On page 30, column 2, line 4, the intensity of HRmax was given as 79.7%, but this is incorrect.The correct sentence should be: "Therefore, this interventional study provides only Class IV level of evidence that a moderate to vigorous endurance exercise program (mean HR= 69.7% HRmax) improves motor function in mild to moderate PD [36]."
Orthostatic hypotension (OH) is the most common manifestation of cardiovascular autonomic dysfunction in Parkinson's disease. In this viewpoint, we discuss five practical questions regarding OH in Parkinson's disease: 1) How common is the problem? 2) Why should people with Parkinson's disease and providers care about OH? 3) What are the symptoms of OH? 4) How to confirm a diagnosis of OH? And 5) How to treat OH? OH is an important non-motor symptom of Parkinson's disease for which we have available treatments to significantly mitigate morbidity and possibly positively impact the disease course.
Total serum protein levels, serum protein fraction levels, and specific serum immunoglobulin class or subclass levels were measured in colostrum-fed (CF) and colostrum-deprived (CD) calves during the first 144 hours after birth. Total serum protein values increased at 24 hours in the CF group and then decreased slightly at 144 hours. The increase in total serum protei5) in beta1-, beta2-, and gamma-globulins. The beta2- and gamma-globulin levels decreased by 144 hours, while the serum level of beta1-globulin continued to increase. The CD calves exhibited a significant decrease (P less than 0.05) in total serum protein at 24 hours, folhours, the level of beta1-globulin inlowed by a significant increase (P less than 0.05) at 144 hours. At 24 hours, the level of beta1-globulin decreased slightly, and the level of beta2- and gamma-globulins increased slightly. At 144 creased, and the level of gamma-globulin decreased. The beta2-globulin level did not change. At birth, immunoglobulin (Ig) M was detected in 5 of the 10 calves, IgG1 in 6 of the 10 calves, and IgG2 in 3 of the 10 calves. By 24 hours after birth, all CF calves had detectable levels of IgM, IgG1, and IgG2, and there were significant increases (P less than 0.01) in the mean serum levels of all 3 immunoglobulins. By 144 hours after birth, the serum levels of IgM, IgG1, and IgG2 decreased to various degrees. At 24 hours, the IgM level had not increased in CD calves; however, the level of IgG2 appeared to increase slightly, and the mean IgG1 level increased by approximately 50%. By 144 hours after birth, there was a significant increase (P less than 0.01) in the mean level of serum IgM. The level of IgG, also appeared to increase substantially, while the level of IgG2 appeared to increase slightly.
INTERFERON-β-1A (IFN-β-1A) IS an immunomodulator that is commonly used to treat relapsing–remitting multiple sclerosis (MS).1 Psychotic features are rare in MS,2 and they are rarely associated with IFN-β as side-effects.1 Herein we report a case of psychosis with IFN-β-1a, which went into clinical remission after treatment discontinuation. The patient gave the authors informed consent to publish this letter. A 21-year-old woman with relapsing–remitting MS treated with IFN-β-1a presented with delusion, mistrust, suspiciousness, ideas of persecution and showed poor social functioning. MS had been diagnosed 15 months earlier and IFN-β-1a, which was the first immunomodulator treatment she received, was previously well tolerated. Her psychiatric history was negative. She did not take any other drugs or intoxicants and did not report any history of external or environmental trauma. Neurological examination was normal. Cerebral magnetic resonance imaging (MRI) was not different from the previous scans. Routine laboratory testing was normal. We decided to stop the immunomodulator treatment and to introduce an antipsychotic drug (risperidone 2 mg per day). Three months later the patient showed normal social functioning, and was neither depressed nor delirious. There was no relapse after 9 months and a new immunomodulator (glatiramer acetate) was started. Psychosis is an unusual behavioral consequence of MS2 and the specific mechanism of IFN-β-1a-related psychiatric disorders remains unknown. Reiss et al. published a case of psychosis in MS with left temporal lobe lesions.3 In the present case cerebral MRI did not indicate any change in this area. We analyzed the data at the pharmacovigilance department of the CHU of Caen and, according to the French imputation method, the score of imputability was determined to be possible (C1S1). The time of appearance of the event and the complete remission of symptoms after treatment discontinuation were compatible with IFN-β-1a as a cause. In the literature we found one case of psychosis with IFN-β-1a.4 The other cases were associated with IFN-β-1b5 or unpublished. The present case suggests than IFN-β-1a was responsible for the psychotic symptoms. Physicians should be aware of the possibility of psychiatric side-effects with IFN-β-1a.
There is compelling evidence that exercise must be part of main line therapy for people with Parkinson's disease. In this viewpoint, we outline the four key components of exercise: aerobic exercise, resistance exercise, flexibility exercise, and neuromotor exercises (posture, gait, balance, and agility) that can improve both motor and non-motor symptoms of the disease and, in the case of aerobic exercise, may delay the disease. We outline guidelines on how to change and optimize the exercise prescription at different stages of the disease.
