Poruchy chůze u extrapyramidových onemocnění.

• Název práce v češtině: Poruchy chůze u extrapyramidových onemocnění.
• Název v anglickém jazyce: Gait impairment in movement disorders.
• Klíčová slova: chůze, extrapyramidová onemocnění, Parkinsonova nemoc, methanol, vizuální cueing
• Klíčová slova anglicky: gait, movement disorders, Parkinson's disease, methanol, visual cueing
• Akademický rok vypsání: 2013/2014
• Typ práce: disertační práce
• Jazyk práce: čeština
• Ústav: Neurologická klinika 1. LF UK a VFN (11-00600)
• Vedoucí / školitel: doc. MUDr. Hana Brožová, Ph.D.
• Řešitel: skrytý - zadáno a potvrzeno stud. odd.
• Datum přihlášení: 06.08.2014
• Datum zadání: 06.08.2014
• Datum potvrzení stud. oddělením: 06.08.2014
• Datum a čas obhajoby: 28.06.2021 13:00
• Místo konání obhajoby: Kateřinská 30, Praha 2, budova D5, NEURP1, Kateřinská 30, přízemí, posluchárna
• Datum odevzdání elektronické podoby: 20.03.2021
• Datum proběhlé obhajoby: 28.06.2021
• Předmět: Obhajoba dizertační práce (B90002)
• Oponenti: doc. PhDr. Ondřej Čakrt, Ph.D.

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Předběžná náplň práce

Extrapyramidová onemocnění jsou charakteristická poruchami hybnosti na podkladě postižení bazálních ganglií či jejich spojů. Nejčastější je Parkinsonova nemoc (PN), s dominující hypokinezí s klidovým třesem a/nebo rigiditou, které jsou ovlivnitelné dopaminergní terapií či invazivními metodami včetně hluboké mozkové stimulace (DBS). Poruchy stoje a chůze jsou součástí parkinsonského syndromu, postupně progredují v průběhu onemocnění a v pozdních stádiích často omezují běžné denní aktivity, kvalitu života, mohou vést k pádům a přispívají k vyšší mortalitě pacientů. Terapie bývá obtížná. Poruchy chůze a parkinsonismus se vyskytují i u dalších onemocnění včetně intoxikací, které poškozují bazální ganglia.
Obecná část práce se zabývá fyziologií chůze, jejími poruchami a vyšetřením. Část věnovaná extrapyramidovým onemocněním se cíleně věnuje Parkinsonově nemoci a intoxikaci methanolem.
Speciální část je tvořena 3 studiemi, zaměřenými na hodnocení poruchy chůze a možností ovlivnění u pacientů s pokročilou PN, 4. studie dokumentuje poruchu chůze u přeživších po masové otravě methanolem, která v České republice proběhla mezi lety 2012 a 2014.
Výsledkem práce je potvrzení účinnosti DBS v prodloužení délky kroku a zvýšení rychlosti chůze u pacientů s PN. Kompenzační strategie pomocí vizuálních podnětů (tzv. cueing) byla účinnější v normalizaci prodloužené fáze dvojí opory chůzového cyklu pacientů s PN. Výhodné bylo zejména užití velkých příčných vizuálních podnětů, které lze začlenit do vzorů podlah ve veřejných prostranstvích či interiérech. Dále byla ověřena validita české verze screeningového dotazníku na freezing chůze, který je vzhledem k epizodickému a nepředvídatelnému charakteru často obtížně vyšetřitelný v běžné klinické praxi.
Otrava methanolem je typická rozvojem metabolické acidózy, poruch zraku a poškozením bazálních ganglií, které lze dokumentovat pomocí MRI. Prokázaná porucha chůze však odpovídá spíše frontálnímu typu, pravděpodobně na podkladě porušeného spojení bazálních ganglií s frontální kůrou.

Předběžná náplň práce v anglickém jazyce

Movement disorders are caused by impairment of the basal ganglia and extrapyramidal connections. The most common is Parkinson's disease (PD), characterised by hypokinesia together with resting tremor and / or rigidity, which may be influenced by dopaminergic therapy or invasive methods, including deep brain stimulation (DBS). Gait and balance disorders are part of the Parkinson's syndrome, progress during the disease course and limit daily activities, quality of life, may lead to falls and contribute to higher mortality of the patients in the late stages. Therapy is difficult. Gait disorders and parkinsonism may occur also in other diseases, including intoxications which may also lead to basal ganglia impairment.
The theoretical part include the physiology of gait, gait disorders and examination. The section devoted to movement disorders focuses on Parkinson's disease and methanol intoxication.
The practical part consists of 3 studies evaluating gait disorder in patients with advanced PD and possibilities of the treatment, the 4th study documents gait disorder in survivors after mass methanol poisoning with outbreak between 2012 and 2014 in the Czech Republic.
The result confirm the effect of DBS in step length prolongation and gait speed increment in patients with PD. Compensation strategies using visual stimuli (cueing) were more effective in normalization of the prolonged double support phase of the gait cycle of PD patients. Beneficial were large transverse visual stimuli, which can be incorporated into floor patterns in public spaces or interiors. Also the validity of the Czech version of the screening Freezing of gait questionnaire was verified, which may help to investigate freezing in the clinical practice despite its episodic and unpredictable nature.
Methanol poisoning is characterized by development of metabolic acidosis, visual disturbances, and basal ganglia damage, which can be documented by MRI. The gait disorder, however, corresponds to the frontal type, probably due to impaired connection between basal ganglia and frontal cortex.