Nerve Conduction Study for Patients with Parkinson Disease Who Developed Persistent Sensory Symptom during Optimal Levodopa Treatment

OBJECTIVE: Sensory symptoms are common in patients with Parkinson disease (PD), although its exact prevalence and causes are not well known. We aimed to investigate whether peripheral pathology contribute to chronic sensory symptoms in patients with PD by nerve conduction test. METHODS: We recruited consecutively 34 patients with clinically probable PD (Hoehn-Yahr stage, 1–3) who developed persistent sensory symptoms in their lower extremities during optimal dopamine replacement therapy. Twenty-five patients who are above age of 70 or have other possible causes of neuropathy as determined by laboratory testing or medical record were excluded. Age- and gender-matched PD patients with same disease severity who have never developed sensory symptom during the same period were allocated to paired controls. Total 18 subjects participated in this study. Nerve conduction tests on peroneal motor nerve and sural sensory nerve were performed in all subjects. Amplitude and conduction velocity were compared between the paired subjects using Wilcoxon signed rank test. RESULTS: Subjective sensory symptoms of the 9 patients were variable: pain (4/9), chilling (3/9), burning (1/9), and tingling sense (1/9). There were no significant difference of mean values of compound muscle action potential/sensory nerve action potential amplitude and conduction velocity between patients and their paired controls. CONCLUSION: This study supports the hypothesis that the origin of chronic sensory symptoms in PD patients is more central than peripheral.

Sensory Symptoms in Parkinson's Disease

BACKGROUND AND PURPOSE: A variety of sensory disturbances such as tingling, numbness, muscle cramp, pain and burning are recognized in Parkinson's disease. There is a hypothesis that sensory symptoms of Parkinson's disease could be related to "release" of sensory centers from extrapyramidal systems. We investigated the characteristic features of sensory symptoms in Parkinsonian patients and the possibilities that sensory symptoms may be related to dopaminergic pathways. METHODS: We included 130 patients with Parkinson's disease. The patients with medical illness such as diabetes, arthritis or musculoskeletal disease were excluded. We studied 38 Parkinsonian patients with sensory complaints using electrophysiologic studies and neuroimaging. RESULTS: 1) Thirty-eight(29.2%) of 130 Parkinsonian patients(mean age ; 57.9 +/- 10.1 ; 13 men, 25 women) had sensory symptoms. 2) Among thirty-eight Parkinsonian patients with sensory symptoms, 19 patients had pain, 10 tingling sensation, 3 burning sense, and 2 muscle cramp. 3) The arm and leg were most common sites for sensory symptoms 4) Sensory complaints preceded motor symptoms in 17 patients(21.1 +/- 19.1 months) and followed in 13 patients(26.7 +/- 41.9 months). 5) In 25 patients(66%), sensory symptoms were improved with levodopa. 6) There was no significant correlation between sensory symptoms and motor disabilities. CONCLUSIONS: Many Parkinsonian patients had various sensory complaints as well as motor symptoms. In some patients, sensory symptoms preceded motor disabilities. It was also suggested that sensory symptoms in some patients with Parkinson's disease be related to dopaminergic pathways.

Stress Among Chinese, Korean-Chinese and Korean High School Students: A Transcultural Study / 신경정신의학

About 40% of patients suffering from postencephalitic or idiopathic parkinsonism experience distressing and ill-defined sensations. Antipsychotic-induced acute extrapyramidal syndromes (EFSs) share phenomenological, pharmacological, and biochemical characteristics with these parkinsonisms. Thus, it is conceivable that antipsychotic-induced acute EPSs may also be associated with primary sensory symptoms. The aim of this study was to test this hypothesis, first by examining the frequency and risk factors of primary sensory symptoms and then by contrasting the clinical characteristics in patients with or without antipsychotic-induced acute EFSs and in patients who did or did not report sensory symptoms. The study group comprised 107 patients who receiving antipsychotics. The authors used DSM-IV criteria and Yale Extrapyamidal Symptom Scale for acute EFSs and modified McGill Pain Questionnaire for sensory symptoms. The results were as follows: 1) Twenty-one(19.6%) of 107 patients receiving antipsychotics reported sensory symptoms. Among these 21 patients, 12(57.1%) reported paresthesia, 6(28.6%) reported pain, 3(14.3%) reported both. 2) fifteen(34%) of the 44 patients with antipsychotic-induced EFSs reported sensory symptoms, while only 6(9.5%) of the 63 patients without EFSs reported sensory symptoms(p<0.01). The severity of sensory symptoms was significantly correlated with the EPSs rating score(p=0.001). 3) In the patients with sensory symptoms, the women significantly outnumbered the men(p<0.05). Any risk factor of sensory symptoms, however, couldn't be found in age, diagnosis, and drug. The subjective response including sensory symptoms were associated with drug response, drug compliance, quality of life and prognosis. It is suggested that further systematic investigation and interest about sensory symptoms and subjective response of the acute EPSs should be needed.