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Clinical variants and pathogenic aspects of pain manifestations in Parkinson s disease (clinical, physiological study)


Author: Pavlic Gabriela
Degree:doctor of medicine
Speciality: 14.00.13 - Neurology
Year:2015
Scientific adviser: Ion Moldovanu
doctor habilitat, professor,
Scientific consultant: Victor Vovc
doctor habilitat, professor, Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of Moldova
Institution: Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of Moldova

Status

The thesis was presented on the 11 November, 2015
Approved by NCAA on the 22 December, 2015

Abstract

Adobe PDF document – 1.43 Mb / in romanian

Thesis

CZU 616.858-008.6-009.7-08

Adobe PDF document 4.06 Mb / in romanian
170 pages

Keywords

chronic pain, Parkinson disease, dopaminergic deficit, transcranian electrical direct current stimulation

Summary

The work consists of introduction, two chapters of personal results and discussions, conclusions and recommendations, 252 references, 5 attachments, 131 pages of main text, 29 figures, and 42 tables. Research results’ have been published in 20 scientific works.

Field of study: neurology.

Aim and objectives of the study: to determine characteristics and correlations of clinical parameters in Parkinson disease (PD) patients’ with chronic pain and the effect of transcranial direct current stimulation on pain and motor signs.

Novelty and originality of the study: it has been shown that chronic pain in PD is associated with clinical disease severity; the dopaminergic hypothesis was confirmed in the pathogeny of pain in this disorder; the positive therapeutic effect of transcranial direct current stimulation on pain in Parkinson disease has been proved for the first time. The scientific problem solved in the field. The study results determined the correlation of pain with the severity of motor and non-motor disease’s features, with predominance for the akynetic-rigid phenotype, with more advanced dopaminergic deficit.

Theoretical significance. The data presented in this study expand and offer a deeper understanding of chronic pain in Parkinson disease. The study offered arguments in favor of dopaminergic deficit for pain origin; the concept of clinical heterogeneity, based on association of pain variables with more severe motor features for the akynetic-rigid phenotype, has been confirmed.

The practical value consisted in determining the importance of active pain assessment in PD; there were also established the predictive factors for pain existence based on a defined set of clinical variables. The method of transcranial direct current stimulation was shown to be effective for pain improvement and might be an alternative treatment option in the complex management of this disorder.

Implementation of scientific results: Institute of Neurology and Neurosurgery, Chair of Neurology at State Medical and Pharmaceutical University „N. Testemiţanu”, University Clinic Neuronova-plus.