Effects of Atomoxetine for the Treatment of Neurogenic Orthostatic Hypotension in Patients With Alpha-synucleinopathies: A Systematic Review of Randomized Controlled Trials and a Focus-Group Discussion

Background@#and PurposeNeurogenic orthostatic hypotension (nOH) is one of the most important nonmotor symptoms in patients with α-synucleinopathies. Atomoxetine is a selective norepinephrine transporter blocker that is a treatment option for nOH. This systematic review and expert focus-group study was designed to obtain evidence from published data and clinical experiences of Korean movement-disorder specialists about the efficacy and safety of atomoxetine for the pharmacological treatment of nOH in patients with α-synucleinopathies. @*Methods@#The study comprised a systematic review and a focus-group discussion with clinicians. For the systematic review, multiple comprehensive databases including MEDLINE, Embase, Cochrane Library, CINAHL, PsycInfo, and KoreaMed were searched to retrieve articles that assessed the outcomes of atomoxetine therapy. A focus-group discussion was additionally performed to solicit opinions from experts with experience in managing nOH. @*Results@#The literature review process yielded only four randomized controlled trials on atomoxetine matching the inclusion criteria. Atomoxetine effectively increased systolic blood pressure and improved OH-related symptoms as monotherapy or in combination with other drugs. Its effects were pronounced in cases with central autonomic failure, including multiple-system atrophy (MSA). Atomoxetine might be a safe monotherapy regarding the risk of supine hypertension. @*Conclusions@#Atomoxetine is an effective and safe option for short-term nOH management, which could be more evident in patients with central autonomic dysfunction such as MSA. However, there is a paucity of evidence in the literature, and data from the focus-group discussion were inadequate, and so further investigation is warranted.

The Effect of Mother’s Self-esteem, Acculturation Stress and Children’s Perceived Parenting Attitude on Self-esteem of Multicultural Adolescents: An Application of the Family Stress Model

Purpose@#This study was conducted to develop a predictive model for self-esteem of adolescents in multicultural families. The study was based on the theory of family stress model and literature review. @*Methods@#This study used some of the data from the 1st year (2011) to the 6th year (2016) of the ‘Multicultural Adolescents Panel Study (MAPS)'.Data analysis was conducted for 1,208 children and 1,208 mothers from the data of the 4th MAPS (2014), which was the first year of the middle school students. The collected data were analyzed using SPSS-WIN Version 20.0 and AMOS Version 20.0. @*Results@#The factors that have influence on the self-esteem of multicultural adolescents are mother’s parenting attitude and mother’s self-esteem. The explanatory power of these variables was 14%. @*Conclusion@#To increase the self-esteem of multicultural adolescents, a program that can positively change the self-esteem and parenting attitudes of multicultural mothers should be developed, and various social supports should be provided for multicultural mothers.

The Grey Zone in Multiple Sleep Latency Test for Diagnosis of Narcolepsy: A Survey of Korean Neurologist

Objectives@#Clinicians often depend on the results of the the multiple sleep latency test (MSLT) for diagnosing narcolepsy, but the diagnosis can be confusing when there is a co-existence of obstructive sleep apnea (OSA). This study is aimed to address the diagnostic tendency and the strategies of treatment for narcolepsy and other hypersomnia in the grey zone. @*Methods@#We performed a web-based survey of Korean neurologists who were interested in narcolepsy and had experience with sleep studies. @*Results@#The results of this survey present their concerns according to the severity of comorbid OSA in analyzing the results of the MSLT. @*Conclusions@#This study also might help by providing the opinions of experienced Korean neurologists for the assessment and management of excessive daytime sleepiness.

Influence of Self-Efficacy, Parenting Stress, and Organizational Culture on Health-Promoting Behavior of Married Nurses / 간호행정학회지

Purpose@#This descriptive study investigated the influence of married nurses’ self-efficacy, parenting stress, and organizational culture on their health-promoting behaviors. @*Methods@#Data were collected from 173 married nurses in G and B metropolitan city; the study was conducted from August to September 2019. Data were analyzed using the independent t-test, one-way ANOVA, Pearson correlation coefficient, and multiple regression with SPSS 18.0. @*Results@#The most significant influencing factors on the health-promoting behavior of the subject were self-efficacy (β=.38, p<.001), followed by parenting stress (β=-.21, p=.002), education (β=-.20, p=.001), perceived health status (β=.19, p=.003) and the overall explanatory power was 42.0%. @*Conclusion@#Based on the results, an intervention program that can increase their self-efficacy and reduce parenting stress is needed, considering education level of married nurses and their perceived health status to be developed.

Human Herpesvirus 6 Meningitis in a Neonatal Case

Incidence of human herpesvirus-6 (HHV-6) infection in the neonatal period has been reported in few cases. HHV-6, commonly responsible for roseola, is known to establish infection during infancy and early childhood. A 14-day-old neonate, presented with a fever of 38.3℃, primarily due to an HHV-6 infection, was admitted to our neonatal intensive care unit. A polymerase chain reaction (PCR) of his cerebrospinal fluid was positive for HHV-6. Additionally, serology for HHV-6 PCR was positive. We believe that HHV-6 can cause infection in febrile newborn infants.

The Effects of Nurses’ Knowledge of Withdrawal of LifeSustaining Treatment, Death Anxiety, Perceptions of Hospice on Their Attitudes toward Withdrawal of Life-Sustaining Treatment / 한국호스피스완화의료학회지

Purpose@#This descriptive study investigated the effects of nurses’ knowledge of withdrawalof life-sustaining treatment, death anxiety, and perceptions of hospice care on their attitudes toward withdrawal of life-sustaining treatment. @*Methods@#Data were collected from 262 nurses at tertiary hospitals, general hospitals, or primary hospitals in Busan, Korea, and statistically analyzed using the t-test, analysis of variance, the Scheffé test, Pearson correlation coefficients, and hierarchical regression analysis. @*Results@#The participants’ scores were 3.68±0.45 (out of 5) for attitudes toward withdrawal of life-sustaining treatment, 0.65± 0.15 (out of 1) for knowledge of withdrawal of life-sustaining treatment, 2.61±0.26 (out of 4) for death anxiety, and 4.06±0.43 (out of 5) for perceptions of hospice care. Furthermore, knowledge of withdrawal of life-sustaining treatment and perceptions of hospice care showed positive correlations with attitudes toward withdrawal of life-sustaining treatment, while death anxiety showed a negative correlation. The most significant factors influencing attitudes toward withdrawal of life-sustaining treatment were perceptions of hospice care, followed by having experienced caring for patients who withdrew life-sustaining treatment, death anxiety, having a spouse, and ethical values, and the overall explanatory power was 43.0%. @*Conclusion@#This study showed that perceptions of hospice were an important fac-tor influencing nurses’ attitudes toward withdrawal of life-sustaining treatment. Therefore,it is necessary to develop and validate educational intervention programs that can improve perceptions of hospice care.

Smoking Cessation, Weight Change, and Risk of Parkinson’s Disease: Analysis of National Cohort Data

Background@#and Purpose: To determine whether the postcessation weight gain modifies the protective effect of smoking on the development of Parkinson’s disease (PD). @*Methods@#This nationwide cohort study included 3,908,687 Korean males aged ≥40 years who underwent at least 2 health checkups biennially between 2009 and 2015. They were grouped into current smokers; quitters with body mass index (BMI) increase, maintenance, and decrease; and never smokers. The occurrence of incident PD was tracked, and Cox proportional-hazard models were used to adjust for potential confounding factors. We also analyzed the impact of weight change regardless of smoking status in the study population. @*Results@#There were 6,871 incident PD cases observed during the 13,059,208 person-years of follow-up. The overall risk of PD was significantly lower in quitters than in never smokers [hazard ratio (HR)=0.78, 95% confidence interval (CI)=0.70–0.86]. The risk of PD was still lower in quitters with BMI increase (HR=0.80, 95% CI=0.65–0.98) and in those with BMI maintenance (HR=0.77, 95% CI=0.68–0.87). This tendency was also observed in quitters with BMI decrease (HR=0.76, 95% CI=0.55–1.06), although it was not as robust as in the other two groups.With respect to weight change alone, BMI increase (HR=1.10, 95% CI=1.02–1.18) but not BMI decrease (HR=1.06, 95% CI=0.98–1.14) significantly increased the PD risk compared to BMI maintenance. @*Conclusions@#Postcessation weight gain in males did not offset the protective impact of smoking on PD development, although overall weight gain predicted an increased risk of PD.

Meteorological Factors Associated with the Number of Emergency Room Patients with Wrist-Cutting Behavior / 정신신체의학

Objectives@#：Although the seasonality of suicide is a well-known phenomenon, little is reported about the seasonality of non-suicidal self-injury. The purpose of this study was to identify the seasonality of wristcutting behavior and to examine its relationship with meteorological factors. @*Methods@#：To identify the presence of seasonality, we investigated whether there was a difference in the average number of visits per month to an emergency room (ER) of an urban hospital for 226 patients with wrist-cutting behavior enrolled between December 2014 and May 2019. To ascertain significant meteorological factors, we used the multiple Poisson regression using generalized additive model with time, monthly temperature, monthly sunshine hour, and atmospheric pressure in the prior month as explanatory variables. @*Results@#：In males, the average number of monthly visits to the ER for wrist cutting behavior differed by month and was the highest in September (male : p=0.048, female : p=0.21, total : p=0.28). As a result of multiple regression analysis, the average number of patients admitted to the ER for wrist cutting behavior was related to the interaction between atmospheric pressure in the prior month and temperature in males (p=0.010), and showed a positive correlation with sunlight in females [p=0.044 , β=4.70×10-3 , 95% CI=(1.19×10-4 , 9.27×10-3 )]. @*Conclusions@#：Wrist cutting behavior shows seasonality in male, which is associated with changes in meteorological variables.

Meteorological Factors Associated with the Number of Emergency Room Patients with Wrist-Cutting Behavior / 정신신체의학

Objectives@#：Although the seasonality of suicide is a well-known phenomenon, little is reported about the seasonality of non-suicidal self-injury. The purpose of this study was to identify the seasonality of wristcutting behavior and to examine its relationship with meteorological factors. @*Methods@#：To identify the presence of seasonality, we investigated whether there was a difference in the average number of visits per month to an emergency room (ER) of an urban hospital for 226 patients with wrist-cutting behavior enrolled between December 2014 and May 2019. To ascertain significant meteorological factors, we used the multiple Poisson regression using generalized additive model with time, monthly temperature, monthly sunshine hour, and atmospheric pressure in the prior month as explanatory variables. @*Results@#：In males, the average number of monthly visits to the ER for wrist cutting behavior differed by month and was the highest in September (male : p=0.048, female : p=0.21, total : p=0.28). As a result of multiple regression analysis, the average number of patients admitted to the ER for wrist cutting behavior was related to the interaction between atmospheric pressure in the prior month and temperature in males (p=0.010), and showed a positive correlation with sunlight in females [p=0.044 , β=4.70×10-3 , 95% CI=(1.19×10-4 , 9.27×10-3 )]. @*Conclusions@#：Wrist cutting behavior shows seasonality in male, which is associated with changes in meteorological variables.

The Influence of Education Level on Tinnitus and Quality of Life in Korean Adults / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES@#We aimed to evaluate the effect of the level of education on the prevalence of tinnitus and quality of life (QoL) in the Korean population. SUBJECTS AND METHOD: Our study included 3155 participants from a representative sample. Tinnitus was measured using questionnaires that evaluated perception of ringing, buzzing, roaring, or hissing sounds. Participants were asked to indicate “Yes” or “No” to these questions. Participants who felt that the sensation was “A little annoying” or “Very annoying” were considered to have moderate or severe tinnitus, respectively. Hearing thresholds were measured using an automatic audiometer. QoL was evaluated using the EuroQoL (EQ) scale. @*RESULTS@#The number of participants in the low, middle, and high education groups were 1521, 967, and 667, respectively. Participants with any degree of tinnitus or moderate to severe tinnitus increased as the level of education decreased. Multivariate logistic regression analysis showed that the low education group had significantly higher odds ratios compared to the middle or high education groups for moderate to severe tinnitus. Abnormal EQ 5-dimensions (EQ-5D) were higher in participants with tinnitus and a low level of education. For participants, univariate and multivariate analyses showed EQ-5D index and EQ-visual analog scale in the low education group were lower than that in the other groups. @*CONCLUSION@#Our study showed that low education level was associated with moderate to severe tinnitus in the Korean adult population. Participants with tinnitus and a low level of education had poorer QoL than those with tinnitus and a high level of education.

Effect of Delayed Elevation of Thyrotropin on Feeding Intolerance in Very Low Birth Weight Infants

PURPOSE: We investigated the effect of delayed elevation of thyrotropin (TSH) (deTSH) on gastrointestinal motility in very low birth weight infants (VLBWI). METHODS: This study retrospectively investigated 228 premature VLBWI aged ≥4 weeks with normal neonatal TSH screening test results and free serum thyroxine levels. Infants with serum TSH levels ranging from 5 to 10 µIU/mL were categorized as the deTSH group (n=76), when TSH was measured at 4 (n=53), 8 (n=20), or 12 (n=3) weeks of age. Serum TSH levels in the control group (n=152) were <5 µIU/mL. Multivariate logistic regression analysis was used to determine the risk factors for the development of deTSH. Covariance analysis was used to analyze the relationship between deTSH and gastrointestinal motility. RESULTS: The mean gestational age and birth weight were 29.11±2.25 weeks and 1,157.4±218.0 g, respectively. Risk factors affecting deTSH were dopamine administration (odds ratio [OR], 8.71; 95% confidence interval [CI], 1.80 to 42.05; P=0.007) and operation time (OR, 6.95; 95% CI, 1.43 to 33.75; P=0.016) when the cumulative operating time was ≥1 hour. The mean±standard deviation (SD) duration of a nil per os (NPO) status was significantly higher in the deTSH (99.57±134.99 hours) than in the control group (37.25±59.02 hours) (P from analysis of covariance [ANCOVA]=0.001). The mean±SD duration (33.84±22.34 days) of total parenteral nutrition (TPN) was considerably longer in the deTSH group than in the control group (27.68±13.08 days) (P from ANCOVA=0.003). CONCLUSION: Clinicians must consider deTSH in VLBWI showing feeding intolerance with a prolonged NPO and TPN status.

A Case of Recurred Herpes Zoster Oticus Concomitantly Occurred with Zoster Laryngopharyngitis Without Vocal Cord Palsy

Herpes zoster oticus is one of complication of varicella zoster virus (VZV) reactivation in the geniculate ganglion of the facial nerve, which is the most common presentation of herpes zoster in the head and neck region. However, VZV infection of the larynx has rarely been described in the literature compared with Herpes zoster oticus. Moreover, zoster laryngopharyngitis simultaneously occurred with recurred Herpes zoster oticus which has no newly developing motor dysfunction has not been reported yet. Therefore, these diseases are difficult to diagnose due to its rareness. However, distinctive appearances such as unilateral herpetic mucosal eruptions and vesicles are useful and essential in making a quick and accurate diagnosis. Thus, we report a characteristic case of zoster laryngopharyngitis simultaneously occurred with recurred Herpes zoster oticus not accompanied by any newly developing motor palsy.

The Influence of Education Level on Tinnitus and Quality of Life in Korean Adults / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: We aimed to evaluate the effect of the level of education on the prevalence of tinnitus and quality of life (QoL) in the Korean population. SUBJECTS AND METHOD: Our study included 3155 participants from a representative sample. Tinnitus was measured using questionnaires that evaluated perception of ringing, buzzing, roaring, or hissing sounds. Participants were asked to indicate “Yes” or “No” to these questions. Participants who felt that the sensation was “A little annoying” or “Very annoying” were considered to have moderate or severe tinnitus, respectively. Hearing thresholds were measured using an automatic audiometer. QoL was evaluated using the EuroQoL (EQ) scale. RESULTS: The number of participants in the low, middle, and high education groups were 1521, 967, and 667, respectively. Participants with any degree of tinnitus or moderate to severe tinnitus increased as the level of education decreased. Multivariate logistic regression analysis showed that the low education group had significantly higher odds ratios compared to the middle or high education groups for moderate to severe tinnitus. Abnormal EQ 5-dimensions (EQ-5D) were higher in participants with tinnitus and a low level of education. For participants, univariate and multivariate analyses showed EQ-5D index and EQ-visual analog scale in the low education group were lower than that in the other groups. CONCLUSION: Our study showed that low education level was associated with moderate to severe tinnitus in the Korean adult population. Participants with tinnitus and a low level of education had poorer QoL than those with tinnitus and a high level of education.

Research Areas and Trends in Articles on Pediatric and Adolescent Tuberculosis in Korea

PURPOSE: Despite the decline in tuberculosis (TB) incidence and mortality rates in the Republic of Korea through a national TB control program, TB remains one of the most critical infectious diseases in Korean children. We investigated the trends and research areas of published articles on TB in Korean children and adolescents. METHODS: In 6 Korean and overseas databases, we searched titles and abstracts including “tuberculo*” or “TB,” “child*” or “adolescen*” or “neonat*” or “infant*” or “pediatric*,” and “korea*.” The publication type, publication year, research areas, journal title, and research subjects were analyzed. RESULTS: Out of the 257 searched documents, 120 papers were included in the analysis. Of these, 82 were original articles (68.3%), 33 case reports (27.5%), 4 review articles (3.3%), and 1 guideline (0.8%). In the original articles, the most common subject of studies was the clinical characteristics of patients with TB (36.6%), followed by diagnostics (29.3%), contact investigations (9.8%), epidemiology (6.1%), treatment (4.9%), vaccine (3.6%), latent TB infection (3.6%), complications (3.6%), and surveys on perception of TB (2.4%). From 1962, 4 articles were published in the 1960s, 10 articles in the 1970s, 11 articles in the 1980s, 22 articles in the 1990s, 26 articles in the 2000s, and 47 articles since 2010. CONCLUSIONS: The amount of research on TB in Korean children has increased over the past 5 decades; however, it has mainly focused on the clinical characteristics and diagnostics. Research in different areas, such as treatment and vaccine, is needed in the future.

Feasibility and Therapeutic Effects of a Novel Magnet-Based Device for Hand Rehabilitation: a Pilot Study

The purpose of this study was to investigate the feasibility and therapeutic effects of a novel concept hand rehabilitation device based on magnetics for subacute stroke patients with hand motor impairment. We developed an end effector type device that can induce various movements of the fingers in accordance with a magnetic field direction using electromagnets and permanent magnets. Subacute stroke patients with hand motor impairments were recruited and divided into two rehabilitation groups. Conventional rehabilitation therapies were also conducted equally in both groups. Active-assisted training of the affected hand was additionally administered for 30 minutes per day for 4 weeks using the developed equipment in the intervention group. Hand motor function and the activities of daily living were evaluated before and after the intervention. The Manual Function Test score significantly increased in the intervention group after 4 weeks of treatment (p = 0.039), and there was a significant difference in the degree of improvement between the two groups (p = 0.016). The scores of the motor Fugl-Meyer Assessment of the upper limb, the Wolf Motor Function Test score and time, and the motor Functional Independence Measure also improved in both groups (all p < 0.05). In addition, the patients in the intervention group showed greater improvements in these outcome measures than those in the control group did (all p < 0.05). An adjuvant rehabilitation therapy using a magnetic based device can be helpful to improve the hand motor function and activities of daily life in subacute stroke patients.

Diagnostic distal 16p11.2 deletion in a preterm infant with facial dysmorphism

The 16p11.2 microdeletion has been reported in patients with developmental delays and intellectual disability. The distal 220-kb deletion in 16p11.2 is associated with developmental delay, autism spectrum disorder, epilepsy, and obesity at a young age. We have reported a case of distal 16p11.2 deletion syndrome in a preterm infant with unusual facial morphology and congenital heart disease. We suggest using chromosome microarray analysis to detect chromosomal abnormalities in newborns, especially preterm infants with unusual morphologies.

Pontine Hypoplasia and Cri-du-chat Syndrome in a Preterm Infant / 고신대학교의과대학학술지

A premature infant with gestational age 36⁺⁴ weeks was admitted with respiratory distress syndrome. Surfactant and ventilation were firstly done to improve his respiration. After extubation, weak, high-pitched cry and asymmetric face with micrognathia and hypertelorism were detected. Therefore, cytogenetic analysis was performed, and his karyotype was 46, XY, del(5) (p14p15.33). Pontine hypoplasia was detected on cranial magnetic resonance imaging (MRI). Therefore, karyotyping and cranial MRI should be performed in case of preterm infants with suspicion of Cri-du-chat syndrome (CdCS).

Association between Impulsivity and Medical Lethality of Suicide Attempts among Suicide Attempters

OBJECTIVES: Although impulsivity has long been thought as an important factor influencing suicidal behaviors, it is unknown whether impulsivity increases the risk of dying from suicidal behaviors and what specific component among constructs of impulsivity contributes to the risk of dying among suicide attempters. METHODS: To elucidate the association between impulsivity and medical lethality of suicide attempt among suicide attempters, we consecutively recruited 46 suicide attempters who visited an emergency room of a general hospital located in a metropolitan area, Seoul, Republic of Korea, due to suicide attempts and consented to participate in this study. Then we assessed medical lethality with the Beck Lethality Scale (LS) and impulsivity with the Korean version of the Barratt Impulsiveness Scale-11-Revised (BIS). Demographic variables were obtained from medical records and structured social work reports for suicide attempters. RESULTS: Although total scores of the BIS did not correlate with LS scores, only the scores of self-control, that is one of the Barret's six theoretical constructs of impulsivity in which the higher score indicates less self-control and more impulsivity, had a significant positive correlation with scores of LS (p = 0.003). The association remained significant after adjusting for variables known to affect suicide lethality such as job status, recent alcohol consumption, diagnosis of depressive disorders, and having a plan for suicide (β = 0.429, p = 0.009). CONCLUSIONS: Not impulsivity in general, but poor self-control, in particular, predicts lethal suicidal behaviors among suicide attempters. The degree of self-control should be evaluated when assessing patients with elevated suicide risk, and proper measures should be installed to prevent possible future lethal suicide attempts.

Causes of Transfer of Neonates (Born after ≥34 Weeks of Gestation) to the Neonatal Intensive Care Unit Owing to Respiratory Distress and their Clinical Features

PURPOSE: Respiratory morbidity is the most common problem among neonates admitted to neonatal intensive care units. Therefore, the aim of this study was to make a differential diagnosis between transient tachypnea of the newborn (TTN), respiratory distress syndrome (RDS), and pneumonia through comparison of clinical features and test results. METHODS: This retrospective study was conducted in 86 infants with TTN, RDS, or pneumonia. These were infants who had respiratory distress, were born after ≥34 weeks of gestation, and transferred to the neonatal intensive care unit of Kosin University Gospel Hospital between June 1, 2011 and June 30, 2016. RESULTS: The numbers (percentage) of infants with TTN, RDS, and pneumonia were 51 (59.3%), 20 (23.3%), and 15 (17.4%), respectively. Late-preterm and early-term newborns accounted for 65.1% of the infants. Tachypnea was observed in 74.4% of the neonates. The median age at admission was 4 hours (0 to 116) after birth. The infants with RDS had significantly lower birth weights, pH levels, base excess and oxygen saturation levels at admission, longer duration of total ventilator therapy, and hospital stay than those in the other two groups. The infants with pneumonia showed significantly high initial high-sensitivity C-reactive protein levels and significant chest radiographic findings. CONCLUSION: Early differential diagnosis for TTN, RDS, and pneumonia is challenging because they show similar respiratory symptoms at an early stage. Clinical features and test results can be used to determine the etiology of respiratory distress and early antibiotic treatment.

Amantadine and the Risk of Dyskinesia in Patients with Early Parkinson's Disease: An Open-Label, Pragmatic Trial

OBJECTIVE: We examined whether amantadine can prevent the development of dyskinesia. METHODS: Patients with drug-naïve Parkinson's disease (PD), younger than 70 years of age and in the early stage of PD (Hoehn and Yahr scale < 3), were recruited from April 2011 to December 2014. The exclusion criteria included the previous use of antiparkinsonian medication, the presence of dyskinesia, significant psychological disorders, and previous history of a hypersensitivity reaction. Patients were consecutively assigned to one of 3 treatment groups in an open label fashion: Group A-1, amantadine first and then levodopa when needed; Group A-2, amantadine first, dopamine agonist when needed, and then levodopa; and Group B, dopamine agonist first and then levodopa when needed. The primary endpoint was the development of dyskinesia, which was analyzed by the Kaplan-Meier survival rate. RESULTS: A total of 80 patients were enrolled: Group A-1 (n = 27), Group A-2 (n = 27), and Group B (n = 26). Twenty-four patients were excluded from the analysis due to the following: withdrawal of amantadine or dopamine agonist (n = 9), alternative diagnosis (n = 2), withdrawal of consent (n = 1), and breach in the protocol (n = 12). After exclusion, 5 of the 56 (8.93%) patients developed dyskinesia. Patients in Group A-1 and A-2 tended to develop dyskinesia less often than those in Group B (cumulative survival rates of 0.933, 0.929, and 0.700 for A-1, A-2, and B, respectively; p = 0.453). CONCLUSION: Amantadine as an initial treatment may decrease the incidence of dyskinesia in patients with drug-naïve PD.