Effect of Musthadi Rajayapana Vasti in Parkinson’s Disease

Parkinson’s disease is a progressive neurodegenerative disorder, affecting the older adult. It is a syndrome consisting of classical triad of resting tremor, bradykinesia and rigidity. The triad does not include the equally important gait and postural instability problem which also constitute syndrome. Lakshanas of Vata prakopa can be seen in Parkinson’s Disease. Madhavanidana, Vangasena, Sarngadhara samhita, Basavatrajiya has quoted the pathology Kampavata- a disease condition that explains Parkinson’s disease in similar way. In short Parkinson’s disease can be compared to Kampavata. Vasti is Paramoushadha of Vata. To be specific, Musthadi rajayapana vasti is Brimhana and Vatahara in nature. So it is the best choice for a Vatavikara like Parkinson’s disease. Brimhana type of vasti plays an important role, hence Rajayapana vasti. The study is pre-post study. participants registered in IPD and OPD of Govt Ayurveda Panchakarma Hospital, Poojappura satisfying inclusion criteria were selected. After collecting baseline data, detailed history and examination were done using clinical case proforma. 15 participants were selected for the study. Musthadi rajayapana vasti was done continuously for 7 days. Assessment of efficacy was done before Vasti, after Vasti on 8th day and after follow up on 14th day by Unified Parkinson’s Disease Rating Scale. Quantitative and qualitative assessment of Vasti dravya was also done. Data were analysed according to ‘Wilcoxon signed rank test’. Based on statistical analysis Musthadi rajayapana vasti was found to be significant in reducing symptoms. Musthadi rajayapana vasti is effective in reducing severity of symptoms of Parkinson’s disease

Evolução das manifestações clínicas de pacientes com doença de parkinson / Evolution of clinical manifestations of parkinson's disease patients

Objetivos: Avaliar o perfil clínico e epidemiológico dos pacientes parkinsonianos acompanhados no ambulatório de Distúrbios do Movimento do Hospital Governador Celso Ramos utilizando-se escaladas validadas. Métodos: Estudo longitudinal onde foram incluídos 167 pacientes consecutivos, em diferentes estágios da doença de Parkinson, atendidos no ambulatório de distúrbios do movimento do HGCR e reavaliados 20 pacientes em consulta, 5 anos após a primeira. Aplicou-se questionário e avaliou-se o primeiro sintoma motor cardinal entre as associações independentes e entre os escores de sintomas neurológicos motores avaliados através da escala UPDRS-MDS e Schwab and England Activities of Daily Living Scale. Resultados: Tremor foi o primeiro sintoma motor percebido mais frequentemente pelos pacientes (64,9%), dor foi a primeira queixa de 5,2% dos pacientes. A idade de início do primeiro sintoma foi inversamente proporcional à escolaridade. Quanto maior a pontuação nas escalar UPDRS-MDS ­ III (p=0,004) e Schwab and England Activities of Daily Living Scale (p=0,001) maior a tendência a inatividade. Conclusão: A doença de Parkinson geralmente é percebida por seus sintomas motores clássicos, entretanto, uma série de sintomas não motores iniciam e acompanham a evolução da doença conforme mostra a piora do perfil ao longo de 5 anos.

Objectives: To evaluate symptoms, establish a profile for the Parkinsonian patient of HGCR's Movement Disorders's Service. Method: Longitudinal study. 167 consecutive patients, in different stages of Parkinson's disease, and treated at HGCR movement disorders service were inclueded. 20 of them were reevaluated after 5 yers. A questionnaire was administered and the first cardinal motor symptoms was evaluated and associated with independent associations and with the scores of neurological symptoms measured by UPDRS-MDS and through the Schwab and England Activities of Daily Living Scale. Results: Tremor was the first motor symptom perceived most frequently by patients (64.9%), pain was the first complaint of 5,2% of patients. The age of onset of the first symptom was inversely proportional to schooling. The higher the scores in the UPDRS-MDS-III scale (p=0,004) and the Schwab and England Activities of the Daily Living Scale (p = 0,001) the greater the tendency to inactivity. Conclusion: Parkinson's disease is usually noticed by its classic motor symptoms, however, a series of non-motor symptoms begin and accompany the disease's progression. This study evaluated the profile of the clinical and epidemiological patients attending our service and showed important clinical worsening in the evolution of 5 years of disease.

Clinical Observation of Ordinary Acupuncture plus Zhigou (TE6) and Zhaohai (KI6) for Constipation Due to Yin Deficiency in Parkinson's Disease / 上海针灸杂志

Objective To observe the clinical efficacy of ordinary acupuncture plus Zhigou (TE6) and Zhaohai (KI6) in treating constipation due to yin deficiency in Parkinson's disease. Method Sixty eligible patients were randomized into a control group and a treatment group, 30 cases each. The control group was intervened by ordinary acupuncture by selecting the Dance-tremor Control Zone, Baihui (GV20), Fengchi (GB20), Fengfu (GV16), Quchi (LI11), Yanglingquan (GB34), Taixi (KI3) and Taichong (LR3). Based on the ordinary acupuncture, Zhigou (TE6) and Zhaohai (KI6) were added in the treatment group. The treatment was given three times a week, 12 sessions as a course, and the therapeutic efficacy was evaluated after 2 successive treatment courses by using Patient Assessment of Constipation Quality of Life Scale (PAC-QOL), Bristol Stool Scale (BSS), Cleveland Clinic Score (CCS) and Unified Parkinson's Disease Rating Scale (UPDRS) as the observation indexes. Result Before the intervention, there were no significant differences in comparing the PAC-QOL, Bristol, CCS and UPDRS scores between the two groups (P>0.05);after the treatment, the scores of PAC-QOL, Bristol, CCS, and motor function and activities of daily living in UPDRS dropped significantly in the two groups (P<0.05); the PAC-QOL, Bristol and CCS scores in the treatment group were significantly lower than those in the control group after the treatment (P<0.05); the treatment group had a significantly higher effective rate in improving constipation symptoms than the control group (P<0.05); there was no significant difference in comparing the UPDRS score between the two groups after the intervention (P>0.05). Conclusion Ordinary acupuncture plus Zhigou and Zhaohai can significantly improve the quality of life, stool form and difficulty in defecation in constipation of yin-deficiency type in Parkinson's disease, and the therapeutic efficacy is superior to that of ordinary acupuncture.

Effectiveness of electrical stimulation in idiopathic Parkinson’s disease.

Background: Parkinson’s disease is one of the most disabling chronic neurologic diseases and leads to a significant loss of quality of life. Electrical stimulation activate nerves innervating extremities affected by paralysis resulting from Spinal Cord Injury (SCI), head injury, stroke and hence is primarily used to restore function in people with disabilities. Methods: The study was performed after the institutional ethical clearance and informed consent from all the participants. The parameters assessed were time taken to complete 20 M walk with turn round, distance covered in the first 3 minutes of walking, gait dynamics like stride length, step length and cadence and number of falls with the help of video tape recorder, stop watch and measuring tape. Results: We observed a non-significant reduction (P = 0.471) of UPDRS, mean score of PDQ-39 was declined non-significantly (P = 0.36), time taken to complete 20 meters walk with turn was declined significantly (P = 0.017), The distances walked in 3 minutes by the patients were increased significantly (P = 0.000), number of steps during 20 meter walk was recorded and was found to be declined significantly (P = 0.088), stride length of the patients were increased significantly (P = 0.000), step length of the patients was increased significantly (P = 0.000), average number of falls reduced significantly (P = 0.00) during the stimulation period from week 0 to week 8. Conclusion: This study demonstrated the superior efficacy of electrical stimulation over best medical management in patients with advanced Parkinson’s disease.

Evaluation and Rehabilitation of Parkinson's Disease / The Japanese Journal of Rehabilitation Medicine

Hoehn and Yahr (H-Y) staging and the Unified Parkinson's Disease Rating Scale (UPDRS) are commonly used for clinical evaluation of Parkinson's disease (PD). Iodine-123 metaiodobenzylguanidine (MIBG) myocardial scintigraphy and single photon emission computed tomography (SPECT) are useful for the differential diagnosis of PD from other Parkinsonism. Additionally, gravicorders or gait analysis systems and upper limb voluntary movement analyzing systems may be helpful for the quantitative evaluation of parkinsonian symptoms. From the early stage of H-Y, PD patents should be informed and coached about rehabilitation programs by expert therapists. Educational and health promotional gymnastics are the main programs used in stage I and II. Muscle stretching exercises, postural exercises, balance training and activity/instrumental-activity training are needed in stage III and IV. Finally, preventing changes due to disuse and lightening the caregiver load are the main purpose of rehabilitation in stage V. It is very important to understand not only the patients' clinical stages but also their personal situations such as their life-stage and life-style and their family situation. Home visit rehabilitation is useful to discover the actual daily living problems faced by patients and their families. Then, evaluation according to the International Classification of Functioning, Disability and Health (ICF) is available to clarify and solve the problems. With the progression of the clinical stage, patients need many social resources. Therefore, medical social workers (MSW) should be a part of the rehabilitation team to support the home care of patients from their incipient stage.

Calidad de vida relacionada con la salud en la enfermedad de Parkinson / Health-related quality of life in Parkinson's disease

La enfermedad de Parkinson (EP) es un trastorno neurológico, discapacitante y progresivo caracterizado por múltiples síntomas motores y no motores que contribuyen al deterioro en la calidad de vida del paciente. La diversidad de síntomas asociados a la enfermedad y su manejo afectan a la funcionalidad y las expectativas del individuo sobre su bienestar físico, social y mental, que son los componentes fundamentales de la calidad de vida relacionada con la salud (CVRS). El objetivo del presente trabajo fue identificar las principales dimensiones de la CVRS afectadas en una población con EP con un grado de afectación leve-moderado. Treinta y seis pacientes con EP completaron este estudio transversal. Se emplearon el estadio de Hoehn y Yarh, el Unified Parkinson's Disease Rate Scale, la escala de actividades de la vida diaria de Schwab y England y el Test Get Up & Go. La calidad de vida fue valorada con el EuroQoL-5D y con el cuestionario Parkinson's Disease Questionnaire-39 items. Las dimensiones del PDQ-39, excepto el dominio PDQ-39 Dolor, así como el cuestionario EuroQoL-5D se correlacionaron de manera significativa con la gravedad de la enfermedad. La CVRS se correlacionó con el estado funcional de los pacientes. Únicamente el dominio PDQ-39 Dolor se correlacionó con el riesgo de caídas. Nuestros resultados sugieren que la CVRS de los pacientes con EP, en un estado leve-moderado de afectación, está muy influenciada por la gravedad de la enfermedad y el estado funcional.

Parkinson's disease is a disabling and progressive neurological condition characterized by multiple motor and non motor symptoms that contribute to deterioration in quality of life. The diversity of symptoms associated with the disease and its management affect the patients on their physical, social and mental quality of life. The aim of this study was to identify key dimensions of health related quality of life (HRQOL) in a population affected with Parkinson's disease with a degree of mild-moderate impairment. Thirty six patients with Parkinson were recruited. The Hoehn and Yarh scale, the Unified Parkinson's Disease Rate Scale, the scale of activities of daily life and Schwab & England Get Up & Go Test were applied. HRQOL was assessed with the EuroQol-5D and the specific questionnaire Parkinson's Disease Questionnaire-39 items. The dimensions of the PDQ-39, except the PDQ-39 Pain domain and the EuroQol-5D correlated significantly with the severity of the disease. HRQOL was correlated with the functional status of patients. Only the PDQ-39 pain domain correlated with the risk of falls. Our results suggest that the HRQOL of patients with PD, in a state of mild-moderate impairment, is strongly influenced by disease severity and functional status.

Efficacy of Rehabilitation in Parkinson's Disease Patients using the Unified Parkinson's Disease Rating Scale (UPDRS) and Three-dimensional Motion Analysis / The Japanese Journal of Rehabilitation Medicine

Objective : To demonstrate the importance of physical motor function using the unified Parkinson's disease rating scale (UPDRS) and three-dimensional motion analysis in Parkinson's disease rehabilitation strategies. Participants : Seventeen inpatients with Parkinson's disease. Intervention : Physical training to improve joint mobility, muscle strength and muscle stretch to increase physical capacity was conducted for about four weeks. Results: The mean total scores of UPDRS significantly decreased from 37.9±13.2 (before training) to 27.3±11.2 (after training). The ADL scores of the UPDRS decreased from 12.4±6.9 (before training) to 9.5±6.3 (after training). The motor scores decreased from 22.5±7.5 to 15.3±6.5. Furthermore, muscle rigidity and akinesia, two key Parkinson symptoms, were improved as shown by assessment of the UPDRS motor scores. And physical function of the trunk, and upper and lower extremities was also improved. Finally, the increment of stride length and walking velocity and range of motion (ROM) at the hip and pelvic joints were observed by assessment of three-dimensional motion analysis. Conclusion : This study suggests that improvement of Parkinson symptoms and increment of ROM at the pelvic and lower limbs by physical training may improve stride length and walking velocity.

The accuracy of diagnosis of major depression in patients with Parkinson's disease: a comparative study among the UPDRS, the geriatric depression scale and the Beck depression inventory / A precisão do diagnóstico de depressão na doença de Parkinson: um estudo comparativo entre a UPDRS, a escala geriátrica de depressão e o inventário de depressão de Beck

OBJECTIVE: Evaluate the accuracy of diagnosis of major depression in patients with Parkinson's disease (PD) using the UPDRS, the 15-item Geriatric Depression Scale (GDS15) and the Beck Depression Inventory (BDI). METHOD: 50 consecutive patients with PD were evaluated. The diagnosis of major depression was made according to the DSM-IV criteria. RESULTS: We found a 24 percent prevalence of major depression. All depression scales were highly correlated but UPDRS depression item had the lowest diagnostic value. The GDS15 had the more appropriate "receiver operating characteristics" curve. The best cut-off scores for screening depression were 17/18 for BDI and 8/9 for GDS15. We did not find any correlation between the level of depression and intensity of motor symptoms, functional capacity and duration of the disease. CONCLUSION: GDS15 is better than the BDI and the UPDRS for screening depression in PD and depression is not related to the degree of parkinsonian symptoms.

OBJETIVO: Avaliar a precisão do diagnóstico de depressão em pacientes com doença de Parkinson avaliados pela UPDRS, pela Escala Geriátrica de Depressão com 15 itens (EGD15) e pelo Inventário de Depressão de Beck (IDB). MÉTODO: 50 pacientes com DP foram avaliados. O diagnóstico de depressão maior foi feito segundo os critérios do DSM-IV. RESULTADOS: A prevalência de depressão foi 24 por cento. As escalas de depressão tiveram elevada correlação entre si. A UPDRS apresentou a menor sensibilidade para o diagnóstico. A EGD15 mostrou uma curva ROC mais apropriada que o IDB. Os melhores escores-de-corte para diagnóstico de depressão foram 17/18 para o IDB e 8/9 para a EGD15. Não houve correlação entre os níveis de depressão e a intensidade do parkinsonismo, a capacidade funcional ou a duração da doença. CONCLUSÃO: A EGD15 é melhor que o IDB para diagnosticar depressão na DP. A depressão não está relacionada à gravidade dos sintomas parkinsonianos.

Clinical Outcomes of Simultaneous Bilateral Pallidotomy in Advanced Parkinson's Disease

OBJECTIVE: Pallidotomy is known to improve the symptoms of idiopathic Parkinson, s disease (PD), motor fluctuations and dyskinesia related to levodopa therapy. Previous studies reported significantly higher complication rates associated with bilateral pallidotomy than unilateral pallidotomy. The authors assess the safety and clinical outcomes of bilateral pallidotomy for advanced PD. METHODS: Simultaneous bilateral pallidotomy was performed in eight patients with advanced PD between January 1, 2001 and December 31, 2001. All patients underwent lesion making in posteroventral site of internal globus pallidus. The target was localized using macroelectrode stimulation and MRI guided stereotactic technique. The lesions were made by radiofrequency currents. RESULTS: Among eight cases, seven had severe disabling dyskinesias. Compared with baseline scores, the values of dyskinesia after surgery was significantly decreased (P<0.05) for up to 1 year. The mean score changed from 4.4+/-2.1 to 0.3+/-0.5. According to Unified Parkinson's Disease Rating Scale (UPDRS), the mean motor score in off period, which was 38.3+/-13.8 was significantly decreased for 6 months (P<0.05). The ADL (on/off) scores and motor "on" scores of UPDRS were unchanged or deteriorated to 12 months after surgery. There was no apparent adverse effect after surgery in all patients. Only transient mild dysphagia happened in one patient. CONCLUSION: Simultaneous bilateral pallidotomy in advanced PD appears to be effective and safe, particularly in reducing the dyskinesia; in our experience, the side effects are not as high as reported by other groups.

The Relation of Clinical Scale and Non-Linearity of EEG in Early Parkinson's Disease

BACKGROUND: Many recent studies based on non-linearity have been performed to quantify the complex behavior of the brain in order to understand the pathophysiology of Parkinson's disease (PD). METHODS: We calculated the Fractal dimension (FD) and Lyapunov exponent (L1), the non-linear biologic signals, by digital EEG using 'CHASIM' program, non-linear times series signal simulator and then compared the UPDRS score with the degree of atrophy in the substantia nigra upon brain MRI and EEG data respectively. All subjects (N=20) showed definite hemiparkinsonism. RESULTS: Upon EEG analysis, a strong positive correlation was noted between FD of the left hemispheric electrodes (FP1,F3,T3,T5) and the UPDRS scores in left-sided symptomatic patients. Additionally, positive correlations were noted between the ipsilateral MRI index ratio in the right and left-sided symptomatic patients and respective UPDRS scores. CONCLUSIONS: These results suggested that thalamocortical drive is reduced in the contralateral hemisphere to parkinsonian symptoms and thalamocortical or corticothalamic glutaminergic projection in the ipsilateral hemisphere is increased in the early stage of Parkinson's disease. Additionally, hemiparkinsonim may primarilly cause anatomic and functional changes in the contralateral hemisphere and a compensatory effect in the ipsilateral hemisphere at the same time. We suggest that disease duration may be a compensating factor and of which require further investigation. We hope that our results will aid the understanding of the specific patterns of dysfunction and treatment effects by non-linear EEG measures and anatomic changes of the substantia nigra through continuous follow up of the patients. (J Korean Neurol Assoc 19(3):232~238, 2001)

Effects of Senkyu-chacho-san on Motor Symptoms in Patients with Parkinson's Disease / 日本東洋医学雑誌

Senkyu-chacho-san (SC), an herbal medicine, can modulate striatal dopamine levels, but its effects on Parkinson's disease (PD) are unclear. To evaluate the efficacy, tolerance, and safety of SC in PD, 22 patients with idiopathic PD (aged 49 to 82 years; 13 women, staging Hoehen and Yahr 3 or 4) were given SC, 5.0 or 7.5g three times per day, for eight weeks. Existing antiparkinsonian drug regimes were kept unchanged. Motor functions were assessed based on the Unified Parkinson's Disease Rating Scale (UPDRS) at baseline and at weeks four and eight. After four weeks of SC administration, 14 patients showed a significant improvement in motor performance with respect to the motor scores of the UPDRS (p<0.05). The improvement in motor function declined slightly in four patients after eight weeks of treatment. No patients became worse in motor functions during treatment, and no serious adverse events occurred. This study suggests that SC is useful as an adjunct to dopaminergic drugs in PD.

Clinical Observation on 51 Patients with Parkinson's Disease Treated by Yangjinhua Powder Capsule / 中医杂志

Objective To observe the clinical effect of Yangjinhua Powder Capsule(Flos Daturae Powder Capsule)in the treatment of Parkinson's disease(PD).Methods Of the 51 PD patients,15 who came for the first visit were administered Yangjinhua Powder Capsule only,and 36 who had been taking western medicine were given Yangjinhua Powder Capsule without stopping using the original medicine.The Unified Parkinson Disease Rating Scale(UPDRS)was used to score the patients before treatment,7 days,3 months,and 6 months after treatment respectively,and as well to evaluate the total effect and untoward reactions.Results After treatment,29(56.86%)patients were remarkably improved;11(21.57%)patients were improved;and 2(3.92%)patients were slightly improved.Totally 42 patients were improved.The total effective rate was 82.35%.After 7 days' treatment,the improvement of tremor was significant(P

Correlation of striatum dopamine transporter imaging and the scores of Parkinsonian clinical scale in patients with Parkinson's disease / 临床神经病学杂志

Objective To evaluate the correlation of striatum dopamine transporter (DAT) imaging and the scores of Parkinsonian clinical scale in patients with Parkinson's disease(PD).Methods 99m Tc-TRODAT-1 SPECT imaging was used to assess the DAT binding in the striatums of 29 PD patients, their correlations with the subscales of unified PD rating scale (UPDRS), age and disease duration were also evaluated.Results The scores of subscales of UPDRS II, III and V, as well as the disease duration were negatively correlated with DAT bindings in ipsi-, contra- and bilateral striatum regions (r was -0.70, -0.80, -0.49 and -0.54 respectively, all P