It involved a study of the most efficacious surgical operations undertaken and pharmaceutical drugs used to treat these disorders as well genetic studies carried out to date.
The field of movement disorders is one of the most complex branches of neurology. The volume of knowledge acquired is so large that it has needed a number of neurologists to sub-specialise in the matter and multidisciplinary units have been created to tackle problems such as the diagnosis of Parkinson’s Disease and of atypical Parkinsonisms, the choice of the most suitable surgical therapies and pharmaceutical drugs or the carrying out of genetic studies.
Thus is 1998 the Movement Disorders Unit at Cruces Hospital in Bilbao was created with neurologists, neurosurgeons, neurophysiologists, anaesthetists, neuropsychologists and radiologists. Since its creation, more than 100 surgical operations have been carried out, the majority on patients with Parkinson’s Disease. Currently it is a centre of reference for functional surgery in the Autonomous Community of the Basque Country (CAPV), and even receives patients from other autonomous communities.
The PhD the neurologist Juan Carlos Gómez-Esteban presented at the University of the Basque Country (UPV/EHU), Results of clinical research at a movement disorders unit, brings together a number of different lines of research undertaken at the Cruces Hospital Movement Disorders Unit between 1998 and 2007. Mr Gómez-Esteban graduated in Medicine and General Surgery and his PhD, having received excellent ratings cum laude, was led by Dr. Juan José Zarranz Imirizaldu and Dr. Elena Lezcano García, both from the Department of Neurosciences of the Faculty of Medicine and Odontology at the UPV/EHU.
Results of the operations
The initial part of the thesis presented by Dr. Gómez-Esteban reviews the operations carried out at the Movement Disorders Unit; in concrete, analysing deep brain stimulation, a surgical procedure that acts on the nuclei deep inside the brain that do not function correctly in patients affected by different movement disorders. From his research he deduced that what is involved is an effective therapy for patients with advanced Parkinson’s and that the subthalamic nucleus (a small nucleus located at the base of the brain) is the surgical target that provides a more complete answer to an improvement in the symptoms of the illness. The operation involves implanting microelectrodes in this nucleus and which are controlled by a battery similar to a pacemaker.
Dr Gómez-Esteban states that the benefit of this type of operation for the symptoms affecting movement is similar to that obtained with dopaminergic pharmaceutical drugs (those containing dopamina precursors or behave similarly to them), with the exception of trembling, which responds better to surgical treatment rather than to pharmaceutical medicines. Another of the benefits of deep cerebral stimulation is the enhancement of the quality of life not only for the patient, but also for the carer.
It also produces improvements in verbal memory, but changes in verbal fluency or executive functions have not been detected. Although initially symptoms of depression may be produced as a reaction related to patient expectation and to the surgical process itself, Dr. Gómez-Esteban affirms that, in the medium and long term, there is an improvement in the symptoms of depression.
This research also showed that patients suffering from the illness known as Parkinson-type multiple system atrophy as well as those with a specific mutation of the LRRK2-Dardarina gene, do not respond to surgery as well as those suffering from Parkinson’s of unknown cause or from other, hereditary Parkinson’s.
Genetic research: new mutations
Hereditary forms of Parkinson’s and dementia with Lewy bodies (a recently discovered illness previously confused with Parkinson’s or Alzheimer) are not frequent. In fact, Dr. Gómez-Esteban states that genetic defects associated with this last illness have not been found to date. However, the Movement Disorders Unit has discovered a new mutation in Parkinson’s Disease (a specific mutation in the gene known as alpha-synuclein), which is also associated with Lewy Body Dementia. Also notable is the fact that patients registering such a mutation do not have a primary sleep disorder, a reduction in the REM phases (in which dreams are produced) and NREM (in which dreams are not produced), which could even precede motor symptoms.
Sleep fragmentation, psychotic symptoms and analysis of pharmaceutical drugs
Another problem for Parkinson’s sufferers is the fragmentation of sleep or the impossibility of continuous sleep and nicturia (orinating frequently during the night). According to Dr. Gómez-Esteban, the drugs acting directly on the Dopamine receptors appear to improve nicturia, although not improving night time sleep nor the presence of daytime hypersomnia (difficulty in staying awake). 21.9% of patients studied at the Movement Disorders Unit suffer, moreover, from restless legs syndrome, which gives rise to a worsening in the quality of night time sleep and the quality of life.
Dr. Gómez-Esteban also reviewed research of Parkinson’s Disease patients who had psychotic symptom, such as visual hallucinations. The clinical trials undertaken at the Cruces Hospital point to the pharmaceutical drug Ziprasidona as being efficacious as an antipsychotic, having few adverse effects on the motor system that coordinate movement and regulates muscular tone.
Lucía Álvarez | alfa
Study suggests possible new target for treating and preventing Alzheimer's
02.12.2016 | Oregon Health & Science University
The first analysis of Ewing's sarcoma methyloma opens doors to new treatments
01.12.2016 | IDIBELL-Bellvitge Biomedical Research Institute
A multi-institutional research collaboration has created a novel approach for fabricating three-dimensional micro-optics through the shape-defined formation of porous silicon (PSi), with broad impacts in integrated optoelectronics, imaging, and photovoltaics.
Working with colleagues at Stanford and The Dow Chemical Company, researchers at the University of Illinois at Urbana-Champaign fabricated 3-D birefringent...
In experiments with magnetic atoms conducted at extremely low temperatures, scientists have demonstrated a unique phase of matter: The atoms form a new type of quantum liquid or quantum droplet state. These so called quantum droplets may preserve their form in absence of external confinement because of quantum effects. The joint team of experimental physicists from Innsbruck and theoretical physicists from Hannover report on their findings in the journal Physical Review X.
“Our Quantum droplets are in the gas phase but they still drop like a rock,” explains experimental physicist Francesca Ferlaino when talking about the...
The Max Planck Institute for Physics (MPP) is opening up a new research field. A workshop from November 21 - 22, 2016 will mark the start of activities for an innovative axion experiment. Axions are still only purely hypothetical particles. Their detection could solve two fundamental problems in particle physics: What dark matter consists of and why it has not yet been possible to directly observe a CP violation for the strong interaction.
The “MADMAX” project is the MPP’s commitment to axion research. Axions are so far only a theoretical prediction and are difficult to detect: on the one hand,...
Broadband rotational spectroscopy unravels structural reshaping of isolated molecules in the gas phase to accommodate water
In two recent publications in the Journal of Chemical Physics and in the Journal of Physical Chemistry Letters, researchers around Melanie Schnell from the Max...
The efficiency of power electronic systems is not solely dependent on electrical efficiency but also on weight, for example, in mobile systems. When the weight of relevant components and devices in airplanes, for instance, is reduced, fuel savings can be achieved and correspondingly greenhouse gas emissions decreased. New materials and components based on gallium nitride (GaN) can help to reduce weight and increase the efficiency. With these new materials, power electronic switches can be operated at higher switching frequency, resulting in higher power density and lower material costs.
Researchers at the Fraunhofer Institute for Solar Energy Systems ISE together with partners have investigated how these materials can be used to make power...
16.11.2016 | Event News
01.11.2016 | Event News
14.10.2016 | Event News
02.12.2016 | Medical Engineering
02.12.2016 | Agricultural and Forestry Science
02.12.2016 | Physics and Astronomy