Abdul Qayyum Rana

Association of restless legs syndrome, pain, and mood disorders in parkinson's disease

Purpose/Aims: The objectives of the study were to analyze the association between Parkinsons disease and restless legs syndrome, and to explore the relationship between mood disorder comorbidity (anxiety and depression), pain, and restless legs syndrome. Methods: This study included 123 Parkinsons disease patients and 123 non-Parkinsons disease patients matched for age and gender, and evaluated for anxiety severity, depression severity, pain severity, pain interference, pain disability, and restless legs syndrome prevalence. This was performed using semi-structured interviews and a neurological examination through the restless legs syndrome diagnostic criteria and the following inventories; Hospital Anxiety and Depression Scale, Brief Pain Inventory, and Pain Disability Index. Results: Parkinsons disease patients had significantly greater anxiety severity, depression severity, pain severity, pain interference, pain disability, and restless legs syndrome prevalence in comparison to controls. In addition, Parkinsons disease patients’ comorbid for anxiety and depression had significantly greater pain severity, pain interference, and pain disability, but not RLS prevalence, in comparison to Parkinsons disease only, Parkinsons disease anxiety, and Parkinsons disease depression patients. Conclusions: Pain interference, pain severity, and pain disability is greater among Parkinsons disease patients with anxiety and depression, in comparison to Parkinsons disease patients without anxiety and depression. On the contrary, the prevalence of restless legs syndrome was not found to be relevant.

A Review of Primary Writing Tremor

ABSTRACT A task-specific tremor (TST) is a rare form of movement disorder that appears while performing or attempting to perform a particular task. Primary writing tremor (PWT) is the most common form of TST which only occurs during the act of writing and hinders it. (Bain PG, Findley LJ, Britton TC, Rothwell JC, Gresty MA, Thompson PD, Marsden CD. MRC Human Movement, and Balance Unit, Institute of Neurology, London, UK. Primary writing tremor. Brain. 1995;118(6):1461–72.) Primary writing tremor type B is present not only during the act of writing but also when the hand assumes a writing posture. (Bain PG, Findley LJ, Britton TC, Rothwell JC, Gresty MA, Thompson PD, Marsden CD. MRC Human Movement and Balance Unit, Institute of Neurology, London, UK. Primary writing tremor. Brain. 1995;118(6):1461–72.) We first of all describe a remarkable case study of a 50-year old, right-handed male who started experiencing a primary writing tremor in his right hand about a year ago. This case was found to be of particular interest because the patient had it relatively difficult when attempting to write numbers as opposed to writing letters. This review further discusses the clinical manifestations of PWT. In addition, three main hypotheses have been proposed for the causation of PWT, although the exact pathophysiology of PWT still remains unknown. It has been suggested that PWT is a separate entity, a variant of essential tremor and not a separate entity, or a type of dystonia. The various treatment options for PWT are discussed including botulinum toxin and oral pharmacotherapy.

Relationship of dementia and visual hallucinations in tremor and non-tremor dominant Parkinson's disease

OBJECTIVESnBoth visual hallucinations and cognitive dysfunction are experienced by a significant number of patients with Parkinsons disease. There were three main objectives of this study: (1) to determine if there is a difference in the prevalence of dementia in patients with tremor versus non-tremor dominant Parkinsons; (2) to determine if there is a difference of prevalence of visual hallucinations in patients with tremor and non-tremor dominant Parkinsons disease; and (3) to determine if there is a relationship between visual hallucinations and dementia in Parkinsons disease patients.nnnBACKGROUNDnDementia and visual hallucinations are common non-motor symptoms of Parkinsons disease that affect a significant number of patients. Previous research has shown that visual hallucinations may be predictive of future onset of dementia. We wanted to compare the prevalence of these non-motor symptoms in tremor vs. non-tremor dominant Parkinsons disease, although previous research has shown that dementia may be more common in the akinetic rigid variant of Parkinsons disease without tremor. Visual hallucinations have not yet been studied in this way.nnnMETHODSnWe performed a retrospective chart analysis on 314 patients with Parkinsons disease in this study. Patients meeting the inclusion criteria were stratified into several categories based on the presence or absence of tremor dominant PD, akinetic rigid dominant PD, dementia and visual hallucinations. Nonparametric tests were used for performing statistical analyses. The Chi Squared test was used for the analysis of categorical variables.nnnRESULTSnPatients without tremor had a higher prevalence of dementia (29%) than those with tremor (14%). There was no difference in visual hallucinations in tremor versus non-tremor patients, although there was a significant trend between tremor and visual hallucinations in female patients. A significant correlation was found between dementia and visual hallucinations in the sample, however further investigation showed this was largely associated with female Parkinsons disease patients.

Associations of pain and depression with marital status in patients diagnosed with Parkinson's disease

Depression and pain are significant clinical problems that are comorbid with Parkinsons disease (PD). However, the relationship of these variables with the marital status of patients with PD has not been explored in previous studies. Therefore, the goal of this study was to assess the possible relationship between depression prevalence, depression severity, and pain interference with the marital status of the sufferers of PD.

Restless leg syndrome: a risk factor of higher prevalence of anxiety and depression in Parkinson’s disease patients

Background: Many studies have assessed the relationship of depression and anxiety with Parkinson’s disease (PD), as well as examining restless leg syndrome (RLS) with depression and anxiety. Nonetheless, there has not been an extensive effort to show how the prevalence of RLS affects both depression and anxiety in PD patients. The objective of this study was to examine how the prevalence of RLS in PD patients affects the prevalence and severity of depression and anxiety and how they compare with each other. This study is the first of its kind that examines the effects of the combination of the two neurological conditions with depression and anxiety as well as comparing their prevalence and severity to each other. Methods: The study included 27 PD patients who also suffered from RLS, 27 PD patients not suffering from RLS, and 27 gender-matched healthy individuals. All were evaluated for caseness and severity of both anxiety and depression using the Hospital Anxiety and Depression Scale (HADS); HADS-A and HADS-D, respectively. Results: PD patients with RLS reported having the highest prevalence of both anxiety and depression. The least reported cases for both anxiety and depression were in the control group. In comparison, the results for severity of anxiety and depression within the three groups showed that PD patients with and without RLS had significantly higher severity scores for both anxiety and depression than the control group, but the scores did not significantly differ between the two PD patient groups. Conclusion: The presence of RLS in PD patients may increase the occurrence of both anxiety and depression, but the severity of the symptoms is not significant in the two groups of the PD patients.

Prevalence of nocturia in Parkinson's disease patients from various ethnicities

Abstract Objectives: One of the most common non-motor symptoms in Parkinson’s disease (PD) is nocturia. This paper seeks to address the prevalence of nocturia in PD and correlate it to various factors such as gender, Hoehn and Yahr (H&Y) stage, age, and ethnicities. Methods: In particular, 332 PD patients were seen in a community movement disorders clinic and their charts were analyzed from 2005 to 2010. Within this population, more than one-third (34·9%) patients were diagnosed with nocturia. Results: Age, gender, and PD stage were significant predictors of nocturia in PD. With every one-year increase in age, the odds of developing nocturia in PD increases by 3·1% while an increase in H&Y stage increases the odds of nocturia in PD by 1·645 times. Also, males had greater odds of experiencing nocturia in PD. Ethnicities alone were of no significant importance. However, after performing interaction analyses, Asian and Indian males, especially, were at significantly greater risk than other ethnicities. Discussion: Future research is indeed required to understand why certain ethnicities are especially at risk. Clinicians must also be aware of the epidemiology of nocturia in PD to prevent and treat this debilitating symptom.

Impact of Ethnicity on Non-Motor Symptoms of Parkinson's Disease

Parkinsons disease (PD) is a neurodegenerative illness characterized by various non-motor symptoms that may contribute to disability, impaired quality of life and shortened life expectancy. The aim of present study was to determine the relative prevalence of common non-motor symptoms in various ethnic groups. A retrospective chart analysis was performed on Parkinsons disease patients where a total of 314 PD patients from six ethnic categories were examined for the occurrence of anxiety, visual hallucinations, nocturia, drooling and dementia. Our results show that anxiety in PD patients was correlated with their ethnicity classification. Interesting trends were observed with respect to nocturia and dementia symptoms and no significant differences were found between ethnic groups for visual hallucinations and drooling. Our study shows that non-motor symptoms of Parkinsons disease are prevalent across all ethnic groups, and except anxiety there may not be any impact of ethnicity on dementia, nocturia, drooling, and visual hallucinations.

Patient perception of Levido reticularis due to amantadine.

ABSTRACT Livedo reticularis (LR) is a “fish-net like” mottling of the skin, and is attributed to a variety of factors. Amantadine, a medication used in Parkinsons disease, has been known to cause LR localized to the lower, and to a rarer extent, the upper extremities. Patient perception of this condition has been severely under-reported and can impact the patients decision to stop this medication. In this retrospective study, we analyze the perception of five patients presenting with LR and their decision to continue on amantadine. It was seen that patients with the reticularis rash localized in the upper extremities, in addition to the lower extremities, were affected enough to discontinue amantadine despite its useful therapeutic effects. It is imperative that patient perception regarding LR be taken into consideration when initially presented. Furthermore, the decision to change the regiment of amantadine should be individualized according to patient condition and perception of presented rash.

Hereditary Neuropathy with Liability to Pressure Palsy: A Brief Review with a Case Report

ABSTRACT Hereditary Neuropathy with Liability to Pressure Palsy (HNPP) is an autosomal dominant disorder and is usually characterized by episodes of recurrent and painless focal motor and sensory peripheral mononeuropathy. This condition is usually localized around areas of entrapment (predominantly the wrists, knees, elbows, and shoulders). The genetic locus of the disease is chromosome 17p12. A deletion of the PMP22 gene results in the lack of peripheral myelin protein, a key component to the myelin sheet of peripheral nerves. However, this disease may be completely asymptomatic until an event, such as a minor trauma, triggers these episodes, as seen in our presented case report. The diagnosis of HNPP can be somewhat challenging, as other diseases, such as Charcot–Marie–Tooth disease type 1A (CMT) and Hereditary Neuralgic Amyotrophy (HNA) must be included in the differential diagnosis due to their overlapping clinical features. There are currently no treatments to cure the disease, but therapies seek to alleviate the symptoms and recurring episodes.

Increased likelihood of anxiety and poor sleep quality in Parkinson's disease patients with pain

BACKGROUNDnPain is a bothersome non-motor symptom in patients with Parkinsons disease (PD), but the relationships between PD, presence of pain, different pain characteristics, and other non-motor symptoms such as mood and sleep disturbances are unclear.nnnOBJECTIVEnTo investigate the relationship between PD and pain as well as specific subtypes of pain with anxiety, depression and sleep quality.nnnMETHODSnThis cross-sectional case-control study included two groups of PD patients; one with (n=37) and one without pain (n=37). Healthy controls with (n=37) and without pain (n=37) were recruited and matched to the PD groups for age and gender. All participants completed questionnaires regarding pain, mood and sleep.nnnRESULTSnPD patients with pain showed significantly higher anxiety severity and poorer sleep quality than PD patients without pain. Compared to controls with pain, PD patients with pain had more anxiety, depression and worsened sleep quality. PD patients with pain were more likely to report akathisic, tension and sharp pain compared to controls with pain, but these three pain characteristics did not correlate with each other. There were no differences in depression, anxiety, or sleep between PD patients with akathisic, tension and sharp pain and those without.nnnCONCLUSIONnPain in PD seems to be linked with specific pain characteristics (akathisic, tension and sharp pain) as well as heightened anxiety and worsened sleep quality. Integrative approach treatments which address pain in PD may also improve anxiety and sleep quality.