Pattern and treatment of Parkinson’s disease at different health care levels in Bangladesh: a hospital based survey

Background:Parkinson’s disease (PD) is a condition in which part of the brain becomes progressively damaged over many years. This study represents the pattern of Parkinson’s disease and help to identify various drugs which are being used at different health care levels in Bangladesh.Methods:Cross-sectional technique was applied as study design in this research work. We accessed the patients with formulated questionnaire of the Department of Neuroscience of National Institute of Neurosciences and Hospital, Dhaka Medical College and Hospital and Bangabandhu Sheikh Mujib Medical University (BSMMU) for data collection from January 2017 to August 2019.100 patients were selected in the ages between 25-80 years, among them 66were male and 34females.Results:A total number of 100 Parkinson’s disease patients (male 66%, female 34%) were recruited for this study. Genetic factor (56%) is the main cause of PD found in this study. Among various symptoms, the prominent symptoms were voice disorders (96%), slowness of movement (90%), mask-like face expression (86%), tremor (80%), sensory and sleep difficulties (78%), excessive sweating (60%) and insomnia (56%). It was observed that along with physiotherapy, drugs used to manage PD were levodopa (14%), carbamazepine (12%), quetiapine (12%), haloperidol (11%), pramipexole (10%), trihexyphenidyl HCl (10%), carbidopa (8%), amlodipine (8%)andclonazepam (8%).Conclusions:Disgrace exists in the personal life and social context of the PD patients which also unfavourably affects their psychosocial aspects of life. Our population-based data provide evidence for a protective effect of Parkinson’s disease in our country.

Main determinants of physical activity levels in individuals with Parkinson's disease / Fatores determinantes do nível de atividade física de indivíduos com doença de Parkinson

ABSTRACT This study analyzed the relationship between patient characteristics, factors associated with Parkinson’s disease (PD), and physical activity level of individuals affected by the disease. Forty-six volunteers with mild-to-moderate idiopathic PD were assessed using sections II/III of the Unified Parkinson’s Disease Rating Scale and their motor functions were classified according to the modified Hoehn and Yahr (HY) scale. Data such as age, disease duration, the Human Activity Profile (HAP), the Fatigue Severity Scale were collected. Lower limb bradykinesia and clinical subtypes of PD were defined. Two models that explained 76% of the variance of the HAP were used. The first comprised age, ability to perform activities of daily living (ADL), and the HY scale; the second comprised age, ability to perform ADL, and lower limb bradykinesia. Possible modifiable factors such as the ability to perform ADL and lower limb bradykinesia were identified as predictors of physical activity level of individuals with PD.

RESUMO Este estudo analisou a relação entre características dos pacientes, fatores associados com a doença de Parkinson (DP) e nível de atividade física de indivíduos afetados pela doença. Quarenta e seis voluntários com DP leve a moderada foram avaliados usando a Escala de Avaliação Unificada da Doença de Parkinson (UPDRS), e classificados de acordo com a Escala de Hoehn e Yahr modificada (HY). Dados como idade, duração da doença, Perfil de Atividade Humana (PAH), Escala da Severidade da Fatiga (FSS) foram coletados. Bradicinesia de membros inferiores e subtipos clínicos foram definidos. Dois modelos que explicaram 76% da variância do PAH foram observados. O primeiro compreende idade, habilidade de realizar Atividades de Vida Diária (AVD) e a escala de HY modificada; e o segundo compreende idade, habilidade de realizar AVD, e bradicinesia. Fatores modificáveis como a habilidade de realizar AVD e bradicinesia foram identificados como preditores do nível de atividade física de indivíduos com DP.

Movement Disorders in Non-Wilsonian Hepatic Cirrhotic Patients: The Subgroup Analysis of Various Phenotypes and Associated Risk Factors

OBJECTIVE: The aim of this subgroup analysis was to identify the risk factors associated with the development of various movement disorder phenotypes. METHODS: Eighty-three non-Wilsonian cirrhotic patients with abnormal movements were allocated into the following groups: intention tremor, bradykinesia, Parkinsonism, and abnormal ocular movements. These movement types were considered the primary outcomes as there was a sufficient sample size. Researchers took into consideration the gender, etiologies of cirrhosis, cirrhosis-related complications, hepatic encephalopathy, medical illness, and some neurological deficits as potential factors associated with these movement disorders. RESULTS: The male gender (p = 0.002) and alcoholic cirrhosis (p = 0.005) were significant factors for the prevalence of intention tremors. In bradykinesia, hepatic encephalopathy was highly statistically significant (p < 0.001), and females more commonly developed bradykinesia (p = 0.04). The Parkinsonism features in this study were confounded by hyperlipidemia (p = 0.04) and motor or sensory deficits (p = 0.02). Jerky pursuits and a horizontal nystagmus were detected. Jerky pursuits were significantly related to hepatic encephalopathy (p = 0.003) and bradykinesia, but there were no factors associated with the prevalence of nystagmus other than an intention tremor. CONCLUSIONS: The association of alcoholic cirrhosis with the development of intention tremor indicates that the persistent cerebellar malfunction in cirrhotic patients is due to alcohol toxicity. The slowness of finger tapping and jerky pursuit eye movements are significantly associated with hepatic encephalopathy. Thus, further studies are needed to evaluate the diagnostic value of these two signs for an early detection of mild hepatic encephalopathy.

Effect of ethanolic extract of Coriandrum sativum L. on tacrine induced orofacial dyskinesia.

The effect of ethanolic extract of Coriandrum sativum L. seeds (100, 200 mg/kg) was studied on tacrine induced orofacial dyskinesia. Tacrine (2.5 mg/kg, i.p.) treated animals were observed for vacuous chewing movements (VCM), tongue protrusions (TP) and orofacial bursts (OB) for 1 h followed by observations for locomotor changes and cognitive dysfunction. Sub-chronic administration of Coriandrum sativum L. seed extract (E-CS) (100, 200 mg/kg, p.o., for 15 days significantly (P <0.05) decreased the tacrine induced VCM, TP and OB; and also significantly (P <0.05), increased locomotion and cognition compared to the tacrine treated group. Biochemical analysis revealed that tacrine administration significantly (P <0.05) decreased the levels of superoxide dismutase (SOD), Catalase (CAT), glutathione reductase (GSH) levels and also significantly (P <0.05) increased lipid peroxidation (LPO) as an index of oxidative stress, whereas sub-chronic administration of E-CS significantly (P <0.05) improved the antioxidant enzyme (i.e. SOD, CAT, and GSH) levels and also significantly (P <0.05) decreased lipid peroxidation (LPO). The results have demonstrated the protective role of ethanolic extract of Coriandrum sativum. L against tacrine induced orofacial dyskinesia.

Parámetros cinemáticos en la prueba de Tapping en pacientes con enfermedad de Parkinson / Cinematic parameters in the Tapping test in patients with Parkinson's disease

Motor slowness is the most characteristic motor deficit in Parkinson Disease (PD). The tapping test is a timed motor performance task which has been widely used in evaluation of PD. We study kinematics parameters of tapping test in PD and health control. Methods: Subjects consisted on 12 patients (2 women) with Parkinson's disease (PD) and 6 healthy control subjects (2 women). The mean age 63 +/- 9.7years PD and 64.8 +/- 13.3 years control. Duration of disease was 5.8 +/- 4.1 years. All patients were on levodopa medication. Procedures: All participants performed repetitive Hand/Arm movements between two points placed 25 cm apart horizontally for 20 successive taps ("as fast as possible"). The test was performed independently for each hand. Parkinson patients performed under the best ON condition. We assessed patients clinically using the motor section of the Unified Parkinson Disease Rating Scale (UPDRS). Informed consent was obtained. Apparatus: One standard video camera positioned perpendicularly from two target points recorded movement and referential xy system. A light reflective marker was attached to middle finger. The middle finger marker was manually digitized at a rate of 30 Hz using Kinematics Analysis software. Statistical analysis Kuskal-wallis one way analysis of variance, r spearman correlation. A p value < 0.05 was considered statistically significant. Results: Median Velocity in normal control was 94 +/- 11 cm/s and in PD was 67 +/- 15 cm/s (p < 0.001). Maximal velocity in normal control was 198 +/- 20 cm/s and in PD was 143 +/- 33 cm/s (p < 0.001). Median acceleration in normal control was 1630 +/- 331 cm/s2 in PD was 966 +/- 285 cm/s2 (p < 0.001). Median Movement amplitude in Y plane; in normal control was 28 +/- 5 cm and in PD was 21 +/- 8 cm (p < 0.01). Median Movement amplitude in Y plane correlated significantly with bradykinesia summary score (r = -0.59, p < 0.001)...

La bradicinecia es el déficit motor más característico de la enfermedad de Parkinson (EP), generalmente diagnosticado bajo diversos estudios como la prueba de tapping -ampliamente utilizada para determinar la enfermedad-, donde se mide la repetición de una tarea específica en un tiempo determinado. En el siguiente trabajo se estudiaron los parámetros cinemáticos del tapping en EP y controles. El estudio se realizó en 12 pacientes con EP con una edad media de 64,6 +/- 9,4 años -con duración promedio de la EP de 5,8 +/- 4,1 años. Todos los casos estaban en tratamiento con levodopa. Además, se estudiaron 7 controles en personas con una edad media de 64,8 +/- 12,8 años. Se les solicitó a todos que con los dedos de la mano tocaran en forma secuencial dos puntos separados por 25 cm. En el dedo medio se instaló una marca refractaria a la luz, utilizada como referencia para determinar la posición de la mano. El movimiento fue filmado mediante una cámara de video estándar con una velocidad de 30 cuadros por segundo. Los pacientes fueron evaluados clínicamente usando la escala unificada para la valoración de la enfermedad de Parkinson en su sección motora parte III (UPDRS-III). El análisis cinemático se realizó mediante un software especialmente diseñado para determinar la posición espacial de la marca en relación al sistema de referencia cartesiano. El análisis estadístico se realizó con Kurskal-Wallis test y correlaciones de Spearman. Se consideró significación estadística con p < 0,05. Resultados: La velocidad media en el control normal fue de 94 +/- 11 cm/seg y en la EP fue de 67 +/- 15 cm/seg (p <0,001). La velocidad máxima en el control normal fue de 198 +/- 20 cm /seg y en la EP fue de 143 +/- 33 cm/seg (p < 0,001). En el control de aceleración media normal fue 1.630 +/- 331 cm/seg² en la EP fue 966 +/- 285 cm/seg² (p < 0,001). Movimiento amplitud media en el plano Y, en el control normal fue de 28 +/- 5 cm y en la EP fue de 21 +/- 8 cm (p < 0,01)...

The Predictable Clinical Factors for the Levodopa Responsiveness of Resting Tremor in Patients with Parkinson's Disease

BACKGROUND: The pathophysiology of resting tremor in Parkinsons disease (PD) remains unclear. Dopaminergic treatment provides variable effects on resting tremor in PD. We aimed to evaluate the predictable clinical factors for the levodopa responsiveness of resting tremor in patients with PD. METHODS: Eighty-five PD patients with prominent resting tremor who visited Asan Medical Center between June 2004 and June 2005 were included. The prominent resting tremor was defined as tremor scoring more than 3 in at least one limb in the Unified Parkinsons Disease Rating Scale (UPDRS). Subjects were divided into the responsive group (RG) or non-responsive group (NRG) according to the responsiveness of resting tremor to dopaminergic treatment. Responsiveness was defined as a minimum 2 points reduction of UPDRS score for the resting tremor after dopaminergic treatment for more than 3 months. RESULTS: Among the 85 patients, there were 35 men and 50 women ages 34-87 years (mean age, 67 years). Thirty-six patients (42.4%) were grouped into RG and 49 (57.6%) into NRG. Mean age of RG was significantly younger than that of NRG. RG showed significantly higher initial UPDRS part III subtotal score (p=0.015) and more severe Hoehn & Yahr stage (p=0.010) than those of NRG. UPDRS subscores for rigidity (p=0.012), bradykinesia (p=0.021) and postural impairment (p=0.018) were correlated with the responsiveness of dopaminergic treatment. CONCLUSIONS: Resting tremor in PD patients more favorably responded to dopaminergic treatment when it presented in combination with bradykinesia and rigidity suggesting dopaminergic role in the genesis of resting tremor in those PD patients.

Deep Cerebral Venous Thrombosis Showing Parkinsonism such as Micrographia, Hypophonia and Bradykinesia

Deep cerebral venous thrombosis is a rare condition associated with edema, infarction or hemorrhage in basal ganglia, thalamus and periventricular white matter. It presents nonspecific clinical manifestations such as altered consciousness, headache, focal neurological deficit, nausea and vomiting. Extrapyramidal signs are very rare in deep cerebral venous thrombosis. We report a patient who presented micrographia, hypophonia and bradykinesia as an early manifestation of deep cerebral venous thrombosis.

Influence of Individual Symptomatology on the Surgical Results of Parkinson's Disease

Changes in the individual symptomatology were analyzed on twenty-nine patients with Parkinson's disease who underwent thirty-five stereotaxic thalamotomies to evaluate the influence of each symptom on the surgical results. The thalamotomy could obviously improve and prevent progression of tremor and rigidity but not bradykinesia and axial symptoms. Long-term follow-up wtudy with statistical analysis suggested that progressive worsening after surgery was due not to recurrence of tremor and rigidity but aggravation of bradykinesia and axial symptoms in the natural course of the disease. We believe that timely surgical treatment should be encouraged in patients presenting symptoms of tremor and rigidity.

Parkinson's Disease: Some Clinical Observation Based on the Study of 93 Patients Seen at the Yonsei University Medical Center

Between 198O and 1985, 93 patients with Parkinson's disease (paralysls agitans) were seen and examined prior to the initiation of medication. Forty-four of them were men and 49 of them women. Their ages ranged from 32 to 86 years (mean, 56.7 years), with the peak incidence in the seventh decade. The initial symptoms were tremor (67.7%), gait disturbance (16.1%), stiffness (15.1%), back pain, and weakness. Durations of illness until final diagnosis ranged from 2 months to 8 years (mean, 1.5 years). The most frequent signs at first examination were rigidity (95.7%), masked face (94.4%), tremor (89.2%), bradykinesia (87.1%), festinating gait (81.2%) grabella sign, stooped posture, and low voice. No marked dementia was seen in this study, and mild mental change was present in only 7 patients (7.5%). According to the modified Hoehn and Yahr's classification, 13 patients were in stage I, 31 in stage II, 28 in stage III, 13 in stage IV, and 8 in stage V. The more advanced stages were associated with a longer duration of the disease. Fifteen (16.1%) had coexisting disease: 11, hypertension; 3, diabetes mellitus; 2, stroke; and 1, malignant neoplasm. All patients but one responded initially to levodopa (Sinemet).