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ECT in Parkinson's disease: Changes in motor symptoms, monoamine metabolites and neuropeptides
Linköpings universitet, Institutionen för klinisk och experimentell medicin, Geriatrik. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Närsjukvården i centrala Östergötland, Geriatriska kliniken.
Linköpings universitet, Institutionen för klinisk och experimentell medicin, Geriatrik. Linköpings universitet, Hälsouniversitetet.
Linköpings universitet, Institutionen för klinisk och experimentell medicin, Psykiatri. Linköpings universitet, Hälsouniversitetet.
Vise andre og tillknytning
1995 (engelsk)Inngår i: Journal of Neural Transmission. Parkinson's disease and dementia section., ISSN 0936-3076, Vol. 10, nr 2-3, s. 129-140Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

Electroconvulsive therapy (ECT) was given to 16 non-depressed, non-demented patients with advanced Parkinson's disease (PD). In all the patients an antiparkinsonian effect was seen, lasting for 18 months in one patient, 3-5 months in seven patients, and a few days to four weeks in eight patients. After ECT the levels of homovanillic acid and neuropeptide Y in cerebrospinal fluid (CSF) were significantly increased. The eight patients with long lasting motor improvement after ECT had significantly lower CSF-3-methoxy-4-hydroxyphenylglycol compared to the group with short lasting improvement. Five patients developed transitory mental confusion after ECT. In these patients, and in no others, a high albumin-ratio was found already before ECT was given - an indication of blood CSF barrier damage. Our results suggest that ECT is valuable in patients with drug refractory PD or PD with intolerance to antiparkinsonian drugs.

sted, utgiver, år, opplag, sider
1995. Vol. 10, nr 2-3, s. 129-140
HSV kategori
Identifikatorer
URN: urn:nbn:se:liu:diva-13532OAI: oai:DiVA.org:liu-13532DiVA, id: diva2:20919
Tilgjengelig fra: 1999-05-28 Laget: 1999-05-28 Sist oppdatert: 2009-08-18
Inngår i avhandling
1. Aspects of Parkinson's disease. Epidemiology, risk factors and ECT in advanced disease
Åpne denne publikasjonen i ny fane eller vindu >>Aspects of Parkinson's disease. Epidemiology, risk factors and ECT in advanced disease
1999 (engelsk)Doktoravhandling, med artikler (Annet vitenskapelig)
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.

sted, utgiver, år, opplag, sider
Linköping: Linköping University Electronic Press, 1999. s. 61
Serie
Linköping University Medical Dissertations, ISSN 0345-0082 ; 593
Emneord
Parkinson's disease, PD, treatment, epidemiology, electroconvulsive therapy, ECT
HSV kategori
Identifikatorer
urn:nbn:se:liu:diva-5011 (URN)91-7219-336-0 (ISBN)
Disputas
1999-05-17, Berzeliussalen, Campus US, Linköpings universitet, Linköping, 09:00 (engelsk)
Opponent
Veileder
Merknad

On the day of the public defence the status of the article IV was: Submitted; articel V was: Accepted for publication after revision.

Tilgjengelig fra: 1999-05-28 Laget: 1999-05-28 Sist oppdatert: 2020-04-18bibliografisk kontrollert

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