Relationship of Nocturnal Sleep Dysfunction and Pain Subtypes in Parkinson's Disease.

BACKGROUND: Little research has been conducted regarding the relationship between sleep disorders and different pain types in Parkinson's disease (PD). OBJECTIVE: To explore the influence of the various pain subtypes experienced by PD patients on sleep. METHODS: Three hundred consecutive PD patients were assessed with the PD Sleep Scale-Version 2 (PDSS-2), King's PD Pain Scale (KPPS), King's PD Pain Questionnaire (KPPQ), Visual Analog Scales for Pain (VAS-Pain), and Hospital Anxiety and Depression Scale. RESULTS: According to the PDSS-2, 99.3% of our sample suffered from at least one sleep issue. Those who reported experiencing any modality of pain suffered significantly more from sleep disorders than those who did not (all, P < 0.003). The PDSS-2 showed moderate-to-high correlations with the KPPS (rS = 0.57), KPPQ (0.57), and VAS-Pain (0.35). When PDSS-2 items 10 to 12 (pain-related) were excluded, the correlation values decreased to 0.50, 0.51, and 0.28, respectively, while these items showed moderate-to-high correlations with KPPS (0.56), KPPQ (0.54), and VAS-Pain (0.42). Among the variables analyzed, multiple linear regression models suggested that KPPS and KPPQ were the most relevant predictors of sleep disorders (as per the PDSS-2), although following exclusion of PDSS-2 pain items, depression was the relevant predictor. Depression and anxiety were the most relevant predictors in the analysis involving the VAS-Pain. Regression analysis, considering only the KPPS domains, showed that nocturnal and musculoskeletal pains were the best predictors of overall nocturnal sleep disorder. CONCLUSIONS: Pain showed a moderate association with nocturnal sleep dysfunction in PD. Some pain subtypes had a greater effect on sleep than others.

Hypokalaemic rhabdomyolysis.

Hypokalaemic rhabdomyolysis is unusual, but the association between hypokalaemia and rhabdomyolysis can be overlooked if intracellular potassium leakage normalizes serum potassium by the time of presentation. This report describes a patient who presented with severe pain due to non-traumatic rhabdomyolysis and was found to have serum potassium of 1.4 mmol/L; magnesium 0.40 mmol/L; phosphate 1.40 mmol/L; adjusted calcium 1.87 mmol/L and creatine kinase 6421 U/L. In this case, intervention occurred before rhabdomyolysis could progress to the stage at which serum potassium may have self-corrected. This patient's hypokalaemia was at first refractory to treatment with potassium chloride, possibly due to coexisting magnesium deficiency. Initially, the patient denied alcohol abuse, but later admitted alcohol misuse prior to withdrawal three days before presentation. Hypokalaemia is associated with alcohol misuse, but abrupt withdrawal may exacerbate hypokalaemia and hypomagnesaemia. Acute or chronic myopathy is common in alcoholics due to alcohol toxicity and paradoxically the risk of rhabdomyolysis may be increased during periods of abrupt alcohol withdrawal.

Prescribing medications in Parkinson's disease (PD) patients during acute admissions to a District General Hospital.

This is a short report illustrating the problems of the prescribing of anti-Parkinson's disease (PD) medication in patients with PD who are admitted acutely to hospital for any reason. There were a large number of complications as a result of inappropriate or lack of anti-PD drug administration and poor understanding amongst junior doctors and nursing staff. We suggest some changes that we have initiated in our hospital to try to improve the situation.

A case of hedonistic homeostatic dysregulation.

Parkinson's disease (PD) is a common condition especially amongst the elderly population, which is increasing. I present a case of an unusual but also under-recognised syndrome caused by PD therapy, which can have devastating effects on the patient and their family.