..These results did not change after correction for baseline group differences. Deterioration of gait or Stroop performance under dual task conditions was not associated with prospective falls in this large sample of patients with PD...

..The enhanced MFC activity may result either from reduced focusing abilities of the basal ganglia or from compensatory processes...

..We primarily examined whether concurrent auditory cueing interferes with an obstacle avoidance task in patients with PD. The secondary aim was to study differences between patients with and without freezing of gait...

..Therefore, it may be worth evaluating as a diagnostic tool in everyday clinical practice to assess patients with early symptomatic PD, or as part of a more elaborate screening battery in a defined population at risk...

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..Because physical inactivity has many adverse consequences, work is needed to develop safe and enjoyable exercise programs for patients with PD...

..We describe the procedures for developing a ParkinsonNet network. Our initial experience with this new concept is promising, showing an increase in PD-specific and a steady rise in the patient volume of individual therapists...

..These alterations of network properties may underlie abnormal sensorimotor integration in PD...

..Routine brain MRI has limited added value for differentiating between PD and AP when clinical certainty is already high, but has some diagnostic value when the clinical diagnosis is still uncertain...

..These findings suggest that the right extrastriate body area plays a compensatory role in PD by supporting a function that is no longer performed by the dorsal premotor cortex...

..These findings characterize the cerebral bases of the increased dependence on visual information processing during the generation of motor plans in PD, pointing to its compensatory role...

..These findings can provide a rationale for behavioral approaches to treat drooling...

..Compared to the UPDRS-III, it is more objective and more sensitive to change. Therefore, it could be a useful tool for both practical and scientific purposes. (c) 2008 Movement Disorder Society...

..Various quantitative gait assessments have been proposed, but these methods have not proven value for clinical practice...

..We aimed to assess the efficacy of this approach for improving health-care outcomes...

..Acoustic startle reactions may also be partially triggered by vestibular inputs. Similar muscle activation driven by vestibular inputs may be the common element of first trial postural responses and acoustic startle reactions...

..However, the moving treadmill and the obstacle both act as cues, which apparently help to immediately overcome the provoked FOG episode. This may limit the ecological validity of this new approach...

..Instead, resting tremor is associated with increased activity in a distinct cerebellothalamic circuit. To date, it remains unknown how the interplay between basal ganglia and the cerebellothalamic circuit can result in resting tremor...

..We critically review the shortcomings of posturography as it is presently used, and conclude with several recommendations for future research...

..We conclude that parkinsonian tremor influences motor imagery by modulating central somatosensory processing through the VIM. This mechanism may explain clinical differences between PD patients with and without tremor...

..Given the known difficulties to elicit FOG when examining patients, we aimed to investigate which simple clinical test would be the most sensitive to provoke FOG objectively...

..The present results concur with observations that low baseline dopamine states predispose to drug and other addictions...

..Of note, marked levodopa- resistant axial motor symptoms before surgery correlated with an adverse treatment effect. We conclude that STN stimulation does not alleviate levodopa-resistant postural instability in Parkinson's disease...

..These factors should be considered as future targets for therapies that aim to reduce falls in Huntington's disease...

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..To study the relationship between nocturnal hypokinesia and sleep quality in Parkinson's disease (PD)...

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..However, because of physical and cognitive impairments, patients with PD require specific support to increase their level of physical activity...

..Finding comorbid CVD in such patients could have prognostic implications, and could necessitate treatment to arrest further progression of CVD...

..The postural instability in SCA was found to be multidirectional, although there is generally more pitch than roll instability corresponding with predominant involvement of the spinocerebellum...

..This will help to determine how "generically" the human brain compensates for a preclinical dopaminergic dysfunction...

..In early disease stages it can be clinically difficult to differentiate idiopathic Parkinson's disease (IPD) from patients with multiple system atrophy predominated by parkinsonism (MSA-P)...

..The objective was to develop a method to determine the power of a trial, based on minimal information from a previous (reference) trial...

..History taking ought to be detailed and specific to understand the full impact of drooling for an individual patient. Therapeutic options should be evaluated more intensively...

..Finally, we provide some directions for future research stimulated by this fascinating observation...

..To develop a reliable, objective and sensitive measure of axial trunk rotations in PD, which can be applied in an ambulatory setting...

..In order to fully interpret gait and postural stability of PD patients in everyday situations, the role of impairments in working memory and response generation should be taken into account...

..1-7.7, P<0.05). Disease duration was not associated with BMI. Because a low body weight is associated with negative health effects and a poorer prognosis, monitoring weight and nutritional status should be part of PD management...

..Diffusion tensor imaging (DTI) provides alternative information on microstructural white matter integrity. The association between SVD, its microstructural integrity, and incident dementia and parkinsonism has never been investigated...

..To evaluate the reliability and user experiences of an automated telephone system to monitor falls during a prolonged period of time...

..We infer that short-term storage of sensory information and preparation of motor responses have differential and specific access to the output stage of the motor system...

..Further systematic studies are required to pinpoint the clinical and surgical determinants of this late gait deterioration...

..We provide some recommendations for future research, and discuss innovative strategies to improve the organization of allied health care in PD, making evidence-based care available to all PD patients...

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..To examine the clinical characteristics, motor impairments, and drug treatments of nursing home residents with Parkinson's disease (PD)...

..We argue that this deficient control of cortical excitability may set the stage for the emergence of paroxysmal neural dysfunction in this disorder...

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..Current referral to and delivery of allied health care in PD are suboptimal. Evidence-based guidelines for allied health care in PD and active implementation of these guidelines are needed...

..We conclude by proposing a practical three-step approach to categorise gait disorders and we present a simplified classification system based on clinical signs and symptoms...

..Clinicians should be aware of this problem in ataxia patients and should try to prevent falls...

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..The nature of the involuntary movements, which did not easily comply with classic descriptions of hyperkinetic movement disorders, is probably best referred to as dystonia...

..Treatment with excision of the femoral head and debridement of the hip followed by a total hip, in combination with chelating therapy, led to a remarkable remission...

..We suggest that focal encephalopathy resulting from postradiation edema secondary to microangiopathy led to dysfunction of the globus pallidus and thalamus...

..A 'phobia' for levodopa—or, indeed, for any other antiparkinsonian medication—is unacceptable according to current evidence...

..We finally propose future directions of research that may help to improve the therapeutic efficacy of rTMS in PD...

..We suggest that SCA-14 should be considered in the differential diagnosis of progressive myoclonic ataxia...

..Modern methods of communication (text message reminders) and 'smart' pill dispensers may be beneficial, but the advantages of such interventions have not yet been scientifically studied...

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..All 6 study participants discontinued levodopa early, due to lack of effect and sometimes worsening of motor function. The results provide important clues for pathophysiological mechanisms and suggestions for future treatment options...

..As a first step towards patient-centered care in Parkinson's disease (PD), we explored the unmet needs of PD patients and their informal caregivers...

..Between-group differences showed a trend towards superiority for the submandibular group. Injecting the submandibular glands instead of the parotid glands seems a promising approach, and larger studies are justified...

..We illustrate this diagnostic process for the most common types of movement disorder, namely, akinetic-rigid syndromes and the various types of hyperkinetic disorders (myoclonus, chorea, tics, dystonia and tremor)...

..These preliminary findings suggest that Nordic walking could provide a safe, effective, and enjoyable way to reduce physical inactivity in PD and to improve the quality of life. A large randomized clinical trial now appears justified...

..We extend this prior work by examining the association between two different executive functions and measures of both gait and balance, with and without two different cognitive dual tasks...

..We propose that CSF analysis may become part of the diagnostic work-up of patients with parkinsonian syndromes...

..These characteristics deserve further study in the context of the frequent falls induced by uneven surfaces during walking...

..To investigate gender differences in basic disease characteristics, motor deterioration and nigrostriatal degeneration in Parkinson's disease (PD)...

..The aim of our study was to investigate the effect of both the severity and location of both WMLs and lacunar infarcts on gait...

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..Here, we describe one such patient with a very unusual gait disturbance that might be regarded as a variant of astasia-abasia. The patient characteristics are described and discussed in a historical context...

..The observed pathophysiology is very different from that seen in other patient populations...

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..These findings highlight the flexibility of the human balance repertoire and underscore both the advantages and limitations of using trained voluntary movements to aid balance corrections in man...

..To determine which test for postural instability in Parkinson's disease (PD) is reliable, valid, and easy to perform in a clinical setting...

..CONCLUSIONS: Low frequency, subthreshold rTMS of the motor cortex increases ipsilateral cortico-cortical and interhemispheric coherence in the alpha band. This may, in part, mediate the inhibitory effects of low frequency rTMS...

..In this study, history of falls and performance on an easy-to-administer single walking task identified old persons at higher risk for falling who could benefit from fall preventive strategies...

..Sweating disturbances are common and distressing symptoms of PD that are related mainly to autonomic dysfunction, off periods, and dyskinesias...

..Our findings suggest that the presynaptic dopaminergic deficits seen in PD are absent in most patients with VP. [(123)I]beta-CIT SPECT imaging may be useful to help distinguish between PD and VP patients during life...

..In the Netherlands, referral rates of PD patients to physiotherapy are high and treatment duration is lengthy. Referral seems, to some extent, arbitrary. Scientific evidence for the effectiveness of physiotherapy in PD remains limited...

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