Levodopa induced motor complications in Thai Parkinson's disease patients.

BACKGROUND: Long-term levodopa usage in Parkinson's disease (PD) patients is known to cause several motor complications. It may be related to several factors such as levodopa dosage, duration of treatment and severity of disease. OBJECTIVE: To study the prevalence of levodopa motor complications and associated factors in Thai Parkinson's disease patients. MATERIAL AND METHOD: The authors prospectively collected baseline characteristics of PD patients, details of treatment and complications from 3 hospitals in various parts of Thailand. These patients were diagnosed by UK PD Brain Bank criteria. RESULTS: A total of 154 patients aged 68.1 +/- 9.5 years were recruited. Age of onset was 61.2 +/- 9.8 years. Most patients were in Hoehn-Yahr stage 1-3. The common clinical features were bradykinesia, rigidity and resting tremor Treatments were levodopa (98.1 per cent), anticholinergic (29.9 per cent), dopamine agonists (26 per cent) and COMT inhibitor (9.1 per cent). Eighty-five per cent of the patients had excellent response to levodopa. However, 25 per cent of patients developed motor complications, which were wearing off (79 per cent), on-off fluctuation (45 per cent), freezing (42 per cent), morning dyskinesia (10.5 per cent) and permanent dyskinesia (23.7 per cent). Twelve patients developed severe levodopa induced chorea. Factors associated with levodopa side effects were earlier age of onset, long duration of disease, advanced stage, higher levodopa dosage and long duration of levodopa treatment. In the present study, age of onset was inversely correlated with H-Y stage, while dosage of levodopa was positively correlated with H-Y stage but inversely correlated with lower ADL score, which may be due to advanced disease state. CONCLUSION: Levodopa motor complications are common in Thai PD patients. Wearing off on-off fluctuation and freezing are common forms of motor complications.

Seizure-related injuries in northeast Thailand.

OBJECTIVE: The authors aimed to assess the frequency, characteristics, and risk of seizure-related injuries from traffic accidents, near-drowning, burns, fractures, head and soft tissue injuries. MATERIAL AND METHOD: Attending physicians assisted 300 consecutive seizure patients to complete a questionnaire. The types and frequency of injuries were then expressed in terms of the type of seizure and related activity. RESULTS: The male (154) and female (146) patients were between 13 and 91 years of age (mean, 36.27 +/- 14.55). The seizure types comprised of Generalized Tonic-Clonic (GTC) (26%), secondary GTCs (21%) and complex partials (19%). Secondary causes accounted for 34% of seizures, and post-stroke was the most common (25.5%). The total number of seizure events per year was 8,525 and of these 7,306 included a fall with soft tissue injury (70%), head injury (22%), near-drowning (3%), burns (3%) and fracture or dislocation (1%). The ranking of significant risk factors for injuries was: 1) GTC seizure; 2) seizure with a fall; and, 3) number of seizures. CONCLUSION: Seizure-related injuries are common among Thai epileptic patients; thus, consistent treatment and education about the risk of injury would protect patients.

Prevalence of hypovitaminosis D in elderly women living in urban area of Khon Kaen province, Thailand.

This study included 106 volunteer elderly women who were living in an urban area of Khon Kaen province. The mean (+/-SD) of age and of serum 25(OH)D concentration of these elderly women was 69.42 (+/-6.77) years and 33.32 (+/-7.14) ng/ml respectively. There was a significant inverse relationship between serum 25(OH)D and PTH concentration. Serum PTH concentration started to increase steeply when serum 25(OH)D concentration declined < or = 35 ng/ml and increased significantly when serum 25(OH)D concentration declined < or = 30 ng/ml. Furthermore mean (+/-SD) of serum 25(OH)D concentration in the group of osteopenia and osteoporosis of femoral neck was 35.25 (+/-6.77) and 30.92 (+/-6.49) ng/ml respectively. As a result, the prevalence of hypovitaminosis D in these selected elderly women would be at least 34.9 per cent, or as high as 65.1 per cent.

Different mechanism of bone loss in ageing women and men in Khon Kaen Province.

The changes of vitamin D status and biochemical markers of bone turnover have been reported with aging. In this study we determined age-related levels of vitamin D and biochemical markers of bone turnover in the general adult population between the ages of 20 and 84 years who were living in Khon Kaen province in northeastern Thailand. Serum 25 hydroxyvitamin D was determined as an indicator of vitamin D status. Serum total alkaline phosphatase and N-terminal mid fragment osteocalcin were measured as biochemical markers of bone formation and serum C-terminal fragment of type I collagen was measured as a marker of bone resorption. The levels of serum 25 hydroxyvitamin D were high in the Khon Kaen population. Men had higher levels of 25 hydroxyvitamin D than did women. However, there were no changes with age in either sex. In women, all biochemical markers of bone turnover increased with age after the fourth decade. The sharp increase was observed in the sixth decade which was around the menopausal age. In contrast, in men all biochemical markers of bone turnover except serum total alkaline phosphatase had a tendency to decrease with age. CONCLUSION: There was no evidence of vitamin D deficiency in a Khon Kaen population. In addition, serum vitamin D levels did not decline with ageing. Women and men showed different changes of biochemical markers of bone turnover with ageing indicating gender difference in the pathogenesis of osteoporosis.