|
|
rigidity in Parkinson's Disease
|
Logged in as: Guest
|
|
Users viewing this topic:
none
|
|
Login  | |
|
rigidity in Parkinson's Disease - April 18, 2000 11:53:00 PM
|
|
|
ptlittlefish
Posts: 4
Joined: April 8, 2000
From: HK
Status: offline
|
Can anyone please tell me is there any difference between the CAUSE of cogwheel rigidity and leadpipe regidity in Parkinson's Disease?
Also does anyone have handon experience with those patient with electrodes surgically placed in the globus pallidus or subthalamic nuclei? Would you kindly share your experience with me about the effectiveness of such kind of treatment?
Thanks so much
I'm interested in Parkinson's disease these days but unfortunately all the books about this in my library have been borrowed. >_<
|
|
|
|
|
Re: rigidity in Parkinson's Disease - April 19, 2000 9:13:00 AM
|
|
|
Andrew M. Ball, MS, PT
Posts: 500
Joined: October 8, 1999
From: Chapel Hill, NC, USA
Status: offline
|
Ptlittlefish
On one hand, I'm glad that this question was asked. I know that plenty of "experienced" PT's are ignorant of the answer, or don't care to know what the answer may be. I therefore would like to commend you as student for asking the question. It takes guts to do that in a public forum. I welcome you to RehabEdge, and hope that you will continue to bring up such wonderful topics for discussion despite what I’m about to say . . .
On the other hand, the asking of this question distresses me a little bit. Not so much that it was asked, but that it was asked without any references, which suggests to me that a simple MEDLINE sweep was never conducted prior to asking the question (or that the Abstracts were not read). If this had been done, we'd be able to discuss the merits of facts and the clinical implications of research, rather than the "clinical opinions" of "experienced" PT's who still think that the cortex is the most important neurologic structure for walking (It is not! Cats don't need a cortex in order to walk, and neither do higher primates. New research strongly suggests that humans don't either). A MEDLINE sweep would have suggested a path for answering the question of different neurologic injuries creating different clinical Parkinson's presentations . . . if not answered the question for you entirely. Yes Ptlittlefish, I’m much tougher on students, I expect more from them because they are the future of the profession, and have been trained in evidence-based practice . . . unlike most of their experienced mentors, most of whom I’ve pretty much written off in this regard. I’m asking, no I’m BEGGING for students to live up to the new responsibilities that the current healthcare system demands, and make no apologies for encouraging them in this direction, even if it means a little “tough love” every now and again.
As I've said time and time again, my area of clinical expertise is pediatrics. My post-graduate work focuses on business management of healthcare education systems. My interest does NOT rest with Parkinson's disease nor how to treat it, unlike the student who asked this question.
That said, why is it that I was able to find a wealth of resources on MEDLINE with a simple 30 second sweep of the literature, enough that would yield an initial answer to the question of neurologic basis of lead-pipe versus cogwheel rigidity (Inoude H, et al., 1997; Yamanouchi H and Nagura H, 1997; and Jellinger KA)? I'd expect this from an "experienced" PT because they tend to be out of the loop and behind the times when it comes to evidence-based practice (rather "practicing" their first year of practice over and over and over again - - this is not true experience, it's just sad), but not from a student or a new graduate.
From a soon to graduate MPT or DPT student, I'd expect more. Ya’ll are better than that.
Make no mistake that the heatlhcare environment of the very near future will expect this kind of "more" from all PT's. If a new graduate expects to get a job upon graduation in the United States, she better darn well expect that of herself. I for one don't want to have to do my own MEDLINE searches when I'm old enough to require neurologic/rehab physical therapy, I expect for my PT to be up to date with the literature, or do the respectable thing and stop practicing. If you think this response is harsh I understand, but make no apologies. Better me than a referring neurologist or primary care physician right? I hope and expect that you look back several years from now and appreciate the "tough love" of this posting. If not, I’m sorry that you didn’t learn anything from this experience. To attack without purpose or rationale is not what I’m trying to accomplish here.
THE ANSWERS TO YOUR QUESTIONS:
It would seem that there are several different clinical presentations and that each has a different underlying neurologic cause. I've not read all of the literature on the subject, just a few that caught my eye. At this point, I'd suggest that cogwheel rigidity is related to the substantia nigra (Inoue, et al 1997), and that lead-pipe rigidity is related to vascular parkinsonism which shows decreased oligodendrocyctes in the frontal white matter of the brain (Yamanouchi 1997). This is not to say that both can't co-exist, which may make teasing this out clinically, a little bit more complicated when neuroradiographic study shows problems with the substantia nigra but the patient exhibits lead-pipe, as opposed to the cogwheel rigidity that we would expect. In such cases, I wonder if the frontal lobe was even considered for examination.
I am aware of some significant research going on in the area of Parkinson's disease. My ex's brother, for example, is currently coordinating a multiple site study on fetal pig tissue implantation into the basal ganglia. Last I spoke to him (which has been a while due to obvious issues of personal politics), the human subjects were making some pretty miraculous improvements. High frequency, computer mediated, chronic electrical stimulation of the globus pallidus did show some interesting results (Pahwa R. et al., 1997), and the patients seemed to feel that they benefited too. At 3 months following the last implant, the majority patients rated themselves as markedly improved, and one patient was moderately improved
REFERENCES:
Inoue H, Udaka F, Takahashi M, Nishinaka K, Kameyama M. Secondary parkinsonism following midbrain hemorrhage. Rinsho Shinkeigaku, 37:266-9, 1997 Mar
This study, though published in Jappanese, suggests that cogwheel rigidity is caused by lesion or problem with the functioning of the midbrain, particularly the substantia nigra.
Yamanouchi H; Nagura H. Neurological signs and frontal white matter lesions in vascular parkinsonism. A clinicopathologic study. Stroke, 28:965-9, 1997 May
This study suggests that the clinical characteristics and the pathological lesions of so-called vascular parkinsonism (VP) are different than Parkinson's with substantia nigra invovlement. VP was defined as the presence of parkinsonism and pathological evidence of cerebrovascular lesions but no depigmentation or Lewy bodies at the substantia nigra. VP was clinically characterized by short-stepped or frozen gait, lead-pipe rigidity, absence of resting tremor, and negative response to levodopa. Upon neuroradiographic study, VP patients showed that the number of oligodendrocytes in the frontal white matter was significantly less than that in age-matched normal control
In short, the core signs and symptoms of autopsy-proved VP differ from those of typical Parkinson's disease, and most VP patients had diffuse cerebral white matter lesions as well as basal ganglia lesions. VP might be related to frontal white matter lesions.
Jellinger KA. Post mortem studies in Parkinson's disease--is it possible to detect brain areas for specific symptoms? J Neural Transm Suppl, 56:1-29, 1999
A great article, but make sure that you've got a few hours to kill before reading it. It's VERY complex and recommended only after all of the others have been read. Make sure you've got your favorite vice handy too, reading it will be VERY neurotaxing and tiring, and you'll need a personal "reward" when you're done.
Pahwa R; Wilkinson S; Smith D; Lyons K; Miyawaki E; Koller WC. High-frequency stimulation of the globus pallidus for the treatment of Parkinson's disease. Neurology, 49:249-53, 1997 Jul
Long-term treatment of Parkinson's disease (PD) with levodopa is complicated by the development of motor fluctuations and dyskinesias. Posteroventral pallidotomy can improve tremor, bradykinesia, rigidity, and dyskinesias in PD. We performed chronic stimulation of the globus pallidus (CSGP) to duplicate the positive results of pallidotomy with reduced risk of permanent neurologic deficit in patients with advanced PD. The lead for CSGP was stereotactically implanted with the aid of microelectrode recordings in the globus pallidus pars interna. An electrical pulse generator was implanted in the subclavicular region. Stimulation settings were adjusted by computer. Five PD patients (four men, one woman) with disabling symptoms were enrolled. Three of the patients had bilateral implants. At 3 months following the last implant, four patients rated themselves as markedly improved, and one patient was moderately improved. The amount of time in the "on" state increased from 21% at baseline to 65% at 3-month follow-up (p < 0.05). There was a significant improvement in all subscales of the UPDRS (p < 0.05). One patient had an asymptomatic intracranial bleed, one patient had transient hemiparesis during surgery with stimulation, and one patient required surgical repositioning of the lead. Adverse effects caused by stimulation were minimal. CSGP is a safe and effective procedure in PD patients with motor fluctuations and dyskinesias.
Please keep us informed as to how your personal literature search develops. I look forward to learning from your experience and hope that you continue to contribute to the success of RehabEdge! I only read a few articles out of many on the subject. I'm curious to know if your reading turns up anything to contradict what I've found.
------------------
Andrew M. Ball, MS, PT
MBA/PhD Candidate
[This message has been edited by Andrew M. Ball, MS, PT (edited April 19, 2000).]
|
|
|
|
|
Re: rigidity in Parkinson's Disease - May 19, 2000 7:02:00 AM
|
|
|
Andrew M. Ball, MS, PT
Posts: 500
Joined: October 8, 1999
From: Chapel Hill, NC, USA
Status: offline
|
Forum,
This thread has been quiet for quite sometime. I am aware that this particular thread has been discussed in several physical therapy education programs, by faculty and students alike. It’s also been about a month since PTLITTLEFISH asked the original question, more than enough time for her to conduct a MEDLINE search of her own and share her findings with the forum. More than enough time for other students, not nearly as courageous as PTLITTLEFISH for having asked the question in the first place, to stand up to the challenge and contribute to the discussion.
I know that some faculty have had their students conduct literature searches on the subject and have sparked "unprecedented student interest in clinical neurology" within the classroom.
I'm also aware that some students have run with this topic on their own.
My literature search was an initial one, and I certainly have not gone into the topic with equal depth as some of the rest of you.
I'd like to learn from all of you out there in cyberspace, and in physical therapy school. Please post and share your findings for discussion . . . maybe we'll all learn something.
Drew
|
|
|
|
|
Re: rigidity in Parkinson's Disease - May 23, 2000 6:35:00 AM
|
|
|
David
Posts: 19
Joined: February 8, 2000
From: St. Augustine, FL....USA
Status: offline
|
Hey Drew....I plan on submitting this question to my neuropath students when their class begins in late June....sorry no one has replied since Littlefish.... [QUOTE]Originally posted by Andrew M. Ball, MS, PT:
Forum,
This thread has been quiet for quite sometime. I am aware that this particular thread has been discussed in several physical therapy education programs, by faculty and students alike. It’s also been about a month since PTLITTLEFISH asked the original question, more than enough time for her to conduct a MEDLINE search of her own and share her findings with the forum. More than enough time for other students, not nearly as courageous as PTLITTLEFISH for having asked the question in the first place, to stand up to the challenge and contribute to the discussion.
I know that some faculty have had their students conduct literature searches on the subject and have sparked "unprecedented student interest in clinical neurology" within the classroom.
I'm also aware that some students have run with this topic on their own.
My literature search was an initial one, and I certainly have not gone into the topic with equal depth as some of the rest of you.
I'd like to learn from all of you out there in cyberspace, and in physical therapy school. Please post and share your findings for discussion . . . maybe we'll all learn something.
Drew[/QUOTE]
|
|
|
|
 New Messages |
 No New Messages |
 Hot Topic w/ New Messages |
 Hot Topic w/o New Messages |
 Locked w/ New Messages |
 Locked w/o New Messages |
|
 Post New Thread
Reply to Message
Post New Poll
Submit Vote
Delete My Own Post
Delete My Own Thread
Rate Posts |
|
0.063
|
Printable Version
