1.7% of 65+ Chinese have Parkinson Disease, accounting for half of the world’s 200 million PD patients

Posted on January 6, 2013 by Maurice Preter MD

我国每百名老人有1人患帕金森病

胡浩, 新华网


2012年4月16日

中国

今 年４月１１日是第１６个世界帕金森日。在１４日举行的“健康小屋关爱行动”中，专家指出， 我国的帕金森患者已达２００万，占全国老年人口的１％。为进一步提高帕金森病患者及其家人 的生活质量，专家建议在帕金森病患者和家庭中间推广正确的疾病管理知识和健康的生活方式， 为帕金森病患者营造一个安全舒适的家居环境。

北京协和医院神经科主任张振馨教授介绍，中国内地１．７％的６５岁以上老年人深受帕金森病 的困扰。最新的流行病学调查显示，中国大陆地区的帕金森病患者已达２００万，占全球帕金森 病患者总人数的一半。此外，临床数据显示，帕金森病正以每年１０万新增病例的速度在我国递 增，成为继心脑血管疾病和老年痴呆症后严重威胁我国中老年人身心健康的“第三杀手”。

帕金森病是一种中老年人常见的中枢神经系统变性疾病，主要影响中老年人，多在５０岁以后发 病。其运动症状表现为静止时肢体不自主地震颤、肌强直、运动迟缓以及姿势平衡障碍等，晚期 会导致患者生活不能自理。

由于行动迟缓及平衡障碍，帕金森病患者较常人更容易跌倒骨折，所以安全舒适的居家环境对帕 金森患者非常重要。

中华医学会北京神经病学分会帕金森病及运动障碍学组组长、卫生部北京医院神经内科主任陈海 波建议，为帕金森病患者营造“健康小屋”，即通过对起居室、厨房，卧室和浴室等家具设计和 摆放等生活环境中的细节改善，如采用杠杆式的门把手、选择不容易绊倒的轻便的整块地毯、将 卧床紧贴墙壁等，方便帕金森病患者的生活。

他还建议，为便于帕金森病患者起身和落座，椅子和沙发坐垫不宜过软，高度不宜过低。家具在 选择时应选择边角为圆钝弧形，以免患者跌倒受伤。

Posted in Aging, China, Fifth Avenue Concierge Medicine, Health, keto, Psychiatry/Neurology | Tagged , , , |

JAMA Network | JAMA | Association Between Use of Interferon Beta and Progression of Disability in Patients With Relapsing-Remitting Multiple Sclerosis

Posted on January 1, 2013 by Maurice Preter MD

Association Between Use of Interferon Beta and Progression of Disability in Patients With Relapsing-Remitting Multiple Sclerosis

Afsaneh Shirani, MD; Yinshan Zhao, PhD; Mohammad Ehsanul Karim, MSc; Charity Evans, PhD; Elaine Kingwell, PhD; Mia L. van der Kop, MSc; Joel Oger, MD, FRCPC; Paul Gustafson, PhD; John Petkau, PhD; Helen Tremlett, PhD

[+] Author Affiliations

JAMA. 2012;308(3):247-256. doi:10.1001/jama.2012.7625.

Context Interferon beta is widely prescribed to treat multiple sclerosis (MS); however, its relationship with disability progression has yet to be established.

Objective To investigate the association between interferon beta exposure and disability progression in patients with relapsing-remitting MS.

Design, Setting, and Patients Retrospective cohort study based on prospectively collected data (1985-2008) from British Columbia, Canada. Patients with relapsing-remitting MS treated with interferon beta (n = 868) were compared with untreated contemporary (n = 829) and historical (n = 959) cohorts.

Main Outcome Measures The main outcome measure was time from interferon beta treatment eligibility (baseline) to a confirmed and sustained score of 6 (requiring a cane to walk 100 m; confirmed at >150 days with no measurable improvement) on the Expanded Disability Status Scale (EDSS) (range, 0-10, with higher scores indicating higher disability). A multivariable Cox regression model with interferon beta treatment included as a time-varying covariate was used to assess the hazard of disease progression associated with interferon beta treatment. Analyses also included propensity score adjustment to address confounding by indication.

Results The median active follow-up times (first to last EDSS measurement) were as follows: for the interferon beta–treated cohort, 5.1 years (interquartile range [IQR], 3.0-7.0 years); for the contemporary control cohort, 4.0 years (IQR, 2.1-6.4 years); and for the historical control cohort, 10.8 years (IQR, 6.3-14.7 years). The observed outcome rates for reaching a sustained EDSS score of 6 were 10.8%, 5.3%, and 23.1% in the 3 cohorts, respectively. After adjustment for potential baseline confounders (sex, age, disease duration, and EDSS score), exposure to interferon beta was not associated with a statistically significant difference in the hazard of reaching an EDSS score of 6 when either the contemporary control cohort (hazard ratio, 1.30; 95% CI, 0.92-1.83; P = .14) or the historical control cohort (hazard ratio, 0.77; 95% CI, 0.58-1.02; P = .07) were considered. Further adjustment for comorbidities and socioeconomic status, where possible, did not change interpretations, and propensity score adjustment did not substantially change the results.

Conclusion Among patients with relapsing-remitting MS, administration of interferon beta was not associated with a reduction in progression of disability.

via JAMA Network | JAMA | Association Between Use of Interferon Beta and Progression of Disability in Patients With Relapsing-Remitting Multiple Sclerosis.

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Increase in multiple sclerosis activity after assisted reproduction technology – Correale – 2012 – Annals of Neurology – Wiley Online Library

Posted on January 1, 2013 by Maurice Preter MD

Increase in multiple sclerosis activity after assisted reproduction technology

Abstract

Objective:

Our objective was to evaluate risk of exacerbations in multiple sclerosis (MS) patients undergoing assisted reproduction technology (ART) infertility treatment.

Methods:

Sixteen patients with relapsing–remitting MS subjected to 26 ART treatment cycles receiving gonadotropin-releasing hormone (GnRH) agonists and recombinant follicle-stimulating hormone were studied prospectively. The baseline study period encompassed 12 months prior to the first cycle and 9 months after final ART cycle. Neurological examinations, brain magnetic resonance imaging (MRI), and immunology testing were conducted every 3 months. Anti–myelin-oligodendrocyte glycoprotein (MOG) antibody production, interleukin (IL)-4, IL-8, IL-10, IL-12, IL-17, interferon (IFN)-γ, and transforming growth factor (TGF)-β secretion by myelin basic protein- and MOG-peptide–specific T cells, as well as ex vivo isolated peripheral blood mononuclear cells (PBMCs), were studied using enzyme-linked immunospot. vascular endothelial growth factor (VEGF) production by PBMCs was assessed using enzyme-linked immunosorbent assay.

Results:

ART was associated with a 7-fold increase in risk of MS exacerbation, and a 9-fold increase in risk of enhanced disease activity on MRI. Worsening was associated with higher number of cells producing IL-8, IL-12, IFN-γ, and TGF-β, as well as increased VEGF production by CD4+ T cells and CXCL-12 plasma levels, all GnRH-mediated effects. A rise in 17-β estradiol production associated with ART increased anti-MOG antibody titers, as well as B-cell survival factor BAFF (B-cell activating factor) and antiapoptotic molecule Bcl-2 levels from purified CD19+ B cells. Finally, ART facilitated PBMC transmigration across an in vitro blood–brain barrier model, an effect mediated by IL-8, VEGF, and CXCL-12.

Interpretation:

Results indicate a significant increase in MS disease activity in patients receiving ART, a risk that neurologists should be aware of. Reproductive hormones appear to exert an important role in regulating immune responses during the course of autoimmune diseases. ANN NEUROL 2012;72:682–694

via Increase in multiple sclerosis activity after assisted reproduction technology – Correale – 2012 – Annals of Neurology – Wiley Online Library.

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A Systematic Review of Randomized, Double-… [Neuroepidemiology. 2012] – PubMed – NCBI

Posted on January 1, 2013 by Maurice Preter MD

Neuroepidemiology. 2012 Dec 18;40(3):147-153. [Epub ahead of print]

A Systematic Review of Randomized, Double-Blind, Placebo-Controlled Trials Examining the Clinical Efficacy of Vitamin D in Multiple Sclerosis.

Pozuelo-Moyano B, Benito-León J, Mitchell AJ, Hernández-Gallego J.

Source

Department of Neurology, University Hospital ’12 de Octubre’, Madrid, Spain.

Abstract

Background: An association between multiple sclerosis (MS) prevalence as well as MS mortality and vitamin D nutrition has led to the hypothesis that high levels of vitamin D could be beneficial for MS. The purpose of this systematic review is to establish whether there is evidence for or against vitamin D in the treatment of MS. Methods: Systematic literature searches were performed to locate randomized, placebo-controlled, double-blind trials measuring the clinical effect of vitamin D on MS in human participants. Data were extracted in a standardized manner, and methodological quality was assessed by the Jadad score. Results: Five trials were located that met the selection criteria. Of the 5 trials, 4 showed no effect of vitamin D on any outcome, and 1 showed a significant effect, namely by a reduction in the number of T1 enhancing lesions on brain magnetic resonance imaging. Three studies commented on adverse effects of vitamin D, with gastrointestinal adverse effects being the most frequently reported. The literature is limited by small study sizes (ranging from 23 to 68 patients), heterogeneity of dosing, form of vitamin D tested (vitamin D3 in 4 trials and vitamin D2 in 1) and clinical outcome measures. Therefore, a meta-analysis was not performed. Conclusions: The evidence for vitamin D as a treatment for MS is inconclusive. Larger studies are warranted to assess the effect of vitamin D on clinical outcomes in patients with MS. We further encourage researchers to also test the effect of vitamin D on the health-related quality of life experienced by patients and their families.

Copyright © 2012 S. Karger AG, Basel.

PMID:

23257784

[PubMed – as supplied by publisher]

LinkOut – more resources

via A Systematic Review of Randomized, Double-… [Neuroepidemiology. 2012] – PubMed – NCBI.

Posted in Complementary - Alternative Medicine, dietary, Fifth Avenue Concierge Medicine, keto, Psychiatry/Neurology | Tagged , , |

Vitamin D in Systemic and Organ-Spe… [Clin Rev Allergy Immunol. 2012] – PubMed – NCBI

Posted on January 1, 2013 by Maurice Preter MD

Clin Rev Allergy Immunol. 2012 Dec 14. [Epub ahead of print]

Vitamin D in Systemic and Organ-Specific Autoimmune Diseases.

Agmon-Levin N, Theodor E, Segal RM, Shoenfeld Y.

Source

The Zabludowics Center for Autoimmune Diseases, Chaim Sheba Medical Center, Tel Hashomer, 52621, Israel.

Abstract

Lately, vitamin D has been linked with metabolic and immunological processes, which established its role as an essential component of human health preservation. Vitamin D has been defined as natural immune modulators, and upon activation of its receptors (VDRs), it regulates calcium metabolism, cellular growth, proliferation and apoptosis, and other immunological functions. Epidemiological data underline a strong correlation between poor vitamin D status and higher risk for chronic inflammatory illnesses of various etiologies, including autoimmune diseases. Epidemiological, genetic, and basic studies indicated a potential role of vitamin D in the pathogenesis of certain systemic and organ-specific autoimmune diseases. These studies demonstrate correlation between low vitamin D and prevalence of diseases. In addition, VDRs’ polymorphisms observed in some of these autoimmune diseases may further support a plausible pathogenic link. Notably, for some autoimmune disease, no correlation with vitamin D levels could be confirmed. Thus, in the current review we present the body of evidence regarding the plausible roles of vitamin D and VDR’s polymorphism in the pathogenesis of autoimmunity. We summarize the data regarding systemic (i.e., systemic lupus erythematosus, rheumatoid arthritis, etc.) and organ-specific (i.e., multiple sclerosis, diabetes mellitus, primary biliary cirrhosis, etc.) autoimmune diseases, in which low level of vitamin D was found comparing to healthy subjects. In addition, we discuss the correlations between vitamin D levels and clinical manifestations and/or activity of diseases. In this context, we address the rational for vitamin D supplementation in patients suffering from autoimmune diseases. Further studies addressing the mechanisms by which vitamin D affects autoimmunity and the proper supplementation required are needed.

PMID:

23238772

[PubMed – as supplied by publisher]

LinkOut – more resources

via Vitamin D in Systemic and Organ-Spe… [Clin Rev Allergy Immunol. 2012] – PubMed – NCBI.

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