Secondary Parkinsonism caused by hypoparathyroidism in young patients has been rarely reported and the effectiveness of comprehensive rehabilitation management is widely varied. We experienced a case of 16 year old patient with secondary Parkinsonism caused by hypoparathyroidism, who has a chief complaint of progressive resting tremor and gait disturbance. At admission, the tremor subscore was 4 on the unified Parkinson's disease rating scale (UPDRS), the initial score of Korean-modified Barthel index (K-MBI) was 33 points and functional independence measure (FIM) was 52 points. Comprehensive rehabilitation consisted of oral antiparkinsonism drugs, range of motion exercise, motor control and coordination training, gait training with biofeedback, and activity daily living training were performed twice a day, 5 days a week. At one month after admission, she had more improved functional state. The tremor subscore was 2 on UPDRS, K-MBI was 72 points, and FIM was 89 points.
Biofeedback, Psychology ; Gait ; Humans ; Hypoparathyroidism ; Parkinson Disease ; Parkinson Disease, Secondary ; Range of Motion, Articular ; Tremor

BACKGROUND: The basal ganglia plays a major role in regulating motor, cognitive and emotional functions. In addition, it has been proposed that the functions of the basal ganglia is also related to control of sensory discrimination and sensorimotor integration. One possible way to test this hypothesis would be to investigate sensory functions in patients with various diseases affecting basal ganglia functions. Since idiopathic Parkinson's disease (IPD) is caused by selective impairment of basal ganglia functions, it could be a good model for this purpose. METHODS: We measured the grating resolution threshold (GRT) using the JVP (Johnson-Van Boven-Phillips) dome in 52 patients with IPD and 25 age-matched healthy controls. Statistical analysis employed unpaired t-test, paired t-test and simple regression analysis. P-values less than 0.05 were considered as significant. RESULTS: Patients showed significantly higher GRT than controls (3.07 +/- 0.74 vs 2.03 +/- 0.80; p<0.05). In patients, the mean GRT was not different between symptomatically dominant and non-dominant hands (3.10 +/- 0.95 vs 2.93 +/- 0.82). In the patients with hemiparkinsonism, GRT was also significantly higher in asymptomatic hands compared with controls (3.00 +/- 0.71 vs 2.03 +/- 0.80; p<0.05). The severity of sensory dysfunction in patients was not correlated with symptom duration or to symptom severity, measured by the modified Columbia rating scale (MCRS). CONCLUSIONS: The present results demonstrate that spatial discrimination is impaired in IPD, suggesting the basal ganglia plays a role in sensory regulation.
Basal Ganglia ; Discrimination (Psychology)* ; Dopamine ; Hand ; Humans ; Parkinson Disease* ; Regression Analysis ; Sensation

OBJECTIVE: Cognitive impairment is one of the nonmotor symptoms in Parkinson's disease (PD), and olfactory dysfunction is used as a marker to detect premotor stages of PD. Serum uric acid (sUA) levels have been found to be a risk factor for PD. Our objective in this study was to examine whether sUA levels are associated with cognitive changes and olfactory dysfunction in early de novo PD patients. METHODS: The study participants included 196 de novo PD patients. We assessed cognitive function by the Korean versions of the Mini-Mental State Examination and the Montreal Cognitive Assessment and assessed olfactory function by the Korean version of the Sniffin' Sticks test. RESULTS: The mean sUA level was 4.7 mg/dL and was significantly lower in women than in men. Cognitive scores were lower in women, suggesting that sUA levels were related to cognitive function. The olfactory functions were not related to sUA level but were clearly associated with cognitive scores. Olfactory threshold, odor discrimination, and odor identification were all significantly related to cognitive scores. CONCLUSIONS: We conclude that lower sUA levels were associated with cognitive impairment, not olfactory dysfunction, in de novo PD patients. This finding suggests that UA is neuroprotective as an antioxidant in the cognitive function of PD patients.
Cognition Disorders ; Cognition ; Discrimination (Psychology) ; Female ; Humans ; Male ; Odors ; Parkinson Disease ; Risk Factors ; Smell ; Uric Acid

BACKGROUND: Patients with Parkinson's disease (PD) experience various types of sleep disturbances, and exhibit multiple risk factors for sleep disturbances. However, few studies have considered the demographic and psychosocial factors related to sleep disturbances in Korean PD patients. This study investigated the characteristics of sleep disturbance and related factors, including demographic and psychosocial factors, in Korean PD patients. METHODS: A population of 181 PD patients was studied; all agreed to be interviewed using structured questionnaires. RESULTS: The Parkinson's Disease Sleep Scale (PDSS) score was not correlated with sex, age, educational level, marital status, household income, or the presence of religion, a job, or a hobby. With regard to psychosocial factors, the PDSS score was positively correlated with the Self-Esteem Score and the Social Support Score. The PDSS score was negatively correlated with the Parkinson Fatigue Scale score, the pain score, the Beck Depression Index, and the Spielberger Anxiety Score. On stepwise multiple regression analysis, the most significant factors contributing to low PDSS scores were severe anxiety, a shorter duration of levodopa therapy, severe fatigue, and a higher daily levodopa dosage, in that order. CONCLUSIONS: Sleep disturbance in PD patients was significantly associated with anxiety, fatigue, and daily levodopa dosage, suggesting that these factors should be carefully managed in PD patients.
Anxiety ; Depression ; Family Characteristics ; Fatigue ; Hobbies ; Humans ; Levodopa ; Marital Status ; Parkinson Disease* ; Psychology ; Surveys and Questionnaires ; Risk Factors

OBJECTIVETo explore the possibility of electroacupuncture (EA) for prevention of the injury of dopaminergic neurons in the substantia nigra of the rat with Parkinson's disease.

METHODSWistar rats were randomly divided into a normal group, a model group, a sham-operation group and an EA group. 6-OH-DA was injected into right substantia nigra of the midbrain to made Parkinson's disease rat model with single side substantia nigra injury, and TH/TUNEL method and rotation behavior observation method were used to observe changes of rotation behavior and apoptosis of dopaminergic neurons in the substantia nigra after EA at "Taichong" (LR 3) and "Fengfu" (GV 16) for 3 d, 7 d and 14 d.

RESULTSThe rotation times/min were same at 3 d, 7 d and 14 d were the basically same in the model group, and at 14 d significantly decreased in the EA group (P<0.05); the rotation starting time at 7 d and 14 d in the model group were significantly longer than those in the EA group (P<0.05); the rotation lasting time at 3 d, 7 d and 14 d in the model group and the EA group were gradually shortened (P<0.01, or P<0.05), but at 7 d, 14 d in the model group were significantly longer than those in the EA group (P<0.05); the DA neuron apoptosis number in the model group were significantly higher than those in the normal group, with a very significant difference (P<0.01); the apoptosis number in the EA group tended to decrease, at 7 d and 14 d were significantly lower than that in the model group (P<0.05).

CONCLUSIONElectroacupuncture can effectively prevent from injury of dopaminergic neurons in the substantia nigra of the rat with Parkinson's disease.

Animals ; Apoptosis ; Behavior, Animal ; Electroacupuncture ; Female ; Male ; Parkinson Disease ; pathology ; psychology ; therapy ; Rats ; Rats, Wistar ; Rotation ; Substantia Nigra ; pathology

PURPOSE: Parkinson's disease (PD) is a common neurodegenerative disorder characterized by motor disabilities and increasing dependence on others for daily life activities with consequent impact on patients' and caregivers' quality of life. The aim of this study was to elucidate the burden on primary caregivers of patients with PD, and identify related factors. METHODS: A cross-sectional descriptive study. Seventy-six primary caregivers of PD patients in a neurology outpatient clinic, Seoul, Korea completed structured questionnaires, of which 68 were analyzed. The structured self-report questionnaire included (1) demographic information on the caregivers, (2) information regarding the disease characteristics of the patients, and (3) the subjective and objective caregiver burdens as assessed on Montgomery, Gonyea, & Hooyman's scale. RESULTS: The mean age of the caregivers was 54.56 years, and spouses represented the largest proportion(47.0%). Caregivers of PD patients experienced high levels of burden (mean scores on the subjective and objective burdens were 45.22 and 34.90, respectively), which were comparable to the caregiver burdens in stroke, and higher than the caregiver burdens in general chronic disease. Older caregivers and spousal caregivers experienced significantly higher burdens (p=.004 and p=.019, respectively). A greater motor disability and higher modified Hoehn and Yahr grade were related to higher caregiver burden (p=.001 and p=.018, respectively). CONCLUSION: Caring for PD patients is associated with a high level of caregiver burden. Therefore, healthcare professionals should identify the burden of caregivers who look after PD patients and develop comprehensive management strategies both for patients and their caregivers.
Adult ; Aged ; *Caregivers/psychology ; *Cost of Illness ; Cross-Sectional Studies ; Female ; Humans ; Korea ; Male ; Middle Aged ; *Parkinson Disease ; *Quality of Life

PURPOSE: To evaluate the safety and usefulness of the fluoroscopy-guided percutaneous gastrostomy (FPG) using a large profile gastrostomy tube accompanied with the pull technique, and without the use of an endoscopy or a gastropexy. MATERIALS AND METHODS: From March 2005 to February 2007, 25 patients underwent an FPG using a large profile gastrostomy tube accompanied by the pull technique, in which a 24F pull-type tube was inserted into a patient's mouth and was pulled to the upper abdominal puncture site using a snare, under fluoroscopy. The 18 patients with difficulty swallowing due to muscular atrophic lateral sclerosis or transitional myodystrophy included 5 cases of quadriplegia, 1 case of Parkinson's disease, and 1 metastatic mediastinal tumor. The technical success rate, occurrence of complications, and clinical outcomes were examined. RESULTS: The technical success rate was found to be 100%. In addition, the retention periods for the indwelling tube ranged from 1 to 24 months (mean: 6.5 months), with all tubes retained at a normal position with normal function. No procedure-related mortality occurred. One patient (4%) did however develop a complication in the form of ascites and ascitic fluid leakage around the tube, which was of hepatic origin and was ultimately resolved after the drainage of ascites. CONCLUSION: As a result of this study the FPG, accompanied with the pull technique using a 24F tube, should be considered as a safe and effective method for examining patients. It was found to have a high success rate and a low complication rate.
Ascites ; Ascitic Fluid ; Deglutition ; Drainage ; Endoscopy ; Fluoroscopy ; Gastropexy ; Gastrostomy ; Humans ; Intubation ; Motor Neuron Disease ; Mouth ; Muscular Dystrophies ; Parkinson Disease ; Punctures ; Quadriplegia ; Retention (Psychology) ; SNARE Proteins ; Stomach

BACKGROUND: Quality of life (QoL) has emerged as an important issue to patients with chronic illness. Parkinson's disease (PD) is a chronic neurodegenerative disorder requiring life-time treatment and supportive care, which affects not only physical activity but also cognition, mood, and daily living. The author investigated the QoL of patients with PD and aimed to find factors that have an influence on the QoL. METHODS: One hundred thirty patients with PD were evaluated. The QoL was measured and assessed by the Parkinson's disease quality of life questionnaire (PDQL). The author analyzed demographic and social data and clinical profiles. The Beck Depression Inventory (BDI) and Spielburger's State-Trait Anxiety Inventory were used to evaluate depressive symptoms and anxiety levels. RESULTS: The mean age of onset of parkinsonian symptom was 55.2 +/-10.9 years and the average duration of treatment was 34.7 +/-36.9 months. Patients with high BDI score, low Schwab and England activities of daily living scale (SEADLS) score, high bradykinesia score, progressed Hoehn and Yahr stage, high Unified Parkinson's disease rating scale score, low educational period and high economic state were all correlated with low PDQL scores. Multivariate regression analysis showed that BDI score, bradykinesia score, SEADLS score, and educational period were significantly associated with PDQL score. CONCLUSIONS: In order of magnitude, BDI, bradykinesia, SEADLS and educational period were influenc-ing factors on PDQL. Therefore, to improve the QoL in patients with PD, we should consider not only physical disabili-ty, but also psychological factors, including depressive mood.
Activities of Daily Living ; Age of Onset ; Anxiety ; Chronic Disease ; Cognition ; Depression ; England ; Humans ; Hypokinesia ; Motor Activity ; Neurodegenerative Diseases ; Parkinson Disease* ; Psychology ; Quality of Life* ; Surveys and Questionnaires

Monoamine oxidase inhibitors (MAO-I) belong to the earliest drugs tried in Parkinson's disease (PD). They have been used with or without levodopa (L-DOPA). Non-selective MAO-I due to their side-effect/adverse reaction profile, like tranylcypromine have limited use in the treatment of depression in PD, while selective, reversible MAO-A inhibitors are recommended due to their easier clinical handling. For the treatment of akinesia and motor fluctuations selective irreversible MAO-B inhibitors selegiline and rasagiline are recommended. They are safe and well tolerated at the recommended daily doses. Their main differences are related to (1) metabolism, (2) interaction with CYP-enzymes and (3) quantitative properties at the molecular biological/genetic level. Rasagiline is more potent in clinical practise and has a hypothesis driven more favourable side effect/adverse reaction profile due to its metabolism to aminoindan. Both selegiline and rasagiline have a neuroprotective and neurorestaurative potential. A head-to head clinical trial would be of utmost interest from both the clinical outcome and a hypothesis-driven point of view. Selegiline is available as tablet and melting tablet for PD and as transdermal selegiline for depression, while rasagiline is marketed as tablet for PD. In general, the clinical use of MAO-I nowadays is underestimated. There should be more efforts to evaluate their clinical potency as antidepressants and antidementive drugs in addition to the final proof of their disease-modifying potential. In line with this are recent innovative developments of MAO-I plus inhibition of acetylcholine esterase for Alzheimer's disease as well as combined MAO-I and iron chelation for PD.
Acetylcholine ; Alzheimer Disease ; Antidepressive Agents ; Depression ; Freezing ; Handling (Psychology) ; Head ; Indans ; Iron ; Levodopa ; Moclobemide ; Monoamine Oxidase ; Monoamine Oxidase Inhibitors ; Parkinson Disease ; Phenelzine ; Selegiline ; Tranylcypromine

BACKGROUND AND OBJECTIVES: As a society develops, olfactory disturbance increases with the increased industrial disaster, traffic accidents, upper respiratory tract infection, chronic sinusitis and allergic rhinitis from air pollution, Parkinson's disease and Alzheimer's disease from aging process. Nevertheless, there is no practical clinical test of olfactory function in Korea. Authors decided to develop the "Korean olfactory test" using the odorants which are familiar to Koreans. MATERIALS AND METHODS: KVSS Test (Korean Version of Sniffin' Sticks Test) is composed of KVSS Test I (screening test) and KVSS Test II (comprehensive test). KVSS Test I was performed on 120 controls with normosmia, 39 patients with hyposmia, and 24 patients with anosmia. KVSS Test II was performed on 117 controls with normosmia, 29 patients with hyposmia, and 22 patients with anosmia. The subjects ranged in ages from 20 to 69 years. RESULTS: In KVSS Test I, the range of scores (smell test) was 5.36-7.34 in normosmia, 3.41-6.73 in hyposmia, and 1.14-3.16 in anosmia. In KVSS Test II, the range of T.D.I. score (the sum of olfactory threshold score, odor discrimination score, and odor identification score) was 25.98-35.48 in normosmia, 17.01-30.63 in hyposmia, and 7.32-14.06 in anosmia (p<0.001). CONCLUSION: It is concluded that KVSS Test I and II are suitable for the routine clinical assessment of olfactory performance in Koreans.
Accidents, Traffic ; Aging ; Air Pollution ; Alzheimer Disease ; Disasters ; Discrimination (Psychology) ; Humans ; Korea ; Odors ; Olfaction Disorders ; Parkinson Disease ; Respiratory Tract Infections ; Rhinitis ; Sinusitis