Malattia di Parkinson

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Malattia di Parkinson

• Diagnosi differenziale

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Cholinergic and adrenergic nerves
Autonomic reflex pathways
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Innervation of the heart
Autonomic nerves and ganglia in the pelvis
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Malattia di Parkinson

• Genetica

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Loci and genes linked to familial PD
Locus Location Gene Inheritance
PARK1 4p21.3 a-Synuclein AD
PARK2 6q25.2-27 Parkin AR
PARK3 2p13 AD
PARK4 4p15 AD
PARK5 4p14 UCH-L1 AD
PARK6 1p35-p36 PINK1 AR
PARK7 1p36 DJ-1 AR
PARK8 12p11.2-q13.1 Dardarin AD
PARK9 1p36 AR (Kufor-Rakeb syndrome)
PARK 10 1p32 Late-onset susceptibility gene
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The Marsala kindred
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Malattia di Parkinson

• Neurostimolazione

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Methods

• Surgical procedure
• Surgery performed in the practically defined off
  condition
• Talairachs stereotactic frame modified for a
  polar approach. Ventriculography
• Bilateral implant of a Medtronic 3389 lead

3389
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Bilateral STN implant
LEDD reduction at 24 months -62.9
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Bilateral STN implant
Levodopa equivalent daily dose Mean SD
Before surgery 1505.5 722.8
Last available visit 491.7 325.4
Variation -69.3
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Bilateral STN implant
UPDRS-III Baseline 12 months Last visit
UPDRS II 31.6 5.9 10.1 6.1 -68.1 10.0 6.3 -68.4
Schwab England 24.5 14.4 83.6 12.9 80.0 14.1
UPDRS-III 60.2 9.3 30.8 13.7 -48.8 29.9 12.5 -50.2
LEDD 1505.9 722.8 468.3 294.2 -68.3 491.7 325.4 -69.3
Hoehn Yahr 4.3 0.8 2.1 1.1 -51.1 1.9 0.9 -55.9
Energy (?W) 1.56 0.5 1.53 0.5
Patients 22 22 22
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Distonia

• Neurostimolazione

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a
b
c
d
A patient with generalized dystonia and prominent
axial involvement is shown before (a, b) and 6
months after implant with high frequency
stimulation implant in the GPi (c, d). The
improvement in posture and gait is evident from
these still frames taken from video clips
(courtesy of Dr. Nardocci).