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Fall, Per-Arne
Publications (10 of 13) Show all publications
Skogar, O., Borg, A., Larsson, B., Robertsson, L., Andersson, L., Andersson, L., . . . Tornhage, C.-J. (2013). "Effects of Tactile Touch on pain, sleep and health related quality of life in Parkinsons disease with chronic pain": A randomized, controlled and prospective study. European Journal of Integrative Medicine, 5(2), 141-152
Open this publication in new window or tab >>"Effects of Tactile Touch on pain, sleep and health related quality of life in Parkinsons disease with chronic pain": A randomized, controlled and prospective study
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2013 (English)In: European Journal of Integrative Medicine, ISSN 1876-3820, E-ISSN 1876-3839, Vol. 5, no 2, p. 141-152Article in journal (Refereed) Published
Abstract [en]

Introduction: Parkinsons disease (PD) is often associated with chronic PD related pain. Complementary medicine are widely used but randomized, controlled and prospective studies of the effects are sparse. less thanbrgreater than less thanbrgreater thanAims of the study: To compare the effects of Tactile Touch (TT) with Rest to Music (RTM) in PD patients with chronic pain and to describe effects within groups. less thanbrgreater than less thanbrgreater thanPatients and methods: A 34 week controlled randomized and prospective trial compared the effects of TT with RTM in 45 (29 TT and 16 RTM) patients with PD and chronic pain. The whole body tactile stimulation method was performed for each individual patient by the same therapist for 10 times during the first 8 weeks. The RTM group received the same therapy except for the tactile stimulation. Pharmacotherapy was kept unchanged. Participants were assessed at pre- and post-intervention for pain, sleep patterns and health related quality of life (HRQoL). less thanbrgreater than less thanbrgreater thanResults: Differences between TT and RTM groups were few. Total PDSS significantly improved within the TT but not in the RTM-group. No significant differences between groups were seen in pain parameters, although significant improvements were seen within the TT-group after the intervention period. There were significant improvements within both groups in HRQoL and between groups in the items physical role and social functioning 4 weeks after screening. less thanbrgreater than less thanbrgreater thanConclusions: No significant differences between the TT and RTM groups were seen. Only in single aspects did patients with PD and chronic pain have more benefit more from CAM therapy with TT in combination with RTM.

Place, publisher, year, edition, pages
Elsevier, 2013
Keywords
Pain, Parkinsons disease, Quality of life, Rest, Sleep, Touch
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-93979 (URN)10.1016/j.eujim.2012.10.005 (DOI)000318617300007 ()
Note

Funding Agencies|Skaraborg Hospital||Research and Development Council of County Skaraborg||Palle Ferb Foundation||FUTURUM||Academy for Healthcare||Jonkoping County Hospital||Medical Research Council of Southeast Sweden||Skaraborg Institute of Research and Development||Else Torgards Parkitouch memorial Foundation||

Available from: 2013-06-13 Created: 2013-06-13 Last updated: 2017-12-06
Törnhage, C.-J., Skogar, Ö., Borg, A., Larsson, B., Robertsson, L., Andersson, L., . . . Lökk, J. (2013). Short- and long-term effects of tactile massage on salivary cortisol concentrations in Parkinsons disease: a randomised controlled pilot study. BMC Complementary and Alternative Medicine, 13(357)
Open this publication in new window or tab >>Short- and long-term effects of tactile massage on salivary cortisol concentrations in Parkinsons disease: a randomised controlled pilot study
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2013 (English)In: BMC Complementary and Alternative Medicine, ISSN 1472-6882, E-ISSN 1472-6882, Vol. 13, no 357Article in journal (Refereed) Published
Abstract [en]

BACKGROUND:

Parkinson's disease (PD) is a chronic neurodegenerative disorder with limited knowledge about the normal function and effects of non-pharmacological therapies on the hypothalamic-pituitary-adrenal (HPA) axis. The aim of the study was to analyse the basal diurnal and total secretion of salivary cortisol in short- and long-term aspects of tactile massage (TM).

METHODS:

Design: Prospective, Controlled and Randomised Multicentre Trial.Setting and interventions: Forty-five women and men, aged 50-79 years, were recruited. Twenty-nine of them were blindly randomised to tactile massage (TM) and 16 of them to the control group, rest to music (RTM). Ten interventions were given during 8 weeks followed by a 26 weeks of follow up. Salivary cortisol was collected at 8 am, 1 pm, 8 pm, and 8 am the next day, on five occasions. With the first and eighth interventions, it was collected immediately before and after intervention.Main outcome measures: The primary aim was to assess and compare cortisol concentrations before and immediately after intervention and also during the follow-up period. The secondary aim was to assess the impact of age, gender, body mass index (BMI), duration and severity of PD, effects of interventional time-point of the day, and levodopa doses on cortisol concentration.

RESULTS:

The median cortisol concentrations for all participants were 16.0, 5.8, 2.8, and 14.0 nmol/L at baseline, later reproduced four times without significant differences. Cortisol concentrations decreased significantly after TM intervention but no change in diurnal salivary cortisol pattern was found. The findings of reduced salivary cortisol concentrations immediately after the interventions are in agreement with previous studies. However, there was no significant difference between the TM and control groups. There were no significant correlations between cortisol concentrations and age, gender, BMI, time-point for intervention, time interval between anti-parkinson pharmacy intake and sampling, levodopa doses, duration, or severity of PD.

CONCLUSIONS:

Diurnal salivary cortisol rhythm was normal. Salivary cortisol concentrations were significantly reduced after the TM intervention and after RTM, but there were no significant differences between the groups and no sustained long-term effect. No associations were seen between salivary cortisol concentration and clinical and/or pharmacological characteristics.

Place, publisher, year, edition, pages
BioMed Central, 2013
Keywords
Circadian rhythm; Complementary therapies; Cortisol; Massage; Parkinson disease; Stress
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-105593 (URN)10.1186/1472-6882-13-357 (DOI)000332207800001 ()24330473 (PubMedID)
Available from: 2014-03-28 Created: 2014-03-27 Last updated: 2017-12-05Bibliographically approved
Skogar, Ö., Fall, P.-A., Hallgren, G., Bringer, B., Carlsson, M., Lennartsson, U., . . . Lökk, J. (2012). Parkinson’s disease patients’ subjective descriptions of characteristics of chronic pain, sleeping patterns and health-related quality of life. Neuropsychiatric Disease and Treatment, 8, 435-442
Open this publication in new window or tab >>Parkinson’s disease patients’ subjective descriptions of characteristics of chronic pain, sleeping patterns and health-related quality of life
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2012 (English)In: Neuropsychiatric Disease and Treatment, ISSN 1176-6328, E-ISSN 1178-2021, Vol. 8, p. 435-442Article in journal (Refereed) Published
Abstract [en]

Objective: Nonmotor symptoms are common in Parkinson’s disease (PD). Health-related quality of life (HRQoL) is negatively affected by different factors, of which pain and sleep disturbances are important contributors. This study was performed to evaluate and describe subjective experiences of pain, sleeping patterns, and HRQoL in a cohort of PD patients with chronic pain.

Methods: A total of 45 participants with established PD for more than 2 years, and PD-related pain for the preceding three months, were recruited from three sites in Sweden. Data regarding time point for onset, duration and degree of pain parameters, body localization of pain, external influences, and treatments were obtained. HRQoL was evaluated with the Short Form-36® Health Survey, and sleeping patterns were registered with the Parkinson’s disease Sleep Scale, both completed along with a questionnaire.

Results: In one-third of participants, pain preceded the PD diagnosis. Median pain score measured with a visual analog scale was 6.6 and 5.9 (for females and males, respectively) the week before the study. In almost half of the participants, pain was present during all their waking hours. Significantly more females described their pain as troublesome, while more males described their pain as irritating. Feelings of numbness and creeping sensations at night were strongly associated with the maximal visual analog scale scores. Polypharmacy was common; 89% used medication for anxiety/insomnia, and 18% used antidepressants. Only one-third of patients who reported pain relief with analgesics had these prescribed on their drug lists. Sleep was characterized by frequent awakenings. Urinary urgency and restless legs were frequently reported as troublesome. Patients rated HRQoL as significantly worse in all items compared with a healthy reference population matched for age and sex.

Conclusions: Experiences of chronic PD-related pain are complex; there is substantial sleep fragmentation and negative impact on HRQoL.

Keywords
data reporting, pain, Parkinson disease, sleep fragmentation
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-84669 (URN)10.2147/NDT.S34882 (DOI)000309805600001 ()
Note

funding agencies|Research Fund at Skaraborg Hospital||Research and Development Council of Skaraborg County||Palle Ferb Foundation||FUTURUM||Academy for Healthcare, Jonkoping County Hospital||Medical Research Council of Southeast Sweden||Skaraborg Institute of Research and Development and Else Torgards Fund||

Available from: 2012-10-17 Created: 2012-10-17 Last updated: 2017-12-07Bibliographically approved
Skogar, Ö., Fall, P.-A., Hallgren, G., Lökk, J., Bringer, B., Carlsson, M., . . . Törnhage, C.-J. (2011). Diurnal salivary cortisol concentrations in Parkinson’s disease: increased total secretion and morning cortisol concentrations. International Journal of General Medicine, 4, 561-569
Open this publication in new window or tab >>Diurnal salivary cortisol concentrations in Parkinson’s disease: increased total secretion and morning cortisol concentrations
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2011 (English)In: International Journal of General Medicine, ISSN 1178-7074, E-ISSN 1178-7074, Vol. 4, p. 561-569Article in journal (Refereed) Published
Abstract [en]

Background:Parkinson’s disease (PD) is a chronic neurodegenerative disorder. There is limited knowledge about the function of the hypothalamic-pituitary-adrenal axis in PD. The primary aim of this prospective study was to analyze diurnal salivary cortisol concentrations in patients with PD and correlate these with age, gender, body mass index (BMI), duration of PD, and pain. The secondary aim was to compare the results with a healthy reference group.

Methods:Fifty-nine PD patients, 35 women and 24 men, aged 50–79 years, were recruited. The reference group comprised healthy individuals matched for age, gender, BMI, and time point for sampling. Salivary cortisol was collected at 8 am, 1 pm, and 8 pm, and 8 am the next day using cotton-based Salivette ®tubes and analyzed using Spectria®Cortisol I125. A visual analog scale was used for estimation of pain.

Results:The median cortisol concentration was 16.0 (5.8–30.2) nmol/L at 8 am, 5.8 (3.0–16.4) at 1 pm, 2.8 (1.6–8.0) at 8 pm, and 14.0 (7.5–28.7) at 8 am the next day. Total secretion and rate of cortisol secretion during the day (8 am–8 pm) and the concentration of cortisol on the next morning were lower (12.5 nmol/L) in the reference group. No significant correlations with age, gender, BMI, duration of PD, Hoehn and Yahr score, Unified Parkinson’s Disease Rating Scale III score, gait, pain, or cortisol concentrations were found.

Conclusion:The neurodegenerative changes in PD does not seem to interfere with the hypothalamic-pituitary-adrenal axis. Salivary cortisol concentrations in PD patients were increased in the morning compared with the reference group, and were not influenced by motor dysfunction, duration of disease, or coexistence of chronic or acute pain.

Place, publisher, year, edition, pages
Macclesfield, UK: Dove Medical Press Ltd., 2011
Keywords
cortisol, hypothalamic-pituitary-adrenal axis, Parkinson's disease
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:liu:diva-70277 (URN)10.2147/IJGM.S20875 (DOI)21887109 (PubMedID)
Available from: 2011-08-30 Created: 2011-08-30 Last updated: 2017-12-08Bibliographically approved
Fall, P.-A., Saleh, A., Fredrikson, M., Olsson, J.-E. & Granerus, A.-K. (2003). Survival time, mortality, and cause of death in elderly patients with Parkinson's disease: A 9-year follow-up. Movement Disorders, 18(11), 1312-1316
Open this publication in new window or tab >>Survival time, mortality, and cause of death in elderly patients with Parkinson's disease: A 9-year follow-up
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2003 (English)In: Movement Disorders, ISSN 0885-3185, E-ISSN 1531-8257, Vol. 18, no 11, p. 1312-1316Article in journal (Refereed) Published
Abstract [en]

This community-based study of Parkinson's disease (PD) investigated age at death and cause of death in a cohort of 170 previously studied patients. The current study is a 9-year follow-up, and the results are compared to 510 sex- and age-matched controls from the same area. A total of 170 patients were diagnosed with PD on August 31, 1989, within a defined area of Sweden. A control group of 510 persons from the same area and with the same age and sex distribution was also examined regarding age at death and cause of death. After 9.4 years, 121 cases (71.1%) and 229 controls (44.9%) were no longer alive. Thus, the mortality rate ratio was 1.6 (95% confidence interval [CI], 1.3-1.8) when comparing PD patients with controls. The all-cause hazard ratio for cases compared to controls was 2.4 (95% CI, 1.9-3.0). The mean age at death for the cases was 81.9 (95% CI, 80.3-83.0) years and for the controls 82.9 (95% CI, 82.0-83.7) years. Survival analysis also showed a shorter survival time (P < 0.001) for PD patients. Only 53% of the death certificates for the deceased patients recorded PD as an underlying or contributory cause of death. Many PD patients reached a high age but had a shorter survival than the controls. There was a significant increase in deaths from pneumonia.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-23795 (URN)10.1002/mds.10537 (DOI)3314 (Local ID)3314 (Archive number)3314 (OAI)
Available from: 2009-10-07 Created: 2009-10-07 Last updated: 2017-12-13
Fall, P.-A., Ekberg, S., Granerus, A.-K. & Granerus, G. (2000). ECT in Parkinson's disease - dopamine transporter visualised by [I-123]-beta-CIT SPECT. Journal of neural transmission, 107(8-9), 997-1008
Open this publication in new window or tab >>ECT in Parkinson's disease - dopamine transporter visualised by [I-123]-beta-CIT SPECT
2000 (English)In: Journal of neural transmission, ISSN 0300-9564, E-ISSN 1435-1463, Vol. 107, no 8-9, p. 997-1008Article in journal (Refereed) Published
Abstract [en]

Parkinson's disease (PD) is characterised by a loss of dopaminergic neurones in the basal ganglia. These neurones may be visualised by single photon emission computed tomography (SPECT) with the cocaine analogue 2 beta-carboxymethyl-3-beta-(4-iodophenyl)tropane ([(123)]beta-CIT), which labels the dopamine reuptake sites in the nerve terminals. In order to evaluate the possibility to predict the outcome of ECT a prospective study was performed with six PD patients in whom the [I-123]beta-CIT uptake was measured before and after an electroconvulsive therapy (ECT) series. The side-to-side difference in the radiotracer uptake was found to be significantly lower in striatum located contralaterally to the part of the body with the most pronounced symptomathology. No significant change in uptake of the radioligand was seen after ECT. Patients with best uptake and thus with less advanced PD improved most after ECT. The possibility to use the [I-123]beta-CIT uptake to predict the outcome of ECT treatment has to be further evaluated.

Keywords
Parkinson's disease, electroconvulsive therapy, single photon emission computerized tomography (SPECT), [I-123]beta-CIT
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-49623 (URN)
Available from: 2009-10-11 Created: 2009-10-11 Last updated: 2017-12-12
Fall, P.-A., Ekberg, S., Granérus, A.-K. & Granérus, G. (2000). ECT in Parkinson's disease-dopamine transporter visualised by [123I]-beta-CIT SPECT. Journal of Neural Transmission, 107(8-9), 997-1008
Open this publication in new window or tab >>ECT in Parkinson's disease-dopamine transporter visualised by [123I]-beta-CIT SPECT
2000 (English)In: Journal of Neural Transmission, ISSN 0300-9564, Vol. 107, no 8-9, p. 997-1008Article in journal (Refereed) Published
Abstract [en]

Parkinson's disease (PD) is characterised by a loss of dopaminergic neurones in the basal ganglia. These neurones may be visualised by single photon emission computed tomography (SPECT) with the cocaine analogue 2β-carboxymethyl-3-β-(4-iodophenyl)tropane ([123I]β-CIT), which labels the dopamine reuptake sites in the nerve terminals. In order to evaluate the possibility to predict the outcome of ECT a prospective study was per-formed with six PD patients in whom the [123I]β-CIT uptake was measured before and after an electroconvulsive therapy (ECT) series. The side-to-side difference in the radiotracer uptake was found to be significantly lower in striatum located contralaterally to the part of the body with the most pronounced symptomathology. No significant change in uptake of the radioligand was seen after ECT. Patients with best uptake and thus with less advanced PD improved most after ECT. The possibility to use the [123I]β-CIT uptake to predict the outcome of ECT treatment has to be further evaluated.

Keywords
Parkinson's disease, electroconvulsive therapy, single photon emission computerized tomography (SPECT), [123I]β-CIT
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-13533 (URN)10.1007/s007020070048 (DOI)
Available from: 1999-05-28 Created: 1999-05-28 Last updated: 2009-08-18
Ahmadi, A., Fredriksson, M., Jerregård, H., Åkerbäck, A., Fall, P.-A., Rannug, A., . . . Söderkvist, P. (2000). GSTM1 and mEPHX polymorphisms in Parkinson's disease and age of onset. Biochemical and Biophysical Research Communications - BBRC, 269(3), 676-680
Open this publication in new window or tab >>GSTM1 and mEPHX polymorphisms in Parkinson's disease and age of onset
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2000 (English)In: Biochemical and Biophysical Research Communications - BBRC, ISSN 0006-291X, E-ISSN 1090-2104, Vol. 269, no 3, p. 676-680Article in journal (Refereed) Published
Abstract [en]

Both environmental and genetic factors are involved in the development of PD and biotransformation of exogenous and endogenous compounds and may play a role in inter-individual susceptibility. Therefore, we investigated the presence of null genotypes of GSTM1, GSTT1, and two polymorphisms of mEPHX in subjects with Parkinson's disease and in a reference population. The study included 35 male PD patients and a male control group including 283 subjects. Homozygosity of the histidine (H) 113 isoform of mEPHX was significantly increased in PD patients (odds ratio = 3.8 CI 95% 1.2–11.8) and analysis of allele frequencies displayed an increased frequency of the H-allele among PD patients (odds ratio = 1.9 CI 95% 1.1–3.3). However, a significantly elevated median age for the onset of PD was found among GSTM1 gene carriers (median age = 68 years) compared to PD patients being GSTM1 null genotypes (median age = 57 years). Our observations suggest that (H) 113 isoform of mEPHX, which has been suggested as a low activity isoform, is overrepresented in PD patients and that inherited carriers of the GSTM1 gene postpone the onset of PD. These detoxification pathways may represent important protective mechanisms against reactive intermediates modifying the susceptibility and onset of PD.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-24837 (URN)10.1006/bbrc.2000.2338 (DOI)9235 (Local ID)9235 (Archive number)9235 (OAI)
Available from: 2009-10-07 Created: 2009-10-07 Last updated: 2017-12-13Bibliographically approved
Fall, P.-A. (1999). Aspects of Parkinson's disease. Epidemiology, risk factors and ECT in advanced disease. (Doctoral dissertation). Linköping: Linköping University Electronic Press
Open this publication in new window or tab >>Aspects of Parkinson's disease. Epidemiology, risk factors and ECT in advanced disease
1999 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The purpose was to investigate some aspects of epidemiology, risk factors and treatment with ECT in advanced Parkinson’s disease (PD).

In study I, we performed a descriptive epidemiologic population-based survey in the Central Health Care District in Östergötland in south-east Sweden, with a population of almost 150,000 inhabitants 1989. The case finding was accomplished in three ways: 1. Collection of all prescriptions for Parkinson’s disease. 2. Search in medical files. 3. Checking with all nursing homes in the area. The crude prevalence was found to be 115 per 100,000 inhabitants. When we used the European Standard Population as a tool for easy comparisons of PD prevalence between different areas and time periods 76 PD-cases per 100,000 inhabitants were found. The corresponding incidences were 11.0 (crude) and 7.9 (age standardised) per 100,000 person-years. Mean age at onset was 65.6. A low prevalence and a high age at onset suggested that e.g. environmental factors could influence the occurrence of PD, and the results implies that only few such factors were present in the investigated area.

The findings led to study II, a case-control study which investigated the possible impact of nutritional and environmental risk factors for idiopathic Parkinson’s disease (IP), including 113 cases and 263 control subjects. Dietary, drinking, and smoking habits, as well as previous occupation, were requested in a structured questionnaire. No increased risk was found for any of the nutrients. A reduced risk was found for coffee, wine, and spirits but also for broiled meat, smoked ham or meat, eggs, French loaf or white bread, and tomatoes. These findings could indicate an antioxidant effect. Frequency of preceding and present smoking was reduced in IP patients. Possible mechanisms are discussed. Various occupational groups and exposures were analysed and increased risks of IP in men were found for agricultural work, pesticide exposure, male carpenters, and in female cleaners.

In advanced PD there is a need for further therapeutic improvements, and electroconvulsive therapy (ECT) is one insufficiently explored and evaluated method. In study III ECT 16 non-depressed, nondemented PD patients with advanced disease were treated with ECT. In all patients an antiparkinsonian effect of ECT was seen, lasting between a few days and 18 months. Five patients, all with signs of blood brain barrier damage, developed transitory mental confusion after ECT. The results indicated that ECT could cause increased dopaminergic activity, which led us to study IV. Single photon emission computed tomography (SPECT) with the cocaine analogue [123I]-β-CIT was used in order to visualise dopaminergic neurones in the brain. Six patients with PD were examined before and after a series of ECT, and in three cases SPECT was also repeated after one year. The side-to-side difference in the radiotracer uptake was found to be significantly lower in striatum located contralaterally to the part of the body with most pronounced symptomatology. No significant change in uptake of [123I]-β-CIT was seen after ECT, although all patients improved and the most pronounced improvement was seen in patients with less advanced PD.

Study V points at two new positive observations with maintenance ECT (MECT). i.e. repeated ECT treatment of PD. One patient had either severe mental side effects on higher L-dopa doses or intolerable parkinsonian symptoms on lower doses. MECT implied marked improvement in parkinsonian symptoms without mental side effects. Another PD patient, who also had a mental depression, showed slight improvement of motor symptoms on a series of ECT. When treated with MECT further antiparkinsonian effects were seen.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 1999. p. 61
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 593
Keywords
Parkinson's disease, PD, treatment, epidemiology, electroconvulsive therapy, ECT
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-5011 (URN)91-7219-336-0 (ISBN)
Public defence
1999-05-17, Berzeliussalen, Campus US, Linköpings universitet, Linköping, 09:00 (English)
Opponent
Supervisors
Note
On the day of the public defence the status of the article IV was: Submitted; articel V was: Accepted for publication after revision.Available from: 1999-05-28 Created: 1999-05-28 Last updated: 2012-01-24Bibliographically approved
Fall, P.-A. & Granérus, A.-K. (1999). Maintenance ECT in Parkinson's disease. Journal of Neural Transmission, 106(7-8), 737-741
Open this publication in new window or tab >>Maintenance ECT in Parkinson's disease
1999 (English)In: Journal of Neural Transmission, ISSN 0300-9564, Vol. 106, no 7-8, p. 737-741Article in journal (Refereed) Published
Abstract [en]

Electroconvulsive therapy (ECT) has an anti-Parkinsonian effect. In two cases repeated single ECT, i.e. maintenance ECT (MECT), caused different, hitherto unreported positive effects. One patient had either severe mental side effects from higher L-dopa doses or intolerable parkinsonian symptoms on lower doses. MECT entailed a marked improvement in parkinsonian symptoms without mental side effects. Another patient with depression as well as Parkinson's disease who showed a slight improvement of motor symptoms after a series of ECT presented further anti-parkinsonian effects on MECT.

Keywords
Parkinson's disease, paranoid symptoms, hallucination, maintenance ECT
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-13534 (URN)10.1007/s007020050194 (DOI)
Available from: 1999-05-28 Created: 1999-05-28 Last updated: 2009-08-18
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