Pick Topic
Review Topic
List Experts
Examine Expert
Save Expert
  Site Guide ··   
Parkinson Disease: HELP
Articles by Theresa A. Zesiewicz
Based on 18 articles published since 2010
(Why 18 articles?)

Between 2010 and 2020, T. Zesiewicz wrote the following 18 articles about Parkinson Disease.
+ Citations + Abstracts
1 Guideline Practice Parameter: treatment of nonmotor symptoms of Parkinson disease: report of the Quality Standards Subcommittee of the American Academy of Neurology. 2010

Zesiewicz, T A / Sullivan, K L / Arnulf, I / Chaudhuri, K R / Morgan, J C / Gronseth, G S / Miyasaki, J / Iverson, D J / Weiner, W J / Anonymous2050653. ·University of South Florida, Tampa, USA. ·Neurology · Pubmed #20231670.

ABSTRACT: OBJECTIVE: Nonmotor symptoms (sleep dysfunction, sensory symptoms, autonomic dysfunction, mood disorders, and cognitive abnormalities) in Parkinson disease (PD) are a major cause of morbidity, yet are often underrecognized. This evidence-based practice parameter evaluates treatment options for the nonmotor symptoms of PD. Articles pertaining to cognitive and mood dysfunction in PD, as well as treatment of sialorrhea with botulinum toxin, were previously reviewed as part of American Academy of Neurology practice parameters and were not included here. METHODS: A literature search of MEDLINE, EMBASE, and Science Citation Index was performed to identify clinical trials in patients with nonmotor symptoms of PD published between 1966 and August 2008. Articles were classified according to a 4-tiered level of evidence scheme and recommendations were based on the level of evidence. RESULTS AND RECOMMENDATIONS: Sildenafil citrate (50 mg) may be considered to treat erectile dysfunction in patients with Parkinson disease (PD) (Level C). Macrogol (polyethylene glycol) may be considered to treat constipation in patients with PD (Level C). The use of levodopa/carbidopa probably decreases the frequency of spontaneous nighttime leg movements, and should be considered to treat periodic limb movements of sleep in patients with PD (Level B). There is insufficient evidence to support or refute specific treatments for urinary incontinence, orthostatic hypotension, and anxiety (Level U). Future research should include concerted and interdisciplinary efforts toward finding treatments for nonmotor symptoms of PD.

2 Review Management of Early Parkinson Disease. 2020

Zesiewicz, Theresa A / Bezchlibnyk, Yarema / Dohse, Nicolas / Ghanekar, Shaila D. ·Department of Neurology, University of South Florida, Ataxia Research Center, Tampa, FL, USA; Frances J. Zesiewicz Foundation for Parkinson Disease; University of South Florida, Movement Disorders Neuromodulation Center, Tampa, FL, USA. Electronic address: tzesiewi@health.usf.edu. · University of South Florida, Movement Disorders Neuromodulation Center, Tampa, FL, USA; Department of Neurosurgery and Brain Repair, University of South Florida, 2 Tampa General Circle STC-7049, Tampa, FL 33606, USA. · Department of Neurology, University of South Florida, Ataxia Research Center, Tampa, FL, USA; Frances J. Zesiewicz Foundation for Parkinson Disease; Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA. · Department of Neurology, University of South Florida, Ataxia Research Center, Tampa, FL, USA; Frances J. Zesiewicz Foundation for Parkinson Disease; University of South Florida, Movement Disorders Neuromodulation Center, Tampa, FL, USA. ·Clin Geriatr Med · Pubmed #31733700.

ABSTRACT: Early Parkinson disease is the approximate time period between initial diagnosis and the onset of motor fluctuations. Treatment requires an integrative approach, including identification of motor and nonmotor symptoms, choice of pharmacologic treatment, and emphasis on exercise. Patients should be treated for motor symptoms, whereas medications may be delayed for milder symptoms. The choice of treatment in patients with early Parkinson disease must be weighed against financial considerations, ease of administration, and potential long-term adverse events. Nonmotor symptoms should also be identified and treated. Exercise is an important component for treatment of Parkinson disease at any stage.

3 Review Parkinson Disease. 2019

Zesiewicz, Theresa A. · ·Continuum (Minneap Minn) · Pubmed #31356286.

ABSTRACT: PURPOSE OF REVIEW: Parkinson disease is a common neurodegenerative disorder that affects millions of people worldwide. Important advances in the treatment, etiology, and the pathogenesis of Parkinson disease have been made in the past 50 years. This article provides a review of the current understanding of Parkinson disease, including the epidemiology, phenomenology, and treatment options of the disease. RECENT FINDINGS: Parkinson disease is now recognized to be a heterogeneous condition marked by both motor and nonmotor symptoms. It is composed of preclinical, prodromal, and clinical phases. New medications with improved ease of administration have been approved for its treatment. Innovative surgical therapies for Parkinson disease may be used when motor symptoms persist despite optimal medical management. SUMMARY: Parkinson disease is a complex, heterogeneous neurodegenerative disorder. Considerable progress has been made in its treatment modalities, both pharmacologic and surgical. While its cure remains elusive, exciting new research advances are on the horizon.

4 Review Clinically meaningful parameters of progression and long-term outcome of Parkinson disease: An international consensus statement. 2015

Puschmann, Andreas / Brighina, Laura / Markopoulou, Katerina / Aasly, Jan / Chung, Sun Ju / Frigerio, Roberta / Hadjigeorgiou, Georgios / Kõks, Sulev / Krüger, Rejko / Siuda, Joanna / Wider, Christian / Zesiewicz, Theresa A / Maraganore, Demetrius M. ·Department of Neurology, Skåne University Hospital, Lund, Sweden; Lund University, Department of Clinical Sciences, Lund, Neurology, Sweden. · Department of Neurology, San Gerardo Hospital, Milan Center for Neuroscience, Monza, Italy. · Department of Neurology, NorthShore University Health System, Evanston, IL, USA. · St. Olav's Hospital, Department of Neurology, Trondheim, Norway. · Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea. · Faculty of Medicine, University of Thessalia, Larissa, Greece. · Department of Pathophysiology, University of Tartu, Tartu, Estonia. · Clinical and Experimental Neuroscience, Luxembourg Center for Systems Biomedicine (LCSB), University of Luxembourg, Luxembourg, Centre Hospitalier de Luxembourg, Luxembourg. · Department of Neurology, Medical University of Silesia, School of Medicine in Katowice, Poland. · Department of Clinical Neuroscience, Centre Hospitalier Universitaire Vaudois (CHUV-UNIL), Lausanne, Switzerland. · Department of Neurology, University of South Florida, Tampa, FL, USA. · Department of Neurology, NorthShore University Health System, Evanston, IL, USA. Electronic address: dmaraganore@northshore.org. ·Parkinsonism Relat Disord · Pubmed #25952959.

ABSTRACT: Parkinson disease (PD) is associated with a clinical course of variable duration, severity, and a combination of motor and non-motor features. Recent PD research has focused primarily on etiology rather than clinical progression and long-term outcomes. For the PD patient, caregivers, and clinicians, information on expected clinical progression and long-term outcomes is of great importance. Today, it remains largely unknown what factors influence long-term clinical progression and outcomes in PD; recent data indicate that the factors that increase the risk to develop PD differ, at least partly, from those that accelerate clinical progression and lead to worse outcomes. Prospective studies will be required to identify factors that influence progression and outcome. We suggest that data for such studies is collected during routine office visits in order to guarantee high external validity of such research. We report here the results of a consensus meeting of international movement disorder experts from the Genetic Epidemiology of Parkinson's Disease (GEO-PD) consortium, who convened to define which long-term outcomes are of interest to patients, caregivers and clinicians, and what is presently known about environmental or genetic factors influencing clinical progression or long-term outcomes in PD. We propose a panel of rating scales that collects a significant amount of phenotypic information, can be performed in the routine office visit and allows international standardization. Research into the progression and long-term outcomes of PD aims at providing individual prognostic information early, adapting treatment choices, and taking specific measures to provide care optimized to the individual patient's needs.

5 Review Effects of rotigotine transdermal system on non-motor symptoms in Parkinson's disease: an overview. 2013

Zesiewicz, Theresa A / Martinez-Martin, Pablo. ·University of South Florida, Tampa, FL, USA. ·Expert Rev Neurother · Pubmed #24236902.

ABSTRACT: Parkinson's disease (PD) is a progressive neurodegenerative disease, involving the dopaminergic, noradrenergic, serotonergic and cholinergic systems. In addition to its cardinal motor symptoms, PD is associated with a diverse range of non-motor symptoms (NMS) that may be more important than motor symptoms. Although there is evidence for a dopaminergic contribution for several NMS in PD, NMS have been underrecognized and undertreated by clinicians. There is evidence that dopaminergic therapy, including dopamine agonists, may alleviate some NMS, such as anxiety and depression. This review focuses on published data on the effects of the non-ergoline dopaminergic agonist rotigotine transdermal system in the treatment of NMS in patients with PD. Data on the effects of orally administered non-ergoline agonists, including ropinirole and pramipexole, on NMS are also summarized.

6 Clinical Trial A randomized, fixed-dose, dose-response study of ropinirole prolonged release in advanced Parkinson's disease. 2017

Zesiewicz, Theresa A / Chriscoe, Stephen / Jimenez, Theresa / Upward, James / Davy, Maria / VanMeter, Susan. ·University of South Florida, Tampa, FL, USA. · GlaxoSmithKline, Research Triangle Park, Raleigh-Durham, NC, USA. · GlaxoSmithKline, Stevenage, Hertfordshire, UK. ·Neurodegener Dis Manag · Pubmed #28120630.

ABSTRACT: AIM: This Phase IV, double-blind, randomized, parallel-group study characterized the dose-response and tolerability of fixed doses of ropinirole prolonged release (PR) in subjects with advanced Parkinson's disease. PATIENTS & METHODS: Subjects receiving concomitant l-dopa received once-daily ropinirole PR 4, 8, 12, 16 or 24 mg, or placebo, up-titrated for 13 weeks, maintained for 4 weeks. RESULTS: At maintenance period week 4, ropinirole PR significantly reduced total awake 'Off-time' (16 mg; p = 0.027); increased absolute awake time spent 'On' without troublesome dyskinesia from baseline versus placebo (8 mg; p = 0.036); improved Unified Parkinson's Disease Rating Scale motor scores versus placebo (all doses; p = 0.005-0.016). Incidence of adverse events was similar between treatment groups; no dose-related trends were observed. CONCLUSION: Ropinirole PR (16 mg) reduced 'Off-time' with 8 mg the likely lowest maximally effective dose, and the safety profile was consistent with previous studies.

7 Clinical Trial A fixed-dose, dose-response study of ropinirole prolonged release in early stage Parkinson's disease. 2017

Zesiewicz, Theresa A / Chriscoe, Stephen / Jimenez, Theresa / Upward, James / VanMeter, Susan. ·University of South Florida, Tampa, FL, USA. · GlaxoSmithKline, Research Triangle Park, Raleigh-Durham, NC, USA. · GlaxoSmithKline, Stevenage, Hertfordshire, UK. ·Neurodegener Dis Manag · Pubmed #28120629.

ABSTRACT: AIM: This Phase IV, double-blind, randomized, parallel-group study characterized the dose-response and tolerability of fixed doses of ropinirole prolonged release (PR). PATIENTS & METHODS: Subjects with early Parkinson's disease (PD) received placebo or ropinirole PR 2, 4, 8, 12 or 24 mg once daily, up-titrated to randomized or highest tolerated dose, maintained for 4 weeks. RESULTS: The primary end point was not met (change from baseline in Unified PD Rating Scale motor score). However, because the data were not normally distributed, prespecified nonparametric analysis of covariance suggested ropinirole PR (8 and 12 mg/day) was effective in treating motor symptoms. The adverse event profile was consistent with the known safety profile of ropinirole PR. There was no impulse control disorder reported. Although a higher than previously reported rate of sudden onset of sleep events was reported, these were not dose dependent and were likely to have been influenced by the method of data collection. CONCLUSION: The adverse event profile was consistent with the known safety profile of ropinirole PR and ropinirole PR (8 or 12 mg/day) improved motor symptoms of early PD.

8 Article A Randomized Controlled Exploratory Pilot Study to Evaluate the Effect of Rotigotine Transdermal Patch on Parkinson's Disease-Associated Chronic Pain. 2016

Rascol, Olivier / Zesiewicz, Theresa / Chaudhuri, K Ray / Asgharnejad, Mahnaz / Surmann, Erwin / Dohin, Elisabeth / Nilius, Sigrid / Bauer, Lars. ·Clinical Investigation Center CIC1436 and Department of Clinical Pharmacology and Neurosciences, INSERM, Toulouse University Hospital and University of Toulouse, Toulouse, France. · University of South Florida Ataxia Research Center, The Frances J. Zesiewicz Foundation for Parkinson's Disease at USF, Parkinson's Disease and Movement Disorders Clinic at the PADREC, James A. Haley Veterans' Administration, Tampa, FL, USA. · National Parkinson's Foundation International Centre of Excellence, King's College Hospital, Kings College and Kings Health Partners, London, UK. · UCB Pharma, Raleigh, NC, USA. · UCB Pharma, Monheim am Rhein, Germany. · UCB Pharma, Brussels, Belgium. ·J Clin Pharmacol · Pubmed #26626320.

ABSTRACT: Pain is a troublesome nonmotor symptom of Parkinson's disease (PD). This double-blind exploratory pilot study (NCT01744496) was the first to specifically investigate the effect of a dopamine agonist on PD-associated pain as primary outcome. Patients with advanced PD (ie, receiving levodopa) and at least moderate PD-associated chronic pain (≥3 months, ≥4 points on 11-point Likert pain scale) were randomized to rotigotine (optimal/maximum dose ≤16 mg/24h) or placebo and maintained for 12 weeks. Primary efficacy variable was change in pain severity (Likert pain scale) from baseline to end of maintenance. Secondary variables included percentage of responders (≥2-point Likert pain scale reduction), King's PD Pain Scale (KPPS) domains, and PD Questionnaire (PDQ-8). Statistical analyses were exploratory. Of 68 randomized patients, 60 (rotigotine, 30; placebo, 30) were evaluable for efficacy. A numerical improvement in pain was observed in favor of rotigotine (Likert pain scale: least-squares mean [95%CI] treatment difference, -0.76 [-1.87 to 0.34]; P = .172), and proportion of responders was 18/30 (60%) rotigotine vs 14/30 (47%) placebo. An ∼2-fold numerical improvement in KPPS domain "fluctuation-related pain" was observed with rotigotine vs placebo. Rotigotine improved PDQ-8 vs placebo (-8.01 [-15.56 to -0.46]; P = .038). These results suggest rotigotine may improve PD-associated pain; a large-scale confirmatory study is needed.

9 Article Occupational Characteristics and Patterns as Risk Factors for Parkinson's Disease: A Case Control Study. 2015

Sullivan, Kelly L / Mortimer, James A / Wang, Wei / Zesiewicz, Theresa A / Brownlee, H J / Borenstein, Amy R. ·Department of Epidemiology, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, GA, USA. · Department of Epidemiology and Biostatistics, College of Public Health, University of South Florida, Tampa, FL, USA. · Department of Neurology, College of Medicine, University of South Florida, Tampa, FL, USA. · Department of Family Medicine, College of Medicine, University of South Florida, Tampa, FL, USA. ·J Parkinsons Dis · Pubmed #26444091.

ABSTRACT: BACKGROUND: Associations have been reported between the risk of Parkinson's disease (PD) and employment in certain fields. Most studies have focused on toxic exposures as potential causal explanations. However, PD also has been associated with personality characteristics that may influence occupational choices and patterns. OBJECTIVE: This study evaluates the role of personality as indicated by occupational choices and employment patterns in the risk for PD. METHODS: In-person interviews were conducted to assess occupational histories and early-adult personality indicators among 89 PD patients and 99 controls. RESULTS: PD cases had fewer lifetime jobs than controls (mean for cases = 4.38 ± 2.20; mean for controls = 5.00 ± 2.26; p = 0.03). Among women, PD was positively associated with more complex work with people (OR = 1.45, 95% CI 1.12-1.89), representing a 95% increased risk for PD comparing women with the greatest complexity of work with those requiring the least complexity of work with people. Women PD cases also performed less complex work with things compared with controls (OR = 0.69 (95% CI 0.53-0.90)), translating into a 13-fold increased risk for PD among women whose work involved the least complex work with things compared with the most. The numbers of jobs and job types were associated with taking more activity risks as a young-adult (r = 0.19, p = 0.02; r = 0.26, p = 0.001, respectively). CONCLUSIONS: Cases with PD held fewer lifetime jobs compared with controls. Occupational complexity was associated with the risk for PD among women, but not men. Further consideration of the possible influence of personality on occupational choices is warranted.

10 Article Randomized, controlled pilot trial of solifenacin succinate for overactive bladder in Parkinson's disease. 2015

Zesiewicz, Theresa A / Evatt, Marian / Vaughan, Camille P / Jahan, Israt / Singer, Carlos / Ordorica, Raul / Salemi, Jason L / Shaw, Jessica D / Sullivan, Kelly L / Anonymous160825. ·Department of Neurology, University of South Florida, Tampa, FL, USA. Electronic address: tzesiewi@health.usf.edu. · Department of Neurology, Atlanta VA Medical Center and Emory University, Atlanta, GA, USA. · Department of Medicine, Atlanta VA Medical Center and Emory University, Atlanta, GA, USA. · Department of Neurology, University of South Florida, Tampa, FL, USA. · Department of Neurology, University of Miami, Miami, FL, USA. · Department of Urology, University of South Florida, Tampa, FL, USA. · Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX, USA. · Department of Epidemiology, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, GA, USA. ·Parkinsonism Relat Disord · Pubmed #25814050.

ABSTRACT: OBJECTIVE: To evaluate the efficacy of solifenacin succinate in Parkinson's disease (PD) patients suffering from overactive bladder (OAB). BACKGROUND: Urinary dysfunction is a commonly encountered non-motor feature in PD that significantly impacts patient quality of life. DESIGN/METHODS: This was a double-blind, randomized, placebo-controlled, 3-site study with an open label extension phase to determine the efficacy of solifenacin succinate in idiopathic PD patients with OAB. Patients were randomized to receive solifenacin succinate 5-10 mg daily or placebo for 12 weeks followed by an 8-week open label extension. The primary outcome measure was the change in the mean number of micturitions per 24 h period. Secondary outcome measures included the change in the mean number of urinary incontinence episodes and the mean number of nocturia episodes. RESULTS: Twenty-three patients were randomized in the study. There was no significant improvement in the primary outcome measure in the double-blind phase, but there was an improvement in the number of micturitions per 24 h period in the solifenacin succinate group compared to placebo at a mean dose of 6 mg/day (p = 0.01). In the open label phase, the mean number of urinary incontinence episodes per 24 h period decreased (p = 0.03), as did the number of nocturia episodes per 24 h period (p = 0.01). Adverse events included constipation and xerostomia, which resolved after treatment was discontinued. CONCLUSIONS: In this pilot trial, solifenacin succinate treatment led to an improvement in urinary incontinence, despite persistence in other OAB symptoms.

11 Article Rotigotine transdermal system and evaluation of pain in patients with Parkinson's disease: a post hoc analysis of the RECOVER study. 2014

Kassubek, Jan / Chaudhuri, Kallol Ray / Zesiewicz, Theresa / Surmann, Erwin / Boroojerdi, Babak / Moran, Kimberly / Ghys, Liesbet / Trenkwalder, Claudia. ·Department of Neurology, University of Ulm, Oberer Eselsberg 45, 89081 Ulm, Germany. jan.kassubek@uni-ulm.de. ·BMC Neurol · Pubmed #24602411.

ABSTRACT: BACKGROUND: Pain is a troublesome non-motor symptom of Parkinson's disease (PD). The RECOVER (Randomized Evaluation of the 24-hour Coverage: Efficacy of Rotigotine; Clintrials.gov: NCT00474058) study demonstrated significant improvements in early-morning motor function (UPDRS III) and sleep disturbances (PDSS-2) with rotigotine transdermal system. Improvements were also reported on a Likert pain scale (measuring any type of pain). This post hoc analysis of RECOVER further evaluates the effect of rotigotine on pain, and whether improvements in pain may be attributable to benefits in motor function or sleep disturbance. METHODS: PD patients with unsatisfactory early-morning motor impairment were randomized to optimal-dose (up to 16 mg/24 h) rotigotine or placebo, maintained for 4 weeks. Pain was assessed in the early-morning using an 11-point Likert pain scale (rated average severity of pain (of any type) over the preceding 12 hours from 0 [no pain] to 10 [worst pain ever experienced]). Post hoc analyses for patients reporting 'any' pain (pain score ≥1) at baseline, and subgroups reporting 'mild' (score 1-3), and 'moderate-to-severe' pain (score ≥4) were performed. Likert pain scale change from baseline in rotigotine-treated patients was further analyzed based on a UPDRS III/PDSS-2 responder analysis (a responder defined as showing a ≥30% reduction in early morning UPDRS III total score or PDSS-2 total score). As post hoc analyses, all p values presented are exploratory. RESULTS: Of 267 patients with Likert pain data (178 rotigotine, 89 placebo), 187 (70%) reported 'any' pain; of these 87 (33%) reported 'mild', and 100 (37%) 'moderate-to-severe' pain. Change from baseline pain scores decreased with rotigotine compared with placebo in patients with 'any' pain (-0.88 [95% CI: -1.56, -0.19], p = 0.013), and in the subgroup with 'moderate-to-severe' pain (-1.38 [-2.44, -0.31], p = 0.012). UPDRS III or PDSS-2 responders showed greater improvement in pain than non-responders. CONCLUSIONS: The results from this post hoc analysis of the RECOVER study suggest that pain was improved in patients with PD treated with rotigotine; this may be partly attributable to benefits in motor function and sleep disturbances. Prospective studies are warranted to investigate this potential benefit and the clinical relevance of these findings.

12 Article Randomized trial of cognitive speed of processing training in Parkinson disease. 2013

Edwards, Jerri D / Hauser, Robert A / O'Connor, Melissa L / Valdés, Elise G / Zesiewicz, Theresa A / Uc, Ergun Y. ·From the School of Aging Studies (J.D.E., E.G.V.) and Department of Neurology (R.A.H., T.A.Z.), University of South Florida, Tampa · Department of Human Development and Family Science (M.L.O.), North Dakota State University, Fargo · Department of Neurology (E.Y.U.), University of Iowa, Iowa City · and Neurology Service (E.Y.U.), Veterans Affairs Medical Center, Iowa City. ·Neurology · Pubmed #24014503.

ABSTRACT: OBJECTIVE: To examine the efficacy of cognitive speed of processing training (SOPT) among individuals with Parkinson disease (PD). Moderators of SOPT were also examined. METHODS: Eighty-seven adults, 40 years of age or older, with a diagnosis of idiopathic PD in Hoehn & Yahr stages 1-3 and on a stable medication regimen were randomized to either 20 hours of self-administered SOPT (using InSight software) or a no-contact control condition. Participants were assessed at baseline and after 3 months of training (or an equivalent delay). The primary outcome measure was useful field of view test (UFOV) performance, and secondary outcomes included cognitive self-perceptions and depressive symptoms. RESULTS: Results indicated that participants randomized to SOPT experienced significantly greater improvements on UFOV performance relative to controls, Wilks λ = 0.938, F 1,72 = 4.79, p = 0.032, partial η(2) = 0.062. Findings indicated no significant effect of training on secondary outcomes, Wilks λ = 0.987, F2,70 < 1, p = 0.637, partial η(2) = 0.013. CONCLUSIONS: Patients with mild to moderate stage PD can self-administer SOPT and improve their cognitive speed of processing, as indexed by UFOV (a robust predictor of driving performance in aging and PD). Further research should establish if persons with PD experience longitudinal benefits of such training and if improvements translate to benefits in functional activities such as driving. CLASSIFICATION OF EVIDENCE: This study provides Class III evidence that SOPT improves UFOV performance among persons in the mild to moderate stages of PD.

13 Article Placebo-controlled trial of lubiprostone for constipation associated with Parkinson disease. 2012

Ondo, W G / Kenney, C / Sullivan, K / Davidson, A / Hunter, C / Jahan, I / McCombs, A / Miller, A / Zesiewicz, T A. ·Department of Neurology, University of Texas Health Science Center, Houston, TX, USA. William.Ondo@uth.tmc.edu ·Neurology · Pubmed #22573627.

ABSTRACT: OBJECTIVE: To evaluate the efficacy and tolerability of lubiprostone (Amitiza) for constipation in Parkinson disease (PD) in a double-blind, randomized, controlled study. METHODS: Patients with PD and clinically meaningful constipation (constipation rating scale score > 10 [range: 0-28]) were recruited from 2 academic movement disorder centers to participate in the study. After enrollment, patients were initially followed for 2 weeks and then were randomly assigned 1:1 to lubiprostone, and the dose was titrated up to 48 μg/day. They returned 4 weeks later for a final assessment. Data included stool diaries and global impressions (co-primary endpoints), demographics, Unified Parkinson's Disease Rating Scale scores, constipation scale scores, visual analog scale (VAS) scores, a stool diary, and adverse events. RESULTS: Fifty-four subjects (39 male, mean age 67.0 ± 10.1 years, and mean duration of PD 8.3 ± 5.4 years) were randomly assigned to lubiprostone or placebo. One patient in the drug group discontinued the study because of logistics, and one patient in the placebo group discontinued the study because of lack of efficacy. A marked or very marked clinical global improvement was reported by 16 of 25 (64.0%) subjects receiving drug vs 5 of 27 (18.5%) subjects receiving placebo (p = 0.001). The constipation rating scale (p < 0.05), VAS (p = 0.001), and stools per day in the diary (p < 0.001) all improved with drug compared with placebo. Adverse events with drug were mild, most commonly intermittent loose stools. CONCLUSION: In this randomized controlled trial, lubiprostone seemed to be well tolerated and effective for the short-term treatment of constipation in PD.

14 Article Depressive symptoms in Parkinson disease: degree of association and rate of agreement of clinician-based and self-report measures. 2011

Cimino, Cynthia R / Siders, Craig A / Zesiewicz, Theresa A. ·Department of Psychology, University of South Florida, Tampa, FL 33620, USA. cimino@usf.edu ·J Geriatr Psychiatry Neurol · Pubmed #22228826.

ABSTRACT: Depression in Parkinson disease (PD) is associated with faster disease progression, lower activities of daily living, and more severe cognitive impairment. Even mild symptoms of depression may impact outcomes in patients with PD. Nevertheless, a low rate of agreement has been reported between patient and clinician ratings of depression, suggesting that clinicians may underestimate depression in patients with PD. However, to accurately compare the rates of agreement, comparable estimates are needed so that patient and clinician ratings have similar meaning (eg, mild, moderate, severe, etc). The purpose of this study was to examine this question by investigating the degree of association and rate of agreement of levels of symptom severity among self-report and clinician ratings using established cutoffs that correspond to more comparable estimates of these levels for both patient and clinician. Our findings suggest that patient's self-report of depressive symptoms was significantly correlated with clinician-based report irrespective of the stage of disease. Moreover, patients demonstrated a 72% rate of agreement with clinicians in classifying symptoms as asymptomatic, mildly symptomatic, or fully symptomatic, a rate significantly higher than the rate of 35% previously reported. This difference in rate of agreement may be accounted for using varying criteria for severity levels across the studies. Findings suggest that clinician and patient reports show a high rate of agreement across a range of depressive symptoms and that self-report measures may provide a relatively efficient means of detecting depressive symptoms especially if patients are disinclined to initiate their report.

15 Article Clinical vignettes in Parkinson's disease: a collection of unusual medication-induced hallucinations, delusions, and compulsive behaviours. 2011

Friedman, Joseph H / Agarwal, P / Alcalay, R / Black, K J / Chou, K L / Cote, L / Dayalu, P / Frank, S / Hartlein, J / Hauser, R A / Lang, A E / Marsh, L / Marshall, F / Moskowitz, C / Ravina, B / Riley, D / Sanchez-Ramos, J / Simon, D K / Simuni, T / Sutton, J / Tuite, P / Weintraub, D / Zesiewicz, T. ·Department of Neurology, Alpert School of Medicine, Brown University, Providence, Rhode Island 02906, USA. Joseph_friedman@brown.edu ·Int J Neurosci · Pubmed #21663381.

ABSTRACT: Hallucinations, delusions, and compulsive behaviors are frequent iatrogenic complications of the treatment of motor dysfunction in Parkinson's disease (PD). Although these have been studied, and the phenomenology described, there are few detailed descriptions of the various psychiatric problems our treated PD patients live with that allow physicians who do not have a great deal of experience with PD patients to appreciate the extent of their altered lives. This report is a compilation of vignettes describing these behavioral problems that the treating neurologist or psychiatrist attributed to the medications used for treating PD.

16 Article Quantitative analysis of tremors in welders. 2011

Sanchez-Ramos, Juan / Reimer, Dacy / Zesiewicz, Theresa / Sullivan, Kelly / Nausieda, Paul A. ·College of Medicine, University of South Florida, Tampa, FL 33612, USA. jsramos@health.usf.edu ·Int J Environ Res Public Health · Pubmed #21655131.

ABSTRACT: BACKGROUND: Workers chronically exposed to manganese in welding fumes may develop an extra-pyramidal syndrome with postural and action tremors. OBJECTIVES: To determine the utility of tremor analysis in distinguishing tremors among workers exposed to welding fumes, patients with Idiopathic Parkinson's Disease (IPD) and Essential Tremor (ET). METHODS: Retrospective study of recorded tremor in subjects from academic Movement Disorders Clinics and Welders. Quantitative tremor analysis was performed and associated with clinical status. RESULTS: Postural tremor intensity was increased in Welders and ET and was associated with visibly greater amplitude of tremor with arms extended. Mean center frequencies (Cf) of welders and patients with ET were significantly higher than the mean Cf of PD subjects. Although both the welders and the ET group exhibited a higher Cf with arms extended, welders could be distinguished from the ET subjects by a significantly lower Cf of the rest tremor than that measured in ET subjects. CONCLUSIONS: In the context of an appropriate exposure history and neurological examination, tremor analysis may be useful in the diagnosis of manganese-related extra-pyramidal manifestations.

17 Article Delayed clinical improvement after deep brain stimulation-related subdural hematoma. Report of 4 cases. 2011

Oyama, Genko / Okun, Michael S / Zesiewicz, Theresa A / Tamse, Tiffany / Romrell, Janet / Zeilman, Pamela / Foote, Kelly D. ·Department of Neurology, University of Florida Movement Disorders Center, Gainesville, USA. ·J Neurosurg · Pubmed #21476805.

ABSTRACT: OBJECT: The purpose of this paper is to present 4 cases that illustrate the management and outcome of subdural hematoma (SDH) following deep brain stimulation (DBS) lead implantation. METHODS: The authors identified 4 cases of SDH following DBS lead implantation from a pool of 500 consecutive lead implantations (incidence 0.08%) performed at the University of Florida. Cases were characterized by chart review, serial Unified Parkinson's Disease Rating Scale evaluations, and changes on serial postoperative imaging studies. RESULTS: Two of the 4 patients with DBS-related SDH were clinically symptomatic. In the other 2 cases the SDH was incidentally discovered on routine postoperative lead localization imaging studies. None of the patients required craniotomy for evacuation of the SDH in the acute phase. Three of the 4 cases were managed with bur hole drainage in the chronic phase, and one was successfully managed nonoperatively. In all 4 cases, thresholds for stimulationinduced side effects were lower during initial postoperative programming than during intraoperative macrostimulation. Expected clinical improvement from DBS was achieved without lead revision in all 4 cases, but only after a significant delay. CONCLUSIONS: Subdural hematoma is a rare and potentially avoidable complication of DBS that does not typically mandate acute hematoma evacuation or hardware revision and does not preclude an excellent outcome from DBS therapy. The clinical picture and apparent lead position tend to improve with time, and it may be wise to delay repositioning of an ineffective DBS lead following a hemorrhage until the DBS lead and surrounding brain tissue have settled into their final position and the insulted brain has had sufficient time to recover.

18 Minor Parkinson disease: the controversy of levodopa toxicity in Parkinson disease. 2011

Zesiewicz, Theresa A. · ·Nat Rev Neurol · Pubmed #22198404.

ABSTRACT: -- No abstract --