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Malattia di Parkinson Diagnosi differenziale. Cholinergic and adrenergic nerves Autonomic reflex pathways.

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Presentation on theme: "Malattia di Parkinson Diagnosi differenziale. Cholinergic and adrenergic nerves Autonomic reflex pathways."— Presentation transcript:

1 Malattia di Parkinson Diagnosi differenziale

2 Cholinergic and adrenergic nerves Autonomic reflex pathways

3 Innervation of the heartAutonomic nerves and ganglia in the pelvis

4 Malattia di Parkinson Genetica

5 Loci and genes linked to familial PD LocusLocationGeneInheritance PARK14p21.3 -Synuclein AD PARK26q25.2-27ParkinAR PARK32p13AD PARK44p15AD PARK54p14UCH-L1AD PARK61p35-p36PINK1AR PARK71p36DJ-1AR PARK812p11.2- q13.1 DardarinAD PARK91p36AR (Kufor-Rakeb syndrome) PARK 101p32 Late-onset susceptibility gene

6 The Marsala kindred

7 Malattia di Parkinson Neurostimolazione

8 Moro et al. 1999 Methods Surgical procedure Surgery performed in the practically defined off condition Talairachs stereotactic frame modified for a polar approach. Ventriculography Bilateral implant of a Medtronic 3389 lead 3389

9 Romito et al. 2002 Bilateral STN implant LEDD reduction at 24 months: -62.9%

10 Romito et a. 2002 Bilateral STN implant Levodopa equivalent daily doseMean ±SD Before surgery1505.5 ±722.8 Last available visit491.7 ±325.4 Variation-69.3%

11 Romito et a. 2002 Bilateral STN implant UPDRS-IIIBaseline12 monthsLast visit UPDRS II31.6 ±5.910.1 ±6.1 -68.1% 10.0 ±6.3 -68.4% Schwab & England 24.5 ±14.483.6 ±12.980.0 ±14.1 UPDRS-III60.2 ±9.330.8 ±13.7 -48.8% 29.9 ±12.5 -50.2% LEDD1505.9 ±722.8468.3 ±294.2 -68.3% 491.7 ±325.4 -69.3% Hoehn & Yahr4.3 ±0.82.1 ±1.1 -51.1% 1.9 ±0.9 -55.9% Energy ( W) 1.56 ±0.51.53 ±0.5 Patients22

12 Distonia Neurostimolazione

13 ab cd A patient with generalized dystonia and prominent axial involvement is shown before (a, b) and 6 months after implant with high frequency stimulation implant in the GPi (c, d). The improvement in posture and gait is evident from these still frames taken from video clips (courtesy of Dr. Nardocci).


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