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  1. Hi! Has anybody tried TMS? How do you feel it? just find this article Abstract OBJECTIVE: Several studies have reported repetitive transcranial magnetic stimulation (rTMS) therapy as an effective treatment for the control of motor symptoms in Parkinson disease. The objective of the study is to quantify the overall efficacy of this treatment. TYPES: Systematic review and meta-analysis. LITERATURE SURVEY: We reviewed the literature on clinical rTMS trials in Parkinson disease since the technique was introduced in 1980. We used the following databases: MEDLINE, Web of Science, Cochrane, and CINAHL PATIENTS AND SETTING: Patients with Parkinson disease who were participating in prospective clinical trials that included an active arm and a control arm and change in motor scores on Unified Parkinson's Disease Rating Scale as the primary outcome. We pooled data from 21 studies that met these criteria. We then analyzed separately the effects of low- and high-frequency rTMS on clinical motor improvements. SYNTHESIS: The overall pooled mean difference between treatment and control groups in the Unified Parkinson's Disease Rating Scale motor score was significant (4.0 points, 95% confidence interval, 1.5, 6.7; P = .005). rTMS therapy was effective when low-frequency stimulation (≤ 1 Hz) was used with a pooled mean difference of 3.3 points (95% confidence interval 1.6, 5.0; P = .005). There was a trend for significance when high-frequency stimulation (≥ 5 Hz) studies were evaluated with a pooled mean difference of 3.9 points (95% confidence interval, -0.7, 8.5; P = .08). rTMS therapy demonstrated benefits at short-term follow-up (immediately after a treatment protocol) with a pooled mean difference of 3.4 points (95% confidence interval, 0.3, 6.6; P = .03) as well as at long-term follow-up (average follow-up 6 weeks) with mean difference of 4.1 points (95% confidence interval, -0.15, 8.4; P = .05). There were insufficient data to statistically analyze the effects of rTMS when we specifically examined bradykinesia, gait, and levodopa-induced dyskinesia using quantitative methods. CONCLUSION: rTMS therapy in patients with Parkinson disease results in mild-to-moderate motor improvements and has the potential to be used as an adjunct therapy for the treatment of Parkinson disease. Future large, sample studies should be designed to isolate the specific clinical features of Parkinson disease that respond well to rTMS therapy. Copyright © 2016 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.
  2. FDA NEWS RELEASE I know this topic has come up many times in many conversations. Well now it looks like we may have answer. This comes right from the FDA website! For Immediate Release: Feb. 18, 2014 Media Inquiries: Sandy Walsh, 301-796-4669,sandy.walsh@fda.hhs.gov Consumer Inquiries: 888-INFO-FDA FDA approves Northera to treat neurogenic orthostatic hypotension The U.S. Food and Drug Administration today approved Northera capsules (droxidopa) for the treatment of neurogenic orthostatic hypotension (NOH). NOH is a rare, chronic and often debilitating drop in blood pressure upon standing that is associated with Parkinson's disease, multiple-system atrophy, and pure autonomic failure. Symptoms of NOH include dizziness, lightheadedness, blurred vision, fatigue and fainting when a person stands. “People with neurogenic orthostatic hypotension are often severely limited in their ability to perform routine daily activities that require walking or standing,” said Norman Stockbridge, M.D., Ph.D, director of the Division of Cardiovascular and Renal Drugs in the FDA’s Center for Drug Evaluation and Research. “There are limited treatment options for people with NOH and we are committed to helping make safe and effective treatments available.” The FDA is approving Northera under the accelerated approval program, which allows for approval of a drug to treat a serious disease based on clinical data showing that the drug has an effect on an intermediate clinical measure (in this case, short-term relief of dizziness) that is reasonably likely to predict the outcome of ultimate interest (relief of dizziness during chronic treatment). This program provides patient access to promising drugs while the company conducts post-approval clinical trials to verify the drug’s clinical benefit, which for this approval is a long-term effect on patient symptoms in NOH, a chronic disease. Northera has a boxed warning to alert health care professionals and patients about the risk of increased blood pressure while lying down (supine hypertension), a common problem that affects people with primary autonomic failure and can cause stroke. It is essential that patients be reminded that they must sleep with their head and upper body elevated. Supine blood pressure should be monitored prior to and during treatment and more frequently when increasing doses. The most common adverse events reported by clinical trial participants taking Northera were headache, dizziness, nausea, high blood pressure (hypertension) and fatigue. The effectiveness of Northera was shown through two-weeks in two clinical trials in people with NOH. People taking Northera reported a decrease in dizziness, lightheadedness, feeling faint, or feeling as if they might black out compared to those taking an inactive pill (placebo). Durability of the improvement in patient symptoms beyond two weeks has not been demonstrated. Northera received orphan-product designation from the FDA because it is intended to treat a rare disease or condition. Northera is made by Charlotte-based Chelsea Therapeutics Inc. For more information: FDA: Approved Drugs FDA: Drug Innovation National Institute of Neurological Disorders and Stroke: Orthostatic Hypotension The FDA, an agency within the U.S. Department of Health and Human Services, protects the public health by assuring the safety, effectiveness, and security of human and veterinary drugs, vaccines and other biological products for human use, and medical devices. The agency also is responsible for the safety and security of our nation's food supply, cosmetics, dietary supplements, products that give off electronic radiation, and for regulating tobacco products. # # # Read our Blog: FDA Voice Visit the FDA on Facebook , Flickr ,YouTube , and Twitter RSS Feed for FDA News Releases
  3. Speech and voice characteristics typically associated with PD include reduced loudness, hoarse voice quality, monotone, imprecise articulation, and vocal tremor. The underlying physiology of these perceptual characteristics is partly attributable to: Bowed vocal folds (Baker et al., 1998; Smith et al., 1995) Low amplitude desynchronized muscle activity as measured by EMG (Luschei et al., 1999) Decreased coordination of respiration and phonation and decreased respiratory support for speech (Stathopolous, 1993) Small mouth opening (Ho, A.K., Iansek, R., & Bradshaw, J.L. 1999) Hypokinesia and bradykinesia of speech muscles that can compromise articulation This means that people with PD are typically significantly quieter than their age-matched peers (Fox & Ramig, 1997). This study found that not only are people with PD quieter, they are also less likely to initiate conversation and are not understood as clearly as their peers. Sensory deficits associated with PD also contribute to changes in speech. Sensory deficits in PD include problems with internal cueing and self-perception of performance that is evidenced in walking, writing, posture, and speaking (Ho, Bradshaw, Iansek, & Alfredson 1999; Ho, Iansek & Bradshaw, 2000). When a person with PD speaks at normal loudness they may "feel" that they are being loud or shouting but they are only being trained to speak at normal loudness. Motor and sensory deficits need to be addressed in treatment for long-term carryover to functional communication (Fox et al., 2002; Ramig et al., 2002; Sapir et al., 2011).
  4. Medical treatments to improve the symptoms of PD include pharmacological management and more recently, neurosurgical procedures such as the placement of an electrical stimulator in globus pallidus or subthalamic nucleus. Although there have been documented improvements in limb and axial symptoms with medical treatments, the improvement in speech has not been documented as consistently. The consensus is that medical management has a more positive outcome for limb movement than speech function (Kompoliti, Wang, Goetz, Leurgans, & Raman, 2000; Trail, Fox, Ramig, Sapir, Howard & Lai, 2005). Therefore, there is a strong need for people with PD to receive efficacious behavioral treatment from a speech-language pathologist to improve speech. The selection of any speech treatment should be based on the results of an individual evaluation. Specifically, stimulability testing of the impact of different treatment strategies on voice and speech characteristics will determine which treatment approach is most appropriate for a given individual. The treatment chosen should include principles of motor learning such as intensity of treatment and using salient (meaningful) materials in real speech tasks for treatment benefits to last. If you or a family member or friend have noticed a change in your speech then talk to your doctor about getting an evaluation from a speech-language pathologist. You will learn about your individual situation and can use this information to decide which treatment is right for you. Sincerely, Leslie Mahler, PhD, CCC-SLP