The impact of early morning off in Parkinson's disease on patient quality of life and caregiver burden.

BACKGROUND: Early morning off (EMO) is a symptom experienced by patients with Parkinson's disease (PD) in any stage of the illness; however, few studies have explored its prevalence. Thus, the impact of EMO on patient Quality of Life (QOL) and caregiver burden is unclear. MATERIALS AND METHODS: A QOL questionnaire was administered to members of the Japan Parkinson's Disease Association and their caregivers via mail using the PD questionnaire - 8 (PDQ-8), which measures the appearance of EMO. The analysis assessed the responses from 2205 completed surveys. RESULTS: Patients who felt they had EMO amounted to 79.8%, with 37.8% of respondents stating that EMO was a daily occurrence. The prevalence of EMO increased as the Hoehn and Yahr stage increased, but was observed at a rate of 52.4% even in patients at Stage 1. The QOL of those with EMO was significantly reduced (p<0.0001), and the odds of caregivers feeling a sense of burden was higher for the group that experienced EMO even after adjusting for age of patient, age of caregivers, disease duration, relationship to patient, and Hoehn and Yahr stage. CONCLUSION: The prevalence of EMO in the survey results was high, significantly lowering the patients' QOL. Interestingly, EMO was also observed in the early stage of the disease. Since the presence of EMO impacts patients' QOL and caregiver burden, medical intervention and appropriate gathering of information for such intervention should be considered.

Impact of insufficient drug efficacy of antiparkinson agents on patient's quality of life: a cross-sectional study.

BACKGROUND: To understand the current state of insufficient drug efficacy experienced by patients with Parkinson's disease (PD) and its effects on quality of life (QOL), we conducted a survey of patients with PD and analyzed the results from 2,630 completed questionnaires. METHODS: The questionnaires inquired about age, sex, Hoehn and Yahr stage, disease duration, drugs currently being taken, and the current state of insufficient drug efficacy; it also included items of the Parkinson's Disease Questionnaire-8 (PDQ-8). Questionnaires were mailed to members of the Japan Parkinson's Disease Association. RESULTS: Approximately 70% of all subjects reported some type of insufficient drug efficacy, and around half of these experienced this early in the morning or at night. The proportion of subjects who experienced insufficient drug efficacy was found to increase with greater disease severity according to the Hoehn and Yahr stage. However, even among patients with stage I severity, insufficient drug efficacy was reported by approximately 40% of the respondents. QOL was significantly lower in patients who experienced insufficient drug efficacy than in those who did not (PDQ-8 summary index; 42.0 ± 20.1 vs. 30.0 ± 19.5; p < 0.0001). CONCLUSIONS: These results suggest that insufficient drug efficacy might affect the quality of life of patients in most stages PD including the early stages. Therefore, greater awareness of insufficient drug efficacy gained by questioning patients might help medical practitioners in taking appropriate actions.

[Reversible posterior leukoencephalopathy syndrome (RPLS) associated with Wegener's granulomatosis: a case report and review of the literature].

Reversible posterior leukoencephalopathy syndrome (RPLS) is characterized by sudden onset of headaches, visual disorders, decreased consciousness, and convulsion associated with brain edema occurring in the occipital lobe. Several different causes including malignant hypertension, eclampsia, renal failure, and use of immunosuppressants have been reported in patients with RPLS. Our patient was a 45-year-old man who presented with fever, arthralgia, and melena approximately 1 year previously and received the diagnosis of Wegener's granulomatosis. Following steroid therapy his symptoms ameliorated; however, during the course of the illness he developed tension-type headache, nausea and vomiting, and bilateral loss of visual acuity. On admission, his visual acuity was markedly decreased without any abnormal findings in the optic fundus. There was no neurological deficit except the visual symptoms. Imaging of the head revealed multiple lesions in the white and gray matter of the bilateral occipital lobe and cerebellar hemisphere, which proved vasogenic edematous lesions by the hyperintense signals in T(2) weighted, FLAIR, and diffusion weighted images, suggesting the diagnosis of RPLS. Treatment with antihypertensive drug and glycerol was initiated and the patient made a full clinical recovery within a few days. The pathogenesis of RPLS is not fully understood. Our case was not on any immunosuppressant therapy at the time of onset of RPLS, and his hypertension was mild and transient without renal failure. It is possible that RPLS in our patient might be a manifestation related to Wegener's granulomatosis-mediated vascular endothelial injury.

Anti-cholinergics for axial symptoms in Parkinson's disease after subthalamic stimulation.

OBJECTIVE: We studied the effect of anti-cholinergic therapy on axial symptoms that show a tendency to worsen over time after deep brain stimulation of the subthalamic nucleus (STN-DBS) in patients with Parkinson's disease (PD). PATIENTS AND METHODS: We conducted a prospective study of 20 consecutive patients treated with the anti-cholinergic agent trihexyphenidyl after bilateral STN-DBS and assessed the effect of anti-cholinergic therapy on parkinsonism 1 month after its initiation using the Unified Parkinson's Disease Rating Scale (UPDRS). RESULTS: After a mean post-operative follow-up period of 22.3 months, the scores of axial symptoms on UPDRS part II (ADL score) and part III (motor score) deteriorated by 87% and 54% (baseline), respectively, compared with the pre-operative scores (P < 0.001 for both comparisons). After adding trihexyphenidyl to dopaminergic medication with stimulation, the scores of axial symptoms on UPDRS part II and part III improved from baseline by 33% and 39%, respectively (P < 0.001 for both comparisons). CONCLUSIONS: Our findings demonstrated that the anti-cholinergic agent trihexyphenidyl shows positive effect for a patient population developing deterioration of axial symptoms after STN-DBS. The results in the present study may provide insights into the mechanism of emergence or progression of axial symptoms in patients with PD after STN-DBS.