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Parkinsons sjukdom

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Sakkunnig:
Definition:
Degenerativ sjukdom i hjärnan som bland annat drabbar substantia nigra med gradvis utveckling av symtom på dopaminbrist
Förekomst:
Prevalens är ca 1% i åldersgruppen 50–70 år, något högre bland personer över 70 år
Symtom:
Kardinalsymtom är vilotremor, rigiditet, hypo/bradykinesi och postural instabilitet
Kliniska fynd:
Centrala kliniska fynd är vilotremor, rigiditet, hypo/bradykinesi och postural instabilitet. Ofta unilateral symtomdebut.
Diagnostik:
Diagnos ställs på typisk klinisk bild, tilläggsundersökningar kan göras för att utesluta andra sjukdomar.
Behandling:
Läkemedelsbehandling är levodopa, COMT-hämmare, MAO-B-hämmare och/eller dopaminagonist. 
  1. Terapiråd vid utredning och behandlign av Parkinsons sjudkom, SweModis, v 6 2013,
  2. Konsensusdokument från ScandModis (från danska, norska och svenska movement disordersorganisationerna) om indikation och bruk av apomorfin, levodopagel, och djup elektrod stimulering
  3. Gazewood JD, Richards DR, Clebak K. Parkinson disease: an update. Am Fam Physician 2013; 87: 267-73. American Family Physician  
  4. Läkmedelsboken 2013-2014 - Parknsons sjukdom,
  5. Behandlingsrekommendation vid Parkinsons sjukdom, Läkemedelsveket, 2007, lakemedelsverket.se  
  6. de Rijk MC, Launer LJ, Berger K, et al. Prevalence of Parkinson's disease in Europe: a collaborative study of population-based cohorts. Neurology 2000; 54 :(11 suppl 5) S21-23.
  7. Golbe LI. Young-onset Parkinson's disease: a clinical review. Neurology 1991; 41: 168-73. Neurology  
  8. Inzelberg R, Schechtman E, Paleacu D. Onset age of Parkinson disease. Am J Med Genet 2002; 111: 459-60. PubMed  
  9. Baldereschi M, Di Carlo A, Rocca WA, et al. Parkinson's disease and parkinsonism in a longitudinal study: two-fold higher incidence in men. Neurology 2000; 55: 1358-63. Neurology  
  10. Hughes AJ, Daniel SE, Blankson S, Lees AJ. A clinico-pathologic study of 100 cases of Parkinson's disease. Arch Neurol 1993; 50: 140-8. PubMed  
  11. Steece-Collier K, Maries E, Kordower JH. Etiology of Parkinson's disease: Genetics and environment revisited. Proc Natl Acad Sci USA 2002; 99: 13972-74. PubMed  
  12. Braak H, Del Tredici K, Rub U, de Vos RA, Jansen Steur EN, Braak E. Staging of brain pathology related to sporadic Parkinson's disease. Neurobiol Aging 2003; 24: 197-211. PubMed  
  13. de Lau LM, Schipper CM, Hofman A, Koudstaal PJ, Breteler MM. Prognosis of Parkinson disease: risk of dementia and mortality: the Rotterdam Study. Arch Neurol 2005; 62: 1265-69. PubMed  
  14. Payami H, Larsen K, Bernard S, Nutt J. Increased risk of Parkinson's disease in parents and siblings of patients. Ann Neurol 1994; 36: 659-61. PubMed  
  15. Healy DG, Abou-Sleiman PM, Wood NW. PINK, PANK, or PARK? A clinicians' guide to familial parkinsonism. Lancet Neurol 2004; 3: 652-62. PubMed  
  16. Lucking CB, Durr A, Bonifati V, Vaughan J, et al. Association between Early-onset Parkinson's disease and mutations in the parkin gene. N Engl J Med 2000; 342: 1560-7. New England Journal of Medicine  
  17. Sidransky E, Nalls MA, Aasly JO, et al. Multicenter analysis of glucocerebrosidase mutations in Parkinson's disease. N Engl J Med 2009; 361: 1651-61. New England Journal of Medicine  
  18. Schwarzschild MA, Schwid SR, Marek K et al. Serum Urate as a Predictor of Clinical and Radiographic Progression in Parkinson Disease. Arch Neurol 2008; 65: 716-23. PMID: 18413464. PubMed  
  19. Marder K, Tang M, Mejia H, et al. Risk of Parkinson's disease among first degree relatives: a community based study. Neurology 1996; 47: 155-60. Neurology  
  20. Jarman P, Wood N. Parkinson's disease genetics comes of age. BMJ 1999; 318: 1641-2. British Medical Journal  
  21. Hernan MA, Takkouche B, Caamano-Isorna F, Gestal-Otero JJ. A meta-analysis of coffee drinking, cigarette smoking, and the risk of Parkinson's disease. Ann Neurol 2002; 52: 276-84. PubMed  
  22. Bower JH, Maraganore DM, McDonnell SK, Rocca WA. Incidence and distribution of parkinsonism in Olmsted County, Minnesota, 1976-1990. Neurology 1999; 52: 1214-20. Neurology  
  23. Hughes AJ, Daniel SE, Kilford L, Lees AJ. Accuracy of clinical diagnosis of Parkinson's disease: a clinico-pathological study of 100 cases. J Neurol Neurosurg Psychiatry 1992; 55: 181-4. PubMed  
  24. Gelb DJ, Oliver G, Gilman S. Diagnostic criteria for Parkinson's disease. Arch Neurol 1999; 56: 33-9. PubMed  
  25. Jost WH. Autonomic dysfunctions in idiopathic Parkinson's disease. J Neurol 2003; 250 :(suppl 1) I28-30.
  26. Scott BM, Eisinger RS, Burns MR, et al. Co-occurrence of apathy and impulse control disorders in Parkinson disease. Neurology. 2020;95(20):e2769-e2780. PMID: 33004605 PubMed  
  27. Martinez-Martin P, Gil-Nagel A, Gracia LM, Gomez JB, Martinez-Sarries J, Bermejo F. Unified Parkinson's Disease Rating Scale characteristics and structure. Mov Disord 1994; 9: 76-83. PubMed  
  28. Nationella riktlinjer för vård vid multipel skleros och Parkinsons sjukdom – Stöd för styrning och ledning. Socialstyrelsen 2016. www.socialstyrelsen.se  
  29. Demirkiran M, Bozdemir H, Sarica Y. Vascular parkinsonism: a distinct, heterogeneous clinical entity. Acta Neurol Scand 2001; 104: 63-67. PubMed  
  30. Marek K, Seibyl J, Eberly S, Oakes D, Shoulson I, Lang AE, Hyson C, Jennings D; Parkinson Study Group PRECEPT Investigators. Longitudinal follow-up of SWEDD subjects in the PRECEPT Study. Neurology 2014; 82: 1791-7. pmid:24759846 PubMed  
  31. Toft M, Aasly J. Genetikk ved Parkinsons sykdom. Tidsskr Nor Lægeforen 2004; 124: 922-4. PMID: 15060636. PubMed  
  32. Muzerengi S, Clarke C. Initial drug treatment in Parkinson’s disease. BMJ 2015; 351: H4669. pmid:26385603 PubMed  
  33. Rascol O, Goetz C, Koller W, Poewe W, Sampaio C. Treatment interventions for Parkinson's disease: an evidence based assessment. Lancet 2002; 359: 1589-98. PubMed  
  34. Tambosco L, Percebois-Macadré L, Rapin A, et al. Effort training in Parkinson's disease: a systematic review. Ann Phys Rehabil Med. 2014 Mar;57(2):79-104. pmid: 24582335. PubMed  
  35. Uhrbrand A, Stenager E, Pedersen MS, et al. Parkinson's disease and intensive exercise therapy - a systematic review and meta-analysis of randomized controlled trials. J Neurol Sci. 2015; 353(1-2): 9-19. pmid:25936252. PubMed  
  36. Chung CL, Thilarajah S, Tan D. Effectiveness of resistance training on muscle strength and physical function in people with Parkinson's disease: a systematic review and meta-analysis. Clin Rehabil. 2016 Jan;30(1):11-23. pmid: 25691582. PubMed  
  37. Roeder L, Costello JT, Smith SS, et al. Effects of Resistance Training on Measures of Muscular Strength in People with Parkinson's Disease: A Systematic Review and Meta-Analysis. PLoS One 2015. pmid:26146840. PubMed  
  38. Shu HF1, Yang T1, Yu SX1, et al. Aerobic exercise for Parkinson's disease: a systematic review and meta-analysis of randomized controlled trials. PLoS One. 2014 Jul 1;9(7):e100503. PMID: 24983753. PubMed  
  39. Mehrholz J1, Kugler J, Storch A, et al.. Treadmill training for patients with Parkinson's disease.. Cochrane Database Syst Rev. 2015. pmid:26297797 PubMed  
  40. Pincus JH, Barry K. Protein redistribution diet restores motor function in patients with dopa-resistant "off" periods. Neurology 1988; 38: 481-3. Neurology  
  41. Connolly BS, Lang AE. Pharmacological treatment of Parkinson disease: a review. JAMA. 2014 Apr 23-30;311(16):1670-83. doi: 10.1001/jama.2014.3654. DOI  
  42. Nutt JG. Motor fluctuations and dyskinesia in Parkinson's disease. Parkinsonism Relat Disord 2001; 8: 101-08.
  43. Hely MA, Morris JG, Reid WG, et al. The Sydney Multicentre Study of Parkinson's disease: a randomised, prospective five year study comparing low dose bromocriptine with low dose levodopa-carbidopa. J Neurol Neurosurg Psychiatry 1994; 57: 903-10. PubMed  
  44. Koller WC, Hutton JT, Tolosa E, Capilldeo R. Immediate- release and controlled-release carbidopa/levodopa in PD: a 5-year randomized multicenter study. Neurology 1999; 53: 1012-19. Neurology  
  45. Schrag A, Ben-Shlomo Y, Brown R, Marsden CD, Quinn N. Young-onset Parkinson's disease revisited--clinical features, natural history, and mortality. Mov Disord 1998; 13: 885-94. PubMed  
  46. Luquin MR, Scipioni O, Vaamonde J, Gershanik O, Obeso JA. Levodopa-induced dyskinesias in Parkinson's disease: clinical and pharmacological classification. Mov Disord 1992; 7: 117-24. PubMed  
  47. Hiort YH, Pedersen KF, Dalen I, et al. Orthostatic hypotension in Parkinson disease A 7-year prospective population-based study. Neurology 2019; 93: 1526-34. pmid:31527282. www.ncbi.nlm.nih.gov  
  48. Young R. Update on Parkinson`s Disease. American Family Physician, april 1999.
  49. Etminan M, Gill S, Samii A. Comparison of the risk of adverse events with pramipexole and ropinirole in patients with Parkinson's disease: a meta-analysis. Drug Saf 2003; 26: 439-44. PubMed  
  50. Etminan M, Samii A, Takkouche B, Rochon PA. Increased risk of somnolence with the new dopamine agonists in patients with Parkinson's disease: a meta-analysis of randomised controlled trials. Drug Saf 2001; 24: 863-8. PubMed  
  51. Weintraub D, Mavandadi S, Mamikonyan E, et al. Atomoxetine for depression and other neuropsychiatric symptoms in Parkinson disease. Neurology 2010; 75: 448-55. Neurology  
  52. Stacy M. Sleep disorders in Parkinson's disease: epidemiology and management. Drugs Aging 2002; 19: 733-39. PubMed  
  53. Adler CH, Caviness JN, Hentz JG, Lind M, Tiede J. Randomized trial of modafinil for treating subjective daytime sleepiness in patients with Parkinson's disease. Mov Disord 2003; 18: 287-93. PubMed  
  54. Olson EJ, Boeve BF, Silber MH. Rapid eye movement sleep behaviour disorder: demographic, clinical and laboratory findings in 93 cases. Brain 2000; 123: 331-39. PubMed  
  55. Emre M, Aarsland D, Albanese A et al. Rivastigmine for dementia associated with Parkinson's disease. N Engl J Med 2004; 351: 2509-18. New England Journal of Medicine  
  56. Pagano G, Rengo G, Pasqualetti G, et al. Cholinesterase inhibitors for Parkinson's disease: a systematic review and meta-analysis. J Neurol Neurosurg Psychiatry. 2015 Jul;86(7):767-73. doi: 10.1136/jnnp-2014-308764. DOI  
  57. Arenas E. Stem cells in the treatment of Parkinson's disease. Brain Res Bull 2002; 57: 795-808. PubMed  
  58. Bankiewicz KS, Forsayeth J, Eberling JL, et al. Long-term clinical improvement in MPTP-lesioned primates after gene therapy with AAV-hAADC. Mol Ther 2006; 14: 564-70. PubMed  
  59. Pardridge WM. Tyrosine hydroxylase replacement in experimental Parkinson's disease with transvascular gene therapy. NeuroRx 2005; 2: 129-38. PubMed  
  60. Kordower JH, Herzog CD, Dass B, et al. Delivery of neurturin by AAV2 (CERE-120)-mediated gene transfer provides structural and functional neuroprotection and neurorestoration in MPTP-treated monkeys. Ann Neurol 2006; 60: 706-15. PubMed  
  61. Lo Bianco C, Schneider BL, Bauer M, et al. Lentiviral vector delivery of parkin prevents dopaminergic degeneration in an alpha-synuclein rat model of Parkinson's disease. Proc Natl Acad Sci USA 2004; 101: 17510-5. PubMed  
  62. DeLong MR, Wichmann T. Basal Ganglia Circuits as Targets for Neuromodulation in Parkinson Disease. JAMA Neurol. 2015. pmid:26409114 PubMed  
  63. Deep-brain stimulation of the subthalamic nucleus or the pars interna of the globus pallidus in Parkinson's disease. N Engl J Med 2001; 345: 956-63. New England Journal of Medicine  
  64. Krack P, Batir A, Van Blercom N, Chabardes S, Fraix V, Ardouin C et al. Five-year follow-up of bilateral stimulation of the subthalamic nucleus in advanced Parkinson's disease. N Engl J Med 2003; 349: 1925 - 34. New England Journal of Medicine  
  65. Saint-Cyr JA, Trepanier LL, Kumar R, Lozano AM, Lang AE. Neuropsychological consequences of chronic bilateral stimulation of the subthalamic nucleus in Parkinson's disease. Brain 2000; 123: 2091-108. PubMed  
  66. Beric A, Kelly PJ, Rezai A, et al. Complications of deep brain stimulation surgery. Stereotact Funct Neurosurg 2001; 77: 73-78. PubMed  
  67. Pena JIbarretxe-Bilbao NGarcia-Gorostiaga I, et al. Improving functional disability and cognition in Parkinson disease: Randomized controlled trial. Neurology. 2014 Oct 31. pii: 10.1212/WNL.0000000000001043 .
  68. Leung IH, Walton CC, Hallock H, Lewis SJ, Valenzuela M, Lampit A. Cognitive training in Parkinson disease: A systematic review and meta-analysis. Neurology. 2015 Oct 30. pii: 10.1212/WNL.0000000000002145 . pmid: 26519540 PubMed  
  69. Leung IH, Walton CC, Hallock H, et al. Cognitive training in Parkinson disease: A systematic review and meta-analysis. 2015. pmid:26519540 PubMed  
  70. Buter TC, van den Hout A, Matthews FE, Larsen JP, Brayne C, Aarsland D. Dementia and survival in Parkinson disease: a 12-year population study. Neurology 2008; 70: 1017-22. Neurology  
  71. Parkinson Study Group. Mortality in DATATOP: a multicenter trial in early Parkinson's disease. Ann Neurol 1998; 43: 318-25. PubMed  
  72. Hely MA, Morris JGL, Traficante R, et al. The Sydney multicentre study of Parkinson's disease: progression and mortality at 10 years. J Neurol Neurosurg Psychiatry 1999; 67: 300-7. PubMed  
  • Håkan Widner, adj professor och överläkare, Neurologiska kliniken, Skånes universitetssjukhus
  • Anna Nager, med dr och specialist i allmänmedicin, Karolinska institutet
  • Peter D. Jost, spesialist i allmennmedisin, redaktør NEL, Trondheim