Motor fluctuations and dyskinesia in later stages of Parkinson's disease (PD) are caused by pharmacokinetic as well as pharmacodynamic factors, intermittentdopaminergic stimulation being one of the most important. In the healthy brain, dopamine neurons in the substantia nigra pars compacta fire tonically at a steady rate of about 4 cycles/second. In later stages of PD, steady firing is replaced by pulsatile stimulation which causes molecular and physiologic changes in the basal ganglia. Continuous dopaminergic stimulation has been shown to dramatically improve motor fluctuations and dyskinesia by modifications of oral treatment (dopamine agonists, smaller, more frequent levodopa doses, controlled-release formulation of levodopa, addition of agents that slow down the catabolism of dopamine, such as inhibitors of catechol-O-methyl transferase and monoamine oxidase), transdermal delivery (rotigotine), infusion therapies (intravenous levodopa, subcutaneous application of apomorphine and lisuride, duodenal infusion of levodopa) and deep brain stimulation of the subthalamic nucleus.
COBISS.SI-ID: 28380633
The paper describes the process of knowledge elicitation for a neurological decision support system. To alleviate the difficult problem of knowledge elicitation from data and domain experts, we used a recently developed technique called ABML (Argument Based Machine Learning). The paper demonstrates ABML's advantage in combining machine learning and expert knowledge. ABML guides the expert to explain critical special cases which cannot be handled automatically by machine learning. This very efficiently reduces the expert's workload, and combines it with automatically learned knowledge. We developed a decision support system to help the neurologists differentiate between three types of tremors: Parkinsonian, essential, and mixed tremor (co-morbidity). The system is intended to act as a second opinion for the neurologists, and most importantly to help them reduce the number of patients in the "gray area" that require a very costly further examination (DaTSCAN).
COBISS.SI-ID: 8469332
Botulinum treatment has been proven to be a promising treatment for many dystonic and spastic disorders. Apart from correction of posture and pain relief, functional testing is an important part of pre - and post-treatment assessment. We report results and dilemmas of using two assessment scales in a double-blind, placebo controlled cross-over study on 10 patients with upper limb motor disorders. While the improvement on the Arm Function Test (AFT) after the Botulinum session was not statistically significantly higher than after placebo, the difference in favour of the treatment was much more evident on the 0-5 self-assessment scale. We believe that AFT is not sufficiently sensitive or at least not superior to simpler global scales, and that measurement of focal disability does not entirely clarify functional changes after treatment with Botulinum Toxin.
COBISS.SI-ID: 28652249