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Background & Objective: Non-Motor Symptoms (NMS) are common in Parkinson’s disease (PD). While prevalence of each NMS in Thai PD patients is unknown, these NMS might have an impact on patients’ wellbeing. The aim of this study is to identify the prevalence, pattern and impact of NMS on the quality of life in Thai PD patients. Methods: A cross-sectional study in 115 PD patients was conducted at Thammasat University hospital. Subtype of PD, Schwab & England activity of daily living (ADL scale), Unified Parkinson’s Disease Rating Scale (UPDRS) motor score and the modified Hoehn & Yahr (H&Y scale) were recorded. NMS and quality of life were assessed using Thammasat University Non-Motor Symptoms Questionnaire (TU-NMSQuest) and Parkinson’s Disease Questionnaire-8 (PDQ-8). Results: All patients reported at least one NMS. A mean number of 15.94 ± 6.48 NMS was reported by each patient. Nocturia (79.1%), urinary urgency (73%), and fatigue (71.3%) were the most prevalent NMS. Significant correlations were observed between TU-NMSQuest and UPDRS motor score, H&Y scale, ADL scale, subtype of PD, and PDQ-8. Conclusion: NMS are common and have a significant impact on the quality of life in PD patients. Advanced disease stage, poorer motor or ADL function, and non-tremor dominant subtype are associated with a higher number of NMS and lower quality of life in Thai PD patients.
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Background and Objective: Status epilepticus (SE) is an emergency condition with high mortality rate, particularly in patients whose treatment is delayed. This is to describe clinical characteristics, treatment process, and outcome and to determine clinical parameters which impact the SE outcome. Methods: This was a descriptive study in 60 SE patients admitted between 2004-2011 to the Thammasat University Hospital, Pathumthani, Thailand. The correlation between the outcome and clinical parameters was analyzed. Results: Sixty SE patients were included (38 men; 22 women), mean age 55 years. Generalized convulsive status epilepticus was the most common (55 events, 91.6%). Forty-three patients (71.7%) had previous diagnosis of neurological disorders. AED withdrawal and old ischemic stroke were the common causes of SE. The mean time from onset to treatment was 163.4 minutes and door to needle time was 19.8 minutes. Diazepam and phenytoin were most commonly used as first and second line AED. Eight patients (13%) developed refractory SE. The mortality rate was 25%, with 28.3% in total dependent state, 20% had incomplete recovery, and 26.7% had complete recovery. The risk factors which correlated with death were old age, long duration of seizure and coma. Conclusion: In this cohort from north Bangkok and central Thailand, the mortality and morbidity rates were high. More efforts should be taken to address the long delay to treatment, and other correctable factors.
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Background and Objective: Status epilepticus (SE) is an emergency condition with high mortality rate, particularly in patients whose treatment is delayed. This is to describe clinical characteristics, treatment process, and outcome and to determine clinical parameters which impact the SE outcome. Methods: This was a descriptive study in 60 SE patients admitted between 2004-2011 to the Thammasat University Hospital, Pathumthani, Thailand. The correlation between the outcome and clinical parameters was analyzed. Results: Sixty SE patients were included (38 men; 22 women), mean age 55 years. Generalized convulsive status epilepticus was the most common (55 events, 91.6%). Forty-three patients (71.7%) had previous diagnosis of neurological disorders. AED withdrawal and old ischemic stroke were the common causes of SE. The mean time from onset to treatment was 163.4 minutes and door to needle time was 19.8 minutes. Diazepam and phenytoin were most commonly used as first and second line AED. Eight patients (13%) developed refractory SE. The mortality rate was 25%, with 28.3% in total dependent state, 20% had incomplete recovery, and 26.7% had complete recovery. The risk factors which correlated with death were old age, long duration of seizure and coma. Conclusion: In this cohort from north Bangkok and central Thailand, the mortality and morbidity rates were high. More efforts should be taken to address the long delay to treatment, and other correctable factors.
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Knowledge in neuropathic pain has grown rapidly during the past few years. Central and peripheral sensitization is still believed to be the main pathophysiology. New evidence suggests many potential new molecular targets and mechanisms, such as cytokines, lysophosphatidic acid and ion channels. Microglia and astrocyte activation leads to dysregulation of infl ammatory cytokines and pain signaling. Many subtypes of the sodium channel have been shown to be the culprit for both congenital and acquired pain syndromes, especially small fi ber neuropathy. Lysophosphatidic acid is thought to act as an initiator of neuropathic pain, along with other mediators. Animal models of neurodegenerative diseases and chemotherapy-induced neuropathy reaffi rm the role of nociceptor degeneration and cytoskeletal breakdown in peripheral neuropathy. With better understanding of its mechanism, it may lead to new therapeutic targets. Recent trials of new medications, new formulations or new indication of old drugs have shown promising data. We can look forward to better treatment of this debilitating symptom in the near future.
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Background: Parkinson's disease (PD) is a neurobehavioral disorder defined clinically by its motor symp toms alone. Sleep disorders are behavioral problems that are common and under recognized. Inaddition, these problems have impact on patient well being and quality of life.Objective: To evaluate the prevalence of sleep-related problems in patient with PD and its associationwith the quality of life.Material and Method: A cross sectional study in 74 PD patients was conducted at Thammasat University Hospital.Sleep problems and quality of life were assessed by the Modified Parkinson's Disease SleepScale (MPDSS) and Parkinson's Disease Questionnaire (PDQ-8)Results: Sleep-related problems were found in 97% of PD patients. Nocturia, sleep initiation and maintenance problem and snoring were common. Sleep-related problems detected by MPDSS had significant correlation with PDQ-8 scores (p
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Neuromuscular complications from heroin abuse are rare. Most cases are caused by focal nerve compression and recover spontaneously. We report a 22-year-old Caucasian man who presented with shoulder pain and left arm weakness after recovering from coma due to heroin and phenobarbitone overdose. Electrophysiological fi ndings were consistent with complete brachial plexopathy. Investigations did not reveal any other causes. Follow up examination at 4 weeks showed minimal improvement of his weakness. This case highlights an unusual complication of heroin abuse. Its pathophysiology remains unknown. Although heroin abuse is now less common, neurologists should be aware of this condition
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Objective: To develop and examine the effectiveness of individual home rehabilitation program on the mirror neuron concept for ischemic stroke patients. Material and Method: This is a prospective randomized trial (RCT) of forty patients with recent ischemic stroke. After having been discharged from their acute stroke care, they were randomly assigned to receive either a home rehabilitation program (intervention group) or a usual care (control group) for 3 months. We collected outcome data over 3 months after discharge from the hospital. The Barthel index (BI), the Modified Rankin Scale (MRS) and the health-related quality of life by utility index (EQ-5D) were measured for function, disability, and quality of life respectively every month for 3 consecutive months. Results: At 3 months, the BI was more significantly improved in the intervention group than the control group: 59.34, (95% CI, 36.99 to 81.69), with the absolute risk reduction (ARR) 95% (95% CI, 82.20% to 107.80%). The results were similar regarding MRS. It showed a benefit in reducing disability, with a NNT of 2 (95% CI, 0.9 to 1.2). The utility index was more significantly improved in the intervention group than the control group: 0.34, (95% CI, 0.10 to 0.57). In addition, when we compared the mean scores and standard errors for the 5 dimensions (mobility, self-care, usual activities, pain/discomfort and anxiety/depression) of the EQ-5D at 3 months, all dimensions of EQ-5D in the intervention group were more significantly for quality of life and generic health status than the control group. There was no significant interaction between baseline characteristics and treatment outcome. Conclusions: Early home rehabilitation program for ischemic stroke patients in the first 3-month period provided significantly better outcomes in improving function, reducing disability and increasing quality of life than usual care.