Journal of the Association of Physicians of India
Editor : Dr. Siddharth N. Shah
Journal of the Association of Physicians of India
Editor : Dr. Siddharth N. Shah
CURRENT ISSUE • JANUARY 2013 • VOL. 61 SPECIAL ISSUE : A1chieve® Study
Abstracts : Free Papers – Oral Presentation (APICON-2013) - Neurology
Risk Factors and Etiology of Ischemic Stroke in Young
D Vijay Kumar
Aims and Objectives : To compare risk factors and etiological profile of ischemic stroke in “young” (≤ 45 yrs) and in others (>45 yrs)
Materials and Methods : A total of 52 young patients are compared with 52 patients in others group (>45 yrs) in our hospital during Sep-2010 to March 2012. Risk factors were assessed between two groups and patients were classified in to different etiological groups based on TOAST classification.
Results and Conclusion
Study of adult patients with acute febrile encephalopathy
Yadav P, Kalyani A, Neema A, Rijwani C, Gawarikar S, Vyas G
RD Gardi Medical College, Ujjain 456006, Madhya Pradesh
Aims and objectives : Acute febrile encephalopathy is a condition in which altered mental status either accompanies or follows a febrile illness. This is a common problem encountered by the physician practicing in tropical countries like India. This study was intended to find out prevalence, seasonal trends and various etiologies of febrile encephalopathy in adults.
Methods : It was a prospective observational study which was conducted at R. D. Gardi Medical College and associated Hospitals, Ujjain during the period of Jan 2010 to dec 2011. 100 patients were included and these patients formed the material of the present study. Apart from routine blood investigation, blood culture and sensitivity, complete CSF study and CT scan was done.
Results : These patients constitute 7.7% of total ICU admission. Maximum patients (79%) were admitted in the hospital from June to November. Common causes were viral meningoencephalitis, tubercular and bacterial meningitis, sepsis associated encephalopathy and cerebral malaria. 15% patients were having HIV infection. Among them 14% had tubercular meningitis and 1% patient had cryptococcal meningitis as coinfection.
Conclusion : Febrile encephalopathy is prevalent in this area. Common causes of febrile encephalopathy are viral meningoencephalitis, tubercular and bacterial meningitis, sepsis associated encephalopathy and cerebral malaria. Tubercular Meningitis is an important cause of febrile encephalopathy, especially in patients with HIV-AIDS.A lot of patients still remain undiagnosed, even after all investigations, which may be due to late presentation, use of multiple antibiotics and steroids before hospitalizations.
A Rare Overlap of Reading Epilepsy with Juvenile Myoclonic Epilepsy
P Sivaramakrishnan, Stanley Ambroise, CT Suresh
Indira Gandhi Govt. General Hospital and Post Graduate Institute, Puducherry
Epilepsy is a multifarious set of chronic neurological disorders, characterized by seizures. Some seizures are recurrent and unprovoked, but others require only a single seizure combined with brain alterations, which increase the chance of future seizures. Reading epilepsy is a complex type of reflex epilepsy, featured by reading-provoked sensorimotor symptoms. It affects the oral-buccal-lingual facial muscles that are involved in reading aloud. Reading Epilepsy is a rare, benign non-progressive syndrome. This paper presents and discusses an interesting case of a 14 year old boy with Juvenile Myoclonic Epilepsy, who also lands at a state of unawareness while reading (Reading Epilepsy). Neurological examination including fundus examination, video EEG and MRI brain were performed. With high dose Sodium Valporate treatment, the patient resulted in significant improvement. This case of reading epilepsy is presented in view of rarity of the disease and alexic form is very unusual. We also highlight that this is not pure reading epilepsy, but this reflex reading epilepsy is associated with Juvenile Myoclonic Epilepsy.
Case History : A 14 year old boy under treatment for Juvenile Myoclonic Epilepsy was brought by his mother with the following complaints. His mother complained that whenever her son started reading, he went into a state of unawareness. It started when he reads aloud as well as silently. The duration of the episode lasts for 3-4 minutes and when confronted during the event, he responds sometimes irrelevantly and sometimes not at all. On occasions, the book falls from his hand. It is not associated with jaw clicks or tonic clonic movements or tongue biting or frothing. Since one year, he is on sodium valproate at 800mg/day and did not have generalised seizures as well as myoclonic seizures.
His neurological examination including fundus examination was normal. His basic blood investigations and MRI brain was normal. A video EEG was done. Video EEG was recorded by making the patient read aloud. It showed fronto temporal sharp and slow waves and the patient stopped reading and he became unaware of the surroundings. He did not respond to commands for one to two minutes. It was not associated with tonic clonic movements, tongue biting and frothing. He lost grip of the book and had few automatisms of left distal hand and he recovered his consciousness after 3 minutes. His diagnosis was revised as Juvenile myoclonic epilepsy with reading epilepsy of complex partial type – alexic type. The dose of Sodium Valporate was increased to 1000mg/day and his number of attacks reduced.
Discussion : Reading epilepsy is featured by reading-provoked sensorimotor symptoms affecting the oral-buccal-lingual facial muscles that are involved in reading aloud. Bickford et al., investigated this condition and framed its two types - primary and secondary reading epilepsy.2 Primary reading epilepsy is characterized by stereotyped and ictal symptoms. It consists of a clicking sensation or movement in the jaw, occurring only in relation to reading, and these would progress to a generalized convulsion if reading continued.2 In partial reading epilepsy, prolonged alexia, strikingly different from the transitory ‘loss of track in the text’ of the myoclonic form, was the prevailing ictal manifestation.There will be no myoclonic jerk or post ictal confusion.
On the basis of ictal video- EEG studies, two seizure types are classified: (i) myoclonic jerks of the jaw that may spread to the upper limbs (ii) paroxysmal alexia with prolonged and strictly focal, ictal EEG discharges. The typical reading-induced jaw or orofacial myoclonus was the commonest and most constant ictal manifestation. Reading-provoked jerks occasionally spread to the upper limbs. An association of reading epilepsy with juvenile myoclonic epilepsy was suggested on the basis of some clinical findings like - the age at onset, strong influence of heredity, bilateral myoclonic jerks, progression to GTCS, response to sodium valproate and persistence through life.3 In reading epilepsy, myoclonic jerks are reading-induced and involve mostly the jaw, whereas, in the patients with juvenile myoclonic epilepsy, jerks affect the extremities and precipitation with reading has not been described. Furthermore, absences seizures are present in upto one-third of patients with juvenile myoclonic epilepsy, but are unusual in reading epilepsy.
EEG findings include brief discharges and consisted of sharp theta waves, sharp-wave or spike and wave complexes, clearly distinguishable from phasic muscle contractions. The response to the anti-epileptic medication seems to depend on the type of seizure. Clonazepam was particularly effective in myoclonic seizures.2 In myoclonic form, Sodium valproate is considered effective . In patients with prolonged partial seizures, treatment should probably be considered on an individual basis, but drugs for partial seizures seem to be the first choice.3
Conclusion : This case of reading epilepsy is presented in view of rarity of the disease and alexic form is very unusual. A careful history is needed for its diagnosis. Video EEG is very important in diagnosing the case. We also highlight that this is not pure reading epilepsy, but this reflex reading epilepsy is associated with Juvenile myoclonic epilepsy.
Acute viral encephalopathy (AVE): An epidemiological and etiological profile at tertiary care centre of North-India.
Nirdesh Jain, D Himanshu, Arvind Kumar Vaish, Manish Gutch
Department of General Medicine, KGMU, Lucknow
Aims and Objective: Acute viral encephalopathy (AVE): An epidemiological and etiological profile at tertiary care centre of North-India.
Method: This was an observational cross-sectional study conducted over a period of one year at medical indoor of a tertiary care centre, North-India, where all patients who admitted with complain of fever and altered sensorium was screened. The diagnosis AVE was considered who fulfilled the criteria of fever with altered sensorium (with focal symptoms/signs) ± neck signs + CSF cytology (predominantly lymphocytes) +MRI/CT evidence of parenchymal disease+ CSF serology. Tests for detecting IgM antibodies in CSF against JE virus, Dengue virus, HSV, Epstein-Barr virus, Cytomegalovirus, measles virus and mumps in CSF were done in CSF in all patients of suspected cases of acute viral encephalopathy. Data were presented in mean+SD and percentages.
Results: A total of 580 patients admitted with fever and altered sensorium were screened. Out of them 108 patients were diagnosed of AVE, their mean age was 28.97±16.7 years. Males were 69 (63.9%) and Females were 39 (36.1%). More than half of the patients were hailed from these five districts Lucknow (12.96%), Sitapur (12.96%), Faizabad (10.1%), Hardoi (9.26%) and Barabanki districts (8.33%). In clinical profile, besides fever and altered sensorium, seizures in 65 (60.2%), and headache in 40 (37%), and vomiting in 31(28.7%) patients was the presenting complaints. Neck rigidity was present in 26 (24%) and Kernig’s sign was present in 20 (18.5%). The mean GCS was 9.03±3.2. Among CSF parameters, cell count was 138.7+195(5-1235), lymphocytes % was 88.27+16.9, protein was 86.50±92.4 mg/dl, and sugar was 79.40±39.4 mg/dl. JE serology was positive in 60 (55.6%) patients, in 12 (11.1%) patients serology for other viruses was also positive (among them HSV 4 patients, dengue 4 patients, measles 2 patients, and single cases of CMV, mumps and EBV).One patient had serology was positive for both HSV and dengue. In remaining, viral etiology could not be identified. Diffuse edematous brain parenchyma (37%) was the commonest finding in CT brain. MRI brain could be done in 60 patients which showed encephalitis 33 patients (including 3 patients had meningoencephalitis). Interestingly, signal intensity alteration in bilateral thalami, midbrain and pons was seen in 9 patients who all had positive serology for JE virus. The outcome was fatal in 17 (15.7%) patients, 8 were left against medical advice from the hospital and 83 were discharged in satisfactory condition.
Conclusion: AVE is life threatening condition which account for a major toll of morbidity and mortality that commonly encountered in North-India. JE virus is most common responsible infectious agent followed by dengue encephalitis for AVE. Sporadic cases of HSV, EBV, CMV, measles and mumps have also detected.
Familial Myofibrillary Myopathy
Venkataramanappa, Srikantaswamy, Shashidhar, Madhuvan HS, Nikhil B
MVJ Medical College, Hoskote, Bangalore-562114
Myofibrillar myopathy (MFM) describes a group of hereditary myopathies pathologically characterized by markedly disorganized myofibrils with cytoplasmic inclusions. Commonest mode of inheritance is autosomal dominant, however autosomal recessive and x-linked forms have been described. Seven disease-related genes have been identified, including DES, CRYAB, MYOT, ZASP, FLNC, BAG3, and FHL1, all of which encode proteins closely related to Z-line. Clinical presentation is variable with age of onset from infancy to eighth decade.
Case report: Our patient, 33/M presented with h/o progressive difficulty in walking – 2 years H/o difficulty in getting up from sitting and squatting position, difficulty in climbing stairs and walking uphill. No h/o weakness in distal muscles and in upper limbs. No h/o sensory symptoms or cranial nerve involvement or HMF impairment. Non diabetic, recently detected to have HTN and on treatment.
His family history positive for similar complaints (father and 2 other siblings) with different age of onset.
His general physical examination was normal. His cognitive and cortical functions were normal.
Cranial nerve function and sensory tests were intact. Motor examination revealed mild proximal weakness of both legs [ MRC grade IV]. DTR’s- sluggish. Plantars – flexor bilaterally. Gait- WADDLING GAIT. CVS -examination revealed evidence of hypertensive heart disease present, without heart failure.One affected sibling has dilated cardiomyopathy with CCF and atrial fibrillation. Other systems - normal
The blood chemistry test revealed elevated creatine kinase (CK) levels. Other blood work up was normal including thyroid function tests. EMG showed Myopathic pattern with MYOTONIA. NCS- Normal.
A muscle biopsy demonstrated myofibers showed reduced activity of enzymes SDH and NADPH-TR. Some fibers revealed intense reaction with MGT. ATPase reveal atrophic types 1 and 2fibers. Desmin immunolabelling shows subsarcolemmal and central aggregation in moderate numbers. These findings were consistent with Myofibrillary Myopathy. The genetic cause of which was undetermined due to lack of facilities in India.
Here by we report a case of Myofibrillary myopathy in a South Indian family (father and 3 siblings).To the best of our knowledge this is the first case of Familial Myofibrillary Myopathy being reported from India.
Use of intravenous phenytoin increases mortality in patients with intracerebreal haemorrhage
Ayush Dubey, SG Dhavle, Ashish Sharma
Department of Medicine, R.D. Gardi Medical College, Ujjain
Purpose : There is always a dilemma regarding the use of prophylactic antiepileptic drug therapy in patients of intra cerebral haemorrhage. This study was undertaken to assess the outcome after use of antiepileptic drug in intracerebral haemorrhage.
Method : 50 patients of intracerebral haemorrhage were prospectively enrolled in this study 25 such patients received antiepileptic drug and were considered as cases while the rest 25 patients who did not receive antiepileptic drug were considered as control. Neurological status was assessed with glasgow coma scale and outcomes were measured with the modified Rankin scale.
Results : Use of phenytoin was associated with increased chance of fever in intracerebral haemrrhage patients and over all phenytoin was associated with poor outcome in patients of intracerebral haemorrhage. The difference was statistically significant (P< 0.01).
Conclusion : Use of intravenous phenytoin resulted in increased chances of pyrexia and worse outcome in patients of intracerebral haemorrhage.
A Case of Subacute Hsv Encephalitis
Ajith PG*, G Karthikeyan*, S Selvamani**, N Karuppusamy**, S Ramkumar**, Isaac Christian Moses***
*Junior Resident, **Assistant Professor, ***Professor, Coimbatore Medical College Hospital, Coimbatore
We report a rare presentation of Herpes Simplex Virus encephalitis. This patient a 24 year old male was admitted with loss of memory,altered behavior,auditory hallucinations and myoclonic jerks for 3 months duration. On evaluation CSF analysis showed protein 28mg/dl, sugar 54mg/dl, CSF HSV DNA negative. His MRI brain T2 weighted images revealed hyperintensity in both medial temporal lobes suggesting the diagnosis of HSV encephalitis. He was treated with Inj. Acyclovir for 21 days and myoclonic jerks were controlled with Tab. Sodium valproate and Clonazepam. On follow up he is still having loss of recent memory where as he has no recurrence of myoclonic jerks.
Acute Intermittent Porphyria presenting as Quadriparesis
Rosemarie Desouza, R Bhadade, S Badhe
Topiwala Nair Medical College and Hospital, Mumbai
Introduction : Acute Intermittent Porphyria is a disease caused due to deficiency of Hydroxymethylbilane synthase that presents with acute abdomen, neuropsychiatric symtoms and peripheral neuropathy.Difficult to diagnose, a high index of suspicion is necessary for the diagnosis of AIP.
Clinical History : 28 yrs old Female came with complaints of Abdominal Pain since 20 days, Fever without chills since 20 days, vomiting since 7-8 days, 1 episode of GTC seizure 7 days back,mild headache and blurring of vision
On Examination –Pulse -130/min BP – 180/120 Pt was drowsy and power was normal in all limbs.
Reports - TLC – 20,600 Na+ - 114 K+ - 5.2 Creat – 0.9
Fundus – Early changes of Papilloedema
ECG – Left Ventricular Hypertrophy
2D echo – Hypertensive heart disease
CT Brain - Hypodensity in Bilateral high parietal region
Course : Hyponatremia was corrected with IV fluids. BP controlled with antihypertensives. Phenytoin was started for seizures. However patient developed weakness of all 4 limbs around 8th day of admission. Deep tendon reflexes were absent. The weakness increased and pt was quadriplegic within one day.Pt developed respiratory distress and was intubated and initiated on mechanical ventilation. Urine was sent for porphobilinogen which was positive and patient was diagnosed as Acute Intermittent Porphyria. However patient developed bulbar paralysis and cardiorespiratory arrest on the 19th day of admission.
Conclusion : Quadriparesis and autonomic dysfunction are among the very severe manifestations of AIP. The initiation of Phenytoin for the seizures might have worsened the neuropathy in our patient leading to quadriparesis. A high index of suspicion is very essential for diagnosis of AIP. Treating the condition while keeping in mind the precipitating medications still remains a challenge.
Spectrum of CSF changes in Patients presenting with Febrile Encephalopathy
Prakash VS, Tewari AK, Gupta S, Gupta A, Kumar RSV, Naithani N, Nair V
Command Hospital (SC), Pune - 411040
Acute Febrile Encephalopathy is a very commonly encountered problem both among in-patients and at busy casualty set up. Defined as “ state of rapid deterioration of brain function, usually presenting as an alteration in state of consciousness, with or without focal neurological signs.The commonest cause being CNS infections
Aim: To study spectrum of CSF changes that accompanies individuals presenting with febrile encephalopathy
Setting and Design: A observational study carried out at a tertiary care center in the Western India over a period of 20 months.
Material and Methods : A total of 100 patients aged more than 15 yrs who were admitted with Fever of less than 2 weeks duration with associated altered mentation were observed. The individuals were comprehensively examined and historical variables were recorded in detail. In all individuals cerebrospinal fluid analysis,was performed,also relevant haematological,biochemical and microbiological investigations performed.In addition CT Head and MRI brain were performed wherever deemed necessary
Data was analysed as Mean, mode, median and percentages. A p value <0.05 was considered significant
Results and Conclusion : Primary CNS infections accounted for > 50 % of all the causes. Out of these Viral meningoencephalitis accounted for 20%, pyogenic meningitis for 17% and TB meningitis for 18% of cases. Septic encephalopathy was a major cause of febrile encephalopathy (27% cases). Other important cause was cerebral malaria.
Septic encephalopathy is an important cause of encephalopathy especially with the elderly population who have multiple comorbidities. Diagnosing and understanding this etiology has assumed siginificance with ever aeging population who are presenting with multiple complications.CSF correlation of this important enigmatic entity is also discussed.
Evaluation of Csf Ada Levels as a Diagnostic Test for Tuberculous Meningitis and its Correlation with Adverse Neurological Outcome
Diwedi NC, Shukla SK, Mathur M, Sonkar KK, Chaurasia AK, Singh Sandeep Kumar
Dept. of Internal Medicine, MLN Medical College, Allahabad 211001
Background : Tuberculous meningitis (TBM) is usually misdiagnosed. Early diagnosis and treatment is of great importance/thereby a more sensitive diagnostic test is needed to establishing the diagnosis of TBM.
Objective : To evaluate Cerebrospinal fluid adenosine deaminase(CSF-ADA) level as a diagnostic test for TBM and its correlation with poor neurological outcomes.
Method : We conducted a prospective cohort study of 50 patients at Swaroop Rani Nehru Hospital of Moti Lai Nehru Medical College, Allahabad (U.P.).Diagnosis of TBM was made by using clinicopathological diagnostic criteria for TBM -THWAITES CRITERIA, for neurological outcomes, stage of disease at the time of admission assessed by Medical Reasearch Council Staging (MRC) and disability during hospitalization assessed by Modified Rankin Score (MRS).
Result : 74% patients had CSF-ADA level_>_10 IU/L At the time of admission 44% patients were in MRC stage2 with CSF-ADA levels >10 IU/L and 16% patients were in MRC stage3 with CSF-ADA levels >11 lU/L.After an average two weeks of hospitalization 52% patients with CSF-ADA levels>10 IU/L had moderately severe disability(MRS-4) and 18% patient with CSF-ADA levels >13 IU/L had severe disability (MRS-5).Hydrocephalus on neuroimaging was found in 22% patients with CSF-ADA level >11.7 IU/L
Conclusion : CSF ADA level (^10 IU/L) is important in diagnosing TBM and should be considered as a diagnostic test for TBM. High CSF-ADA levels were associated with poor neurological outcomes and abnormal neuroimaging findings.However these findings should further investigated.
A Case of Interhemispheric Subdural Empyema Rare Cause for Young Hemiparesis
P Raja Mahendran*, Eshwarappa*, Anusha*, PS Ramesh*, N Thangaraj*, V Shanmuganathan*, Uvaraj Muruganandam**, A Akila**, Kumar Natarajan***, Isaac Christian Moses***
*Junior Residents, **Assistant Professors, ***Professors
Subdural empyema (SDE) is a rare disorder that accounts for 15-25% of focal suppurative CNS Infections. Sinusitis is the most common predisposing factor for this. Sinusitis associated Subdural empyema has a striking predilection for young males. Here, We are reporting a case of young male who presented with focal deficit due to subdural empyema.
This 18 years old male admitted with history of weakness of left side limbs and headache. Subsequently he developed fever, Focal seizures then became generalized. Neurological examination revealed neck stiffness and spastic hemiparesis on left side and left UMN facial palsy. CT Head revealed Pansinusitis and Right interhemispheric subdural fluid collection. MRI shows Pansinusitis and FLAIR hypointense Right interhemispheric cystic collection suggestive of SUBDURAL EMPYEMA.
Idiopathic Intracranial Hypertension: A Clinical Study
Kuldeep Shetty, Suresh K, Ravishankar AG, Rangaswamy, Yoganna SP
Mysore Medical College and Research Institute, Mysore, Karnataka
Introduction : Known for more than a century now. Idiopathic Intracranial Hypertension (IIH) is a disease, presenting with headache and papilledema/ frequent in overweight adolescent girls and young women, attaining an incidence of 19 to 21 per 100,000 in this group, as compared with 1 to 2 per 100,000 in the general population (Radhakrishnan et al). As per Indian statistlcs,male to female ratio is 13:1, average age being 28.6 year. As defined by the Modified Dandy’s criteria, IIH is a disease defined by elevated CSF pressure, normal CSF content, a normal brain with normal or small ventricles seen in imaging studies, and normal results of neurologic examination except forabducens nerve palsy.
We made an attempt to look at the prevalence of IIH in our referral hospital in patients who presented to outpatient department with headache and ophthalmic evaluation revealed either papilledema or abducens nerve paresis.
Methods: We had 20 patients who fulfilled the criteria for the IIH between Feb 2011 to Feb 2012. All the patients after undergoing detailed clinical evaluation and neuroimaging (CT or MRI) were submitted for the CSF opening pressure monitoring and CSF analysis.
Results: There were 16 females and 4 male patients with mean age of 33 years. 13 had lateral rectus palsy (9 had unilateral; left sided in 7 and right in 2.4 had bilateral), 3 were obese, 2 were hypothyroid. The mean CSF opening pressure was 282 mm of CSF (range 220 to 550 mm of CSF). CT head and MR) was normal in all. However, MRV revealed hypoplastic transverse sinus (Ieft>right) in 6. CSF analysis was normal in all. 8 patients who underwent blind spot mapping had enlargement.
Conclusions: IIH Is a common cause of headache with papilledema in young adults, with female preponderance. Most of the patients respond appreciably to medical line of management. Surgical intervention at appropriate time will save devastating visual loss.
Validation and Feasibility of a Short Community Screening Instrument for Dementia in South Indian Population
Gaurish Karande, Murali Krishna, B Shenoy
CSI Holddsworth Memorial Hospital, Mysore 570021
Dementia is a leading cause of disability, morbidity and mortality in older adults particularly in the developing countries where the recognition and treatment of later life neurocognitive disorders is suboptimal. The 10/66 Dementia research group developed and validated a culture and education fair battery of cognitive tests that can be administered to those with minimal or no education. The short version of the Community Screening Instrument for Dementia (S-CS1D) has been developed for use by those not psychiatrically trained. S-CISD was administered to 220 older adults between 60-94 yrs of age. 105 of them were interviewed in the community and 115 were interviewed at CSI Holdsworth Memorial Hospital, Mysore during their inpatient stay. After the S-CSID was administered by a general trained nurse, a consultant psychiatrist, who was blind to CSID score made an independent diagnosis of Dementia and other mental disorders when present. The agreement between S-CSID and the consultant psychiatrist diagnoses (kappa value) is good 0.7. The tool has been shown to have good specificity and sensitivity. It took 3 minutes to administer the S-CSID. All older adults found it ‘easy’ and it was feasible to administer this is busy medical wards. In conclusion, S-CSID is promising new brief screening instrument for cognitive impairment in the elderly in south Indian population that can be administered by non psychiatrically trained.
A Descriptive study of Non-Motor Symptoms in Parkinson’s disease
Anand KS, Anupriya, Sonam, Verma R
Department of Neurology, PGIMER, Dr RML Hospital, New Delhi
Introduction: In contrast to the motor symptoms of Parkinson’s disease (PD), which physicians and patients are focused on, non-motor symptoms (NMS) in PD, which frequently complicate the course of the illness, are often poorly recognized and inadequately treated. These symptoms are important contributors to severe disability and handicap, poor quality of life, caregiver distress, and institutional care as well as decreased life expectancy. Indian studies in the field are scarce, thus generating the requirement to survey patients’.
Aims and Objectives: The aim of the study was to determine the prevalence of NMS in PD and its frequency across all disease stages.
Methodology: Fifty patients with PD were included consecutively from movement disorder clinic of a tertiary care center. Assessment was done on NMS screening questionnaire (NMSQuest), given by the Parkinson’s Disease Non-Motor Group (PDNMG), consisting 30 common non-motor items. Its relation to disability and severity of PD was evaluated using Hoehn and Yahr staging and Schwab and England Activities of Daily Living respectively.
Results: The average age of subjects (male = 34, female = 16) was 63.7 years (S.D. 12.8). The mean duration of PD was 6.3 years with a range of 0.5 – 16 years. Forty-one of those with PD were being treated with dopaminergic medications. The mean for Hoehn and Yahr staging was 2.55 (SD±0.78) with 7.7 % in stage 1, 4.6 % in stage 1.5, 23.1 % in stage 2, 21.5 % in stage 2.5, 32.3 % in stage 3, and 10.8 % in stage 4. Commonly reported NMS were - forgetfulness (72%), dizziness (62%), increased nocturnal urinary frequency (58%), insomnia (54%), constipation (52%), urinary urgency (50%), and dribbling of saliva (46%). About 1/5th of patients reported sadness and anxiety. Most common system involved was autonomic. Complaints of insomnia dominated amongst sleep symptoms. Non-motor symptoms were significantly associated with disability and higher stages of PD.
Conclusions: Physician’s awareness and recognition of NMS, coupled with patient’s awareness to convey the same to the attention of treating physicians, would improve overall quality of life as effective treatment is available.
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