ABSTRACT
Introduction: actuellement nous n'avons pas de données précises sur les syndromes parkinsoniens à Madagascar. Nous voulions rassembler des données sur ces maladies. Alors l'objectif de notre étude étant de décrire la fréquence et le profil clinique des syndromes parkinsoniens dans notre Service de Neurologie.Méthodes: il s'agit d'une étude rétrospective descriptive allant de janvier 2014 à juin 2018 dans le Service de Neurologie, Befelatanana. Les données démographiques et cliniques des patients diagnostiqués comme ayant un syndrome parkinsonien étaient collectées. Nous en avons évalué les fréquences et les caractéristiques puis comparé les patients avec Maladie Parkinson idiopathique et les autres syndromes parkinsoniens. Les données étaient traitées par le logiciel R.Résultats: nous avons retenus 104 patients sur 3528, vus dans notre service. Parmi les patients avec un syndrome parkinsonien, 67(64,42%) avaient une maladie de Parkinson idiopathique (MP) et 37 (35,47%) un syndrome parkinsonien autre. L'intervalle moyen entre le début de la maladie et la consultation ou l'hospitalisation dans le service était de 2,5 ans. Pour les MP, l'âge moyen de début était à 58,5 [23; 80] ans, l'âge du diagnostic à 62 [28; 83] ans et la sex-ratio était de 1,97. La médiane de score de Hoehn et Yahr était de 2.0. Les formes de MP étaient tremblantes dans 24(35,42%), mixte 28(41,71%) et akineto-rigide 15(22,38%) des cas. Pour les autres syndromes parkinsoniens, 27(72,97%) étaient des hommes, l'âge moyen de début était à 57,5 [26; 83] ans, l'âge du diagnostic à 59,3 [26; 83] ans, les étiologies étaient dominées par l'Atrophie Multi-Systématisée avec 17/37(46,64%). Les patients atteints d'autres syndromes parkinsoniens avaient plus de troubles cognitifs (p=0,0306) et les MP étaient plus sensible au DOPAMINE (p=0,006).Conclusion: les patients parkinsoniens idiopathiques avaient des caractéristiques différentes de ceux avec autre parkinsonisme. Il y a avaient eu un retard diagnostique comme dans les autres pays en voie de développement
Subject(s)
Madagascar , Parkinson Disease/diagnosis , Parkinson Disease/epidemiology , Parkinson Disease/therapy , Signs and SymptomsABSTRACT
BACKGROUND:Parkinson's disease (PD); with a prevalence of up to 4% in Western countries; appears to be less common in Africa; possibly in part because of genetic factors. African studies investigating the genetic causation of PD are limited. OBJECTIVE:To describe the clinical and genetic findings in a group of black South African patients with PD.METHODS:All black African patients with PD from a tertiary hospital neurology clinic were examined. Symptoms were scored according to the Unified Parkinson's Disease Rating Scale (UPDRS); and patients were classified according to motor features. Genomic DNA was extracted and multiplex ligation-dependent probe amplification was used for detection of copy number variation (CNV) mutations in the known PD-causing genes.RESULTS:Sixteen patients were identified (ages 56 - 82 years). Three had a family history of PD. Classification into motor subtypes showed 44% mixed; 31% akinetic-rigid; and 25% tremor-dominant subtypes. UPDRS scores ranged from 7 to 88; with dementia in 20%. No patient had G2019S LRRK2 and A30P SNCA mutations; and all except one had no CNV mutations in the known PD-causing genes. A female patient (age of onset 50 years; no family history) had a parkin gene heterozygous deletion of exon 4. She had hyperreflexia; bilateral Hoffmann's reflexes; normal plantar responses and no dystonia.CONCLUSION:This group of black African patients showed similar characteristics to patients in Western studies; possibly with a higher proportion having tremor-dominant disease. Genetic analysis showed one parkin gene mutation. The limited knowledge on PD-causing genes and mutations in black populations warrants further studies involving next-generation sequencing approaches
Subject(s)
Cohort Effect , Parkinson Disease/diagnosis , Parkinson Disease/epidemiology , Parkinson Disease/geneticsABSTRACT
Background: This study aimed to determine the frequency of cognitive impairment and depression in our Parkinson's Disease (PD) and their relationship with disease severity and disability. Patients and Methods: A total of 40 PD patients and 40 age-; sex-; and educationally matched controls were studied. The Unified Parkinson Disease Rating Scale (UPDRS) Motor and Activities of Daily Living (ADL) scores and the Hoehn and Yahr (HY) stage were documented. Depression was assessed using the Zung Self-Rating Depression Scale (ZSDS); while cognition was evaluated using a composite score of the mini-mental state examination (MMSE) score and category fluency score. Results: A total of 55 (22/40) of PD and 10 (4 of 40) of controls had depression (P0.001). A total of 60 of PD (24/40) and 5 of controls (2/40) had cognitive impairment (P0.001). Both NMS coexisted in 16 of 40 PD (40) compared with none of the controls (P0.001). UPDRS (motor and ADL) scores and HY stage were significantly worse with impaired ZSDS scores - P 0.001. UPDRS ADL was significantly impaired by the presence of cognitive impairment. Coexisting depression and cognitive impairment were associated with significant worsening of all scores of severity and disability. Conclusion: Cognitive impairment and depression accompany our PD and are related to disability and worsening disease severity
Subject(s)
Case-Control Studies , Cognitive Dysfunction , Depression , Disabled Persons/rehabilitation , Parkinson Disease/diagnosisABSTRACT
Bacground: Non-motor symptoms (NMS) of Parkinson's disease (PD) are a key determinant of health; quality of life (QoL) and societal cost of PD. They are often less appreciated than motor symptoms but are important sources of disability for manyPDpatients. Methods:Literature search was performed using the reference databases Medline; Science Citation Index and EMBASE. The keywords used were 'non-motor symptoms'; Parkinson's disease; olfaction and constipation. Papers discovered by this search were reviewed; as were references cited therein. Results: Contrary to common perception; many NMS of PD occur early in PD and some may even predate thediagnosis of PD that is based on motor signs. These include olfactory deficit; sleep problems such as rapid eye movement behaviour disorder; constipation and the more recently described male erectile dysfunctionThere is compelling evidence that nonmotor symptoms of PD play a dominant role in the QoL and disability of PD patients and the QoLof their 'informal' carers. Effective clinical management of PD therefore demands that these symptoms be identified and to the extent possible treated
Subject(s)
Disease Management , Erectile Dysfunction , Olfaction Disorders , Parkinson Disease/diagnosisABSTRACT
Non-motor symptoms (NMS) of Parkinson's disease (PD) are a key determinant of health; quality of life (QoL) and societal cost of PD. They are often less appreciated than motor symptoms but are important sources of disability for manyPDpatients. Literature search was performed using the reference databases Medline; Science Citation Index and EMBASE. The keywords used were 'non-motor symptoms'; Parkinson's disease; olfaction and constipation. Papers discovered by this search were reviewed; as were references cited therein. Contrary to common perception; many NMS of PD occur early in PD and some may even predate the diagnosis of PD that is based on motor signs. These include olfactory deficit; sleep problems such as rapid eye movement behaviour disorder; constipation and the more recently described male erectile dysfunction.There is compelling evidence that nonmotor symptoms of PD play a dominant role in the QoL and disability of PD patients and the QoLof their 'informal' carers. Effective clinical management of PD therefore demands that these symptoms be identified and to the extent possible treated