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Hariz, Gun-Marie
Publications (10 of 35) Show all publications
Sperens, M., Hamberg, K. & Hariz, G.-M. (2018). Challenges and strategies among women and men with Parkinson's disease: striving toward joie de vivre in daily life. British Journal of Occupational Therapy, 81(12), 700-708
Open this publication in new window or tab >>Challenges and strategies among women and men with Parkinson's disease: striving toward joie de vivre in daily life
2018 (English)In: British Journal of Occupational Therapy, ISSN 0308-0226, E-ISSN 1477-6006, Vol. 81, no 12, p. 700-708Article in journal (Refereed) Published
Abstract [en]

Introduction: To offer people with Parkinson's disease optimal occupational therapy, it is important to have a detailed understanding of how they manage everyday life. The aims of this study were to explore how people with Parkinson's disease manage the effect of the disease on everyday life and to investigate gender similarities and differences concerning this issue. Method: We interviewed 24 people with Parkinson's disease (14 men), at a mean of 8 years after diagnosis. The interviews were analysed according to Grounded Theory. Findings: 'Striving to maintain a good everyday life' was established as a core category. To overcome obstacles caused by the disease, the interviewees struggled with perpetual adaptation to the medication regime and ongoing changes in their abilities. To achieve best possible everyday life, it was essential to keep their own spirit up; for example, by prioritising valued occupations. Women and men contributed to all categories and used the same strategies. Conclusion: Men and women with Parkinson's disease used the same strategies to manage daily life challenges. Our findings support the relevance of disease-specific occupational therapy interventions focusing on the individual fit between person, environment and occupation, and highlight the need for joyful occupations to attain a satisfactory daily life.

Place, publisher, year, edition, pages
Sage Publications, 2018
Keywords
Parkinson's disease, occupational therapy, activity of daily living, coping strategies, quality of life, gender
National Category
Physiotherapy
Identifiers
urn:nbn:se:umu:diva-154900 (URN)10.1177/0308022618770142 (DOI)000452512500004 ()
Available from: 2019-01-07 Created: 2019-01-07 Last updated: 2019-01-07Bibliographically approved
Blomstedt, P., Stenmark Persson, R., Hariz, G.-M., Linder, J., Fredricks, A., Häggström, B., . . . Hariz, M. (2018). Deep brain stimulation in the caudal zona incerta versus best medical treatment in patients with Parkinson's disease: a randomised blinded evaluation. Journal of Neurology, Neurosurgery and Psychiatry, 89(7), 710-716
Open this publication in new window or tab >>Deep brain stimulation in the caudal zona incerta versus best medical treatment in patients with Parkinson's disease: a randomised blinded evaluation
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2018 (English)In: Journal of Neurology, Neurosurgery and Psychiatry, ISSN 0022-3050, E-ISSN 1468-330X, Vol. 89, no 7, p. 710-716Article in journal (Refereed) Published
Abstract [en]

Background: Several open-label studies have shown good effect of deep brain stimulation (DBS) in the caudal zona incerta (cZi) on tremor, including parkinsonian tremor, and in some cases also a benefit on akinesia and axial symptoms. The aim of this study was to evaluate objectively the effect of cZi DBS in patients with Parkinson's disease (PD).

Method: 25 patients with PD were randomised to either cZi DBS or best medical treatment. The primary outcomes were differences between the groups in the motor scores of the Unified Parkinson's Disease Rating Scale (UPDRS-III) rated single-blindly at 6 months and differences in the Parkinson's Disease Questionnaire 39 items (PDQ-39). 19 patients, 10 in the medical arm and 9 in the DBS arm, fulfilled the study.

Results: The DBS group had 41% better UPDRS-III scores off-medication on-stimulation compared with baseline, whereas the scores of the non-surgical patients off-medication were unchanged. In the on-medication condition, there were no differences between the groups, neither at baseline nor at 6 months. Subitems of the UPDRS-III showed a robust effect of cZi DBS on tremor. The PDQ-39 domains 'stigma' and 'ADL' improved only in the DBS group. The PDQ-39 summary index improved in both groups.

Conclusion: This is the first randomised blinded evaluation of cZi DBS showing its efficacy on PD symptoms. The most striking effect was on tremor; however, the doses of dopaminergic medications could not be decreased. cZi DBS in PD may be an addition to existing established targets, enabling tailoring the surgery to the needs of the individual patient.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2018
National Category
Neurology
Identifiers
urn:nbn:se:umu:diva-150375 (URN)10.1136/jnnp-2017-317219 (DOI)000438044100010 ()29386253 (PubMedID)
Available from: 2018-08-08 Created: 2018-08-08 Last updated: 2018-08-08Bibliographically approved
Mahlknecht, P., Georgiev, D., Akram, H., Brugger, F., Vinke, S., Zrinzo, L., . . . Limousin, P. (2018). Parkinsonian signs in patients with cervical dystonia treated with pallidal deep brain stimulation. Brain, 141, 3023-3034
Open this publication in new window or tab >>Parkinsonian signs in patients with cervical dystonia treated with pallidal deep brain stimulation
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2018 (English)In: Brain, ISSN 0006-8950, E-ISSN 1460-2156, Vol. 141, p. 3023-3034Article in journal (Refereed) Published
Abstract [en]

Pallidal deep brain stimulation is an established treatment in patients with dystonia. However, evidence from case series or uncontrolled studies suggests that it may lead in some patients to specific parkinsonian symptoms such as freezing of gait, micrographia, and bradykinesia. We investigated parkinsonian signs using the Movement Disorder Society Unified Parkinson's Disease Rating Scale motor score by means of observer-blinded video ratings in a group of 29 patients treated with pallidal stimulation and a non-surgical control group of 22 patients, both with predominant cervical dystonia. Additional assessments included MRI-hased models of volume of neural tissue activated to investigate areas of stimulation related to dystonic symptom control and those likely to induce parkinsonian signs as well as an EMG analysis to investigate functional vicinity of stimulation fields to the pyramidal tract. Compared with controls, stimulated patients had significantly higher motor scores (median, 25th-75th percentile: 14.0, 8.0-19.5 versus 3.0, 2.0-8.0; P < 0.0001), as well as bradykinesia (8.0, 6.0-14.0 versus 2.0, 0.0-3.0; P < 0.0001) and axial motor subscores (2.0, 1.0-4.0 versus 0.0, 0.0-1.0; P= 0.0002), while rigidity and tremor subscores were not different between groups. Parkinsonian signs were partially reversible upon switching stimulation off for a median of 90 min in a subset of 19 patients tolerating this condition. Furthermore, the stimulation group reported more features of freezing of gait on a questionnaire basis. Quality of life was better in stimulated patients compared with control patients, but parkinsonian signs were negatively associated with quality of life. In the descriptive imaging analysis maximum efficacy for dystonia improvement projected to the posteroventrolateral internal pallidum with overlapping dusters driving severity of bradykinesia and axial motor symptoms. The severities of parkinsonian signs were not correlated with functional vicinity to the pyramidal tract as assessed by EMG. In conclusion, parkinsonian signs, particularly bradykinesia and axial motor signs, due to pallidal stimulation in dystonic patients are frequent and negatively impact on motor functioning and quality of life. Therefore, patients with pallidal stimulation should be monitored closely for such signs both in clinical routine and future clinical trials. Spread of current outside the internal pallidum is an unlikely explanation for this phenomenon, which seems to be caused by stimulation of neural elements within the stimulation target volume.

Place, publisher, year, edition, pages
Oxford University Press, 2018
Keywords
dystonia, deep brain stimulation, movement disorders: imaging, bradykinesia, gait
National Category
Neurology
Identifiers
urn:nbn:se:umu:diva-152885 (URN)10.1093/brain/awy217 (DOI)000446548400024 ()30165511 (PubMedID)
Available from: 2018-10-31 Created: 2018-10-31 Last updated: 2018-10-31Bibliographically approved
Sperens, M., Hamberg, K. & Hariz, G.-M. (2017). Are Patients Ready for "EARLYSTIM"?: Attitudes towards Deep Brain Stimulation among Female and Male Patients with Moderately Advanced Parkinson's Disease. Parkinson's Disease, Article ID 1939831.
Open this publication in new window or tab >>Are Patients Ready for "EARLYSTIM"?: Attitudes towards Deep Brain Stimulation among Female and Male Patients with Moderately Advanced Parkinson's Disease
2017 (English)In: Parkinson's Disease, ISSN 2090-8083, E-ISSN 2042-0080, article id 1939831Article in journal (Refereed) Published
Abstract [en]

Objective. To explore, in female and male patients with medically treated, moderately advanced Parkinson's disease (PD), their knowledge and reasoning about Deep Brain Stimulation (DBS). Methods. 23 patients with PD (10 women), aged 46- 70, were interviewed at a mean of 8 years after diagnosis, with open-ended questions concerning their reflections and considerations about DBS. The interviews were transcribed verbatim and analysed according to the difference and similarity technique in Grounded Theory. Results. From the patients' narratives, the core category "Processing DBS: balancing symptoms, fears and hopes" was established. The patients were knowledgeable about DBS and expressed cautious and well considered attitudes towards its outcome but did not consider themselves ill enough to undergo DBS. They were aware of its potential side-effects. They considered DBS as the last option when oral medication is no longer sufficient. There was no difference between men and women in their reasoning and attitudes towards DBS. Conclusion. This study suggests that knowledge about the pros and cons of DBS exists among PD patients and that they have a cautious attitude towards DBS. Our patients did not seem to endorse an earlier implementation of DBS, and they considered that it should be the last resort when really needed.

Place, publisher, year, edition, pages
HINDAWI LTD, 2017
National Category
Neurology
Identifiers
urn:nbn:se:umu:diva-134831 (URN)10.1155/2017/1939831 (DOI)000399239900001 ()
Available from: 2017-05-24 Created: 2017-05-24 Last updated: 2018-06-09Bibliographically approved
Georgiev, D., Hamberg, K., Hariz, M., Forsgren, L. & Hariz, G.-M. (2017). Gender differences in Parkinson's disease: a clinical perspective. Acta Neurologica Scandinavica, 136(6), 570-584
Open this publication in new window or tab >>Gender differences in Parkinson's disease: a clinical perspective
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2017 (English)In: Acta Neurologica Scandinavica, ISSN 0001-6314, E-ISSN 1600-0404, Vol. 136, no 6, p. 570-584Article in journal (Refereed) Published
Abstract [en]

Available data indicate that there are gender differences in many features of Parkinson's disease (PD). Precise identification of the gender differences is important to tailor treatment, predict outcomes, and meet other individual and social needs in women and men with PD. The aim of this study was to review the available clinical data on gender differences in PD. Original articles and meta-analyses published between 1990 and 2016 systematically exploring gender differences in PD were reviewed. There is slight male preponderance in incidence and prevalence of PD. PD starts earlier in men. Women tend to be more prone to develop tremor-dominant PD but are less rigid than men. Motor improvement after deep brain stimulation is equal in both sexes, but women tend to show better improvement in activities of daily living. Furthermore, women with PD show better results on tests for general cognitive abilities, outperform men in verbal cognitive tasks, show more pain symptoms, and score higher on depression scales. It seems, however, that the differences in cognition, mood, and pain perception are not disease specific as similar gender differences can be found in healthy subjects and in other neurological conditions. Despite PD being the most frequently studied movement disorder, studies investigating gender differences in PD are still scarce with most of the studies being cross-sectional. Good-quality, prospective, longitudinal studies analyzing gender differences in PD and comparing them to matched healthy controls are needed in order to properly address the issues of gender differences in PD.

Place, publisher, year, edition, pages
John Wiley & Sons, 2017
Keywords
activities of daily living, gender differences, motor symptoms, non-motor symptoms, Parkinson's disease, quality of life
National Category
Neurology
Identifiers
urn:nbn:se:umu:diva-140684 (URN)10.1111/ane.12796 (DOI)000414488000002 ()28670681 (PubMedID)
Available from: 2017-10-16 Created: 2017-10-16 Last updated: 2018-06-09Bibliographically approved
Jonasson, S. B., Hagell, P., Hariz, G.-M., Iwarsson, S. & Nilsson, M. H. (2017). Psychometric Evaluation of the Parkinson's Disease Activities of Daily Living Scale. Parkinson's Disease, Article ID 4151738.
Open this publication in new window or tab >>Psychometric Evaluation of the Parkinson's Disease Activities of Daily Living Scale
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2017 (English)In: Parkinson's Disease, ISSN 2090-8083, E-ISSN 2042-0080, article id 4151738Article in journal (Refereed) Published
Abstract [en]

Objective. To evaluate a set of psychometric properties (i.e., data completeness, targeting, and external construct validity) of the Parkinson's disease Activities of Daily Living Scale (PADLS) in people with Parkinson's disease (PD). Specific attention was paid to the association between PADLS and PD severity, according to the Hoehn & Yahr (H&Y) staging. Methods. The sample included 251 persons with PD (mean age 70 [SD 9] years). Data collection comprised a self-administered postal survey, structured interviews, and clinical assessments at home visits. Results. Data completeness was 99.6% and the mean PADLS score was 2.1. Floor and ceiling effects were 22% and 2%, respectively. PADLS scores were more strongly associated (r(s) > 0.5) with perceived functional independence, ADL dependency, walking difficulties, and self- rated PD severity than with variables such as PD duration and cognitive function (r(s) < 0.5). PADLS scores differed across H& Y stages (Kruskal- Wallis test, p< 0.001). Those in H&Y stages IV-V had more ADL disability than those in stage III (Mann- Whitney U test p < 0.001), whereas there were no significant differences between the other stages. Conclusion. PADLS revealed excellent data completeness, acceptable targeting, and external construct validity. It seems to be well suited as a rough estimate of ADL disability in people with PD.

Place, publisher, year, edition, pages
HINDAWI LTD, 2017
National Category
Occupational Therapy Neurology
Identifiers
urn:nbn:se:umu:diva-140925 (URN)10.1155/2017/4151738 (DOI)000412541200001 ()
Available from: 2017-10-26 Created: 2017-10-26 Last updated: 2018-06-09Bibliographically approved
Hariz, G.-M., Limousin, P. & Hamberg, K. (2016). "DBS means everything - for some time": Patients' Perspectives on Daily Life with Deep Brain Stimulation for Parkinson's Disease. Journal of Parkinson's Disease, 6(2), 335-347
Open this publication in new window or tab >>"DBS means everything - for some time": Patients' Perspectives on Daily Life with Deep Brain Stimulation for Parkinson's Disease
2016 (English)In: Journal of Parkinson's Disease, ISSN 1877-7171, E-ISSN 1877-718X, Vol. 6, no 2, p. 335-347Article in journal (Refereed) Published
Abstract [en]

Background: Deep brain stimulation (DBS) is an established treatment for Parkinson's disease. However, patients' own perceptions of the impact of DBS on their daily living is not fully explored. 

Objective: We aimed to collect and analyse patients' narratives about their everyday experiences of being on chronic DBS. 

Methods: Semi-structured interviews with open-ended questions were conducted with 42 patients (11 women) who had been on DBS for a mean of three years. The questions were related to patients' ordinary daily life and eventual changes, both negative and positive, brought about by DBS. The interviews were transcribed verbatim and analysed according to the difference and similarity technique in grounded theory. 

Results: From the patients' narratives the core category `DBS means everything - for some time' was established, and supported by the following categories: 1) Relief from invasive tremor. 2) A rescue from cramps and pain. 3) Easier movement swings and more predictable living space. 4) Hard, but compared to previous suffering, bearable adverse events. 5) Parkinson's disease is progressing despite DBS. 

Conclusions: The analysis of the participants' narratives shed light on patients' unique perceptions and perspectives of the impact of DBS on their everyday lives. Patients with advanced PD highly appreciated the positive impact of DBS on their daily life even if this impact is limited in time. For the majority, the relief from the severe parkinsonian symptoms, especially tremor and painful cramps, outweighed the side effects of DBS. The study provided information not readily captured by pre-formulated questionnaires and scales.

Keywords
Parkinson disease, deep brain stimulation, qualitative research, grounded theory, adverse effects, tient satisfaction, activities of daily living
National Category
Neurosciences
Identifiers
urn:nbn:se:umu:diva-124158 (URN)10.3233/JPD-160799 (DOI)000378352200007 ()27003786 (PubMedID)
Available from: 2016-07-21 Created: 2016-07-21 Last updated: 2018-06-07Bibliographically approved
Fischl, C., Morin, J., Norberg, E.-B., Hariz, G.-M., Abrahamsson, B.-I., Munkholm, M., . . . Lindberg, M. (2015). Kontinuitet i uppgifter inom år 3 arbetsterapeutprogrammet. In: Universitetspedagogiska konferensen 2015: gränslös kunskap. Paper presented at Universitetspedagogiska konferensen, gränslös kunskap, 8-9 okt 2015, Umeå universitet (pp. 66-66).
Open this publication in new window or tab >>Kontinuitet i uppgifter inom år 3 arbetsterapeutprogrammet
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2015 (Swedish)In: Universitetspedagogiska konferensen 2015: gränslös kunskap, 2015, p. 66-66Conference paper, Poster (with or without abstract) (Other academic)
National Category
Pedagogy
Identifiers
urn:nbn:se:umu:diva-112381 (URN)
Conference
Universitetspedagogiska konferensen, gränslös kunskap, 8-9 okt 2015, Umeå universitet
Available from: 2015-12-07 Created: 2015-12-07 Last updated: 2018-06-07Bibliographically approved
Loutfi, G., Linder, J., Hariz, G.-M., Hariz, M. & Blomstedt, P. (2014). Pallidal Deep Brain Stimulation in the Treatment of Huntington’s Chorea. Brain Disorders & Therapy, 3(4)
Open this publication in new window or tab >>Pallidal Deep Brain Stimulation in the Treatment of Huntington’s Chorea
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2014 (English)In: Brain Disorders & Therapy, ISSN 2168-975X, Vol. 3, no 4Article in journal (Refereed) Published
Abstract [en]

Despite the success of deep brain stimulation (DBS) in various movement disorders, its use in Huntington´s Disease (HD) has been limited. So far, promising results of pallidal DBS have been reported in 7 patients with HD. We performed bilateral pallidal DBS in a 59 year old woman with HD since 12 years and severe motor symptoms. At the evaluation after 12 months the effect was deemed satisfactory mainly concerning the patient’s choreatic symptoms. However, the improvement according to the unified Huntington’s disease rating scale was modest, with a score reduction from 92 to 81.

Keywords
DBS, Huntington's chorea, Pallidum
National Category
Neurology
Research subject
Neurosurgery
Identifiers
urn:nbn:se:umu:diva-105932 (URN)10.4172/2168-975X.1000136 (DOI)
Available from: 2015-07-01 Created: 2015-07-01 Last updated: 2018-06-07Bibliographically approved
Hariz, G.-M. & Hamberg, K. (2014). Perceptions of living with a device-based treatment: an account of patients treated with deep brain stimulation for Parkinson’s disease. Neuromodulation (Malden, Mass.), 17(3), 272-278
Open this publication in new window or tab >>Perceptions of living with a device-based treatment: an account of patients treated with deep brain stimulation for Parkinson’s disease
2014 (English)In: Neuromodulation (Malden, Mass.), ISSN 1094-7159, E-ISSN 1525-1403, Vol. 17, no 3, p. 272-278Article in journal (Refereed) Published
Abstract [en]

Objectives Deep brain stimulation (DBS) is an established treatment for Parkinson's disease. Little is known about patients' own perceptions of living with the implanted hardware. We aimed to explore patients' own perceptions of living with an implanted device. Materials and Methods Semistructured interviews with open-ended questions were conducted with 42 patients (11 women) who had been on DBS for a mean of three years. The questions focused on patients' experiences of living with and managing the DBS device. The interviews were transcribed verbatim and analyzed according to the difference and similarity technique in grounded theory. Results From the patients' narratives concerning living with and managing the DBS device, the following four categories emerged: 1) The device—not a big issue: although the hardware was felt inside the body and also visible from outside, the device as such was not a big issue. 2) Necessary carefulness: Patients expressed the need to be careful when performing certain daily activities in order not to dislocate or harm the device. 3) Continuous need for professional support: Most patients relied solely on professionals for fine-tuning the stimulation rather than using their handheld controller, even if this entailed numerous visits to a remote hospital. 4) Balancing symptom relief and side-effects: Patients expressed difficulties in finding the optimal match between decrease of symptoms and stimulation-induced side-effects. Conclusions The in-depth interviews of patients on chronic DBS about their perceptions of living with an implanted device provided useful insights that would be difficult to capture by quantitative evaluations.

Keywords
deep brain stimulation, grounded theory, Parkinson’s disease, patient perspective, qualitative method
National Category
Neurology Occupational Therapy
Research subject
Occupational therapy; Family Medicine; Neurosurgery; Neurology
Identifiers
urn:nbn:se:umu:diva-80537 (URN)10.1111/ner.12073 (DOI)000335154500011 ()
Funder
Swedish Research Council
Available from: 2013-09-20 Created: 2013-09-20 Last updated: 2018-06-08Bibliographically approved
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