Development of the Korean Academy of Medical Sciences Guideline for Rating the Impairment in the Brain Injured and Brain Diseased Persons with Motor Dysfunction

To develop an objective and scientific method to evaluate the brain injured and brain diseased persons with motor dysfunction, American Medical Association's Guides to the Evaluation of Permanent Impairment was used as an exemplar. After the motor dysfunction due to brain injury or brain disease was confirmed, active range of motion and muscle strength of affected extremities were measured. Also, the total function of extremities was evaluated through the assessment of activities of daily living, fine coordination of hand, balance and gait. Then, the total score of manual muscle test and functional assessment of impaired upper and lower extremity were added, respectively. Spasticity of upper and lower extremity was used as minus factors. Patients with movement disorder such as Parkinson's disease were assessed based on the degree of dysfunction in response to medication. We develop a new rating system based on the concept of total score

Scoliosis in Patients with Parkinson's Disease

BACKGROUND AND PURPOSE: Scoliosis is more common in patients with Parkinson's disease (PD) than in the general elderly population. We compared clinical characteristics between PD patients with and without scoliosis, to identify the relationship between the direction of scoliosis and the laterality of the dominant symptoms of PD. We also studied the associations between dopaminergic pharmacotherapy and scoliosis (defined by a spinal curvature deviation of 10 degrees or larger). METHODS: The study population comprised 97 patients (42 men and 55 women) with idiopathic PD. All of the patients submitted to a whole-spine scanograph to allow measurement of the degree of scoliosis by Cobb's method. RESULTS: True scoliosis was found in 32 of the 97 PD patients, and was observed more frequently in women than in men (28 vs. 4, respectively; p=0.006). The age of patients without scoliosis was significantly lower than that of those with scoliosis (66.5+/-9.2 years vs. 72.8+/-7.3 years, respectively, mean+/-SD, p<0.001). There was no correlation between PD symptom laterality and scoliosis. The rate of occurrence of scoliosis did not differ between de novo and levodopa (L-dopa)-treated patients. CONCLUSIONS: We suggest that neither L-dopa treatment nor the laterality of the initial symptoms of PD is related to the appearance of scoliosisope

Psychogenic Balance Disorders: Is It a New Entity of Psychogenic Movement Disorders?

The various reported psychogenic dyskinesias include tremor, dystonia, myoclonus, gait disorder, Parkinsonism, tics, and chorea. It is not easy to diagnose psychogenic movement disorders, especially in patients with underlying organic disease. We describe three patients with balance and/or posture abnormalities that occur when they stand up, start to move, or halt from walking, although their gaits are normal. One had an underlying unilateral frontal lobe lesion. All patients improved dramatically after receiving a placebo-injection or medication. These abnormal features differ from the previously reported features of astasia without abasia and of psychogenic gait disorders, including recumbent gait. We describe and discuss the patients’ unique clinical characteristics

Psychogenic Gait Disorders after Mass School Vaccination of Influenza A

Background and Purpose Psychogenic movement disorders (PMD) after war or mass vaccination was reported and well known disease entity already. However, we have seldom been met those patients because we don’t have any chance to experience of those events. Recently, influenza A (H1N1) spreads around world, and many countries have a program of mass vaccination of H1N1. Although PMD in adult is well characterized, childhood-onset PMD has not been extensively studied. Case Reports We present four children of psychogenic gait disorders (PGDs) after mass school vaccination of H1N1. They had fluctuating weakness and their prognosis was good. We confirmed all patients as PGD by placebo. Conclusions Our four cases have two common characteristics. One is that all were young and their prognosis was good. And the other is that all were induced their abnormal gait symptoms after mass school vaccination. We observed that mass PMD has a different characteristics comparing to personal PMD, and PMD in children is differ from adult onset PMD

Adherence to guidelines: primary prevention with aspirin in 1125 medical check-up participants

Aim: The aim of the present study was to assess the 10-year cardiovascular disease (CVD) risk and to apply the current recommendations on aspirin use for primary prevention in Korean participants undergoing a medical check-up.Methods: Adults aged 50 to 69 years were eligible for the study if they did not have a history of atherosclerotic CVD (ASCVD) or stroke. The 10-year CVD risk was calculated using the ASCVD risk estimator (http://tools.acc.org/ASCVD-Risk-Estimator).Results: A total of 1125 participants were enrolled in this study. The mean age was 57 years, and 32% of the participants were women. Based on the 2016 US Preventive Services Task Force recommendations, aspirin was indicated in 266 (23.6%) participants but only 44 (3.9%) participants were taking aspirin regularly. Among these participants, aspirin was prescribed appropriately in 36% of the participants, suggesting that only 6% of the participants were taking aspirin appropriately and 3.3% of the participants were taking aspirin inappropriately. Logistic regression analysis showed that treatment for hypertension was significantly associated with taking aspirin (odds ratio 7.49; 95% confidence interval 3.62-15.49).Conclusion: Our study suggested that there may be an opportunity for decreasing the rate of CVD as well as the risk for major bleeds through tailored education on aspirin use

Carpal Tunnel Syndrome in Patients with Tremor Dominant Parkinson's Disease.

Unilateral hand tremor is one of the cardinal symptoms of Parkinson's disease. Additionally, mechanical traumatic hand movement is one of the risk factors for carpal tunnel syndrome. Our objective in this study was to examine whether repetitive mechanical movement may be related to the development of carpal tunnel syndrome in Parkinson's disease with unilateral hand tremor using neurophysiological methods.The study participants included 33 de novo Parkinson's disease patients with unilateral hand tremor, and we compared the tremor hand and non-tremor hand within the same patients.Seven (21.2%) of the 33 patients had carpal tunnel syndrome. All of carpal tunnel syndrome patients showed neurophysiological abnormalities in both the hand without tremor and the hand with tremor. In addition, in patients without carpal tunnel syndrome, the sensory nerve action potential was lower in the hand without tremor than in the hand with tremor, although there were no significant differences.We concluded that hand tremor in de novo Parkinson's disease patients was not directly related to the development of carpal tunnel syndrome. In contrast, more frequent use of hand without tremor may induce mechanical loading and may be associated with CTS in the hand without tremor. Early diagnosis of Parkinson's disease and proper education in hand use may be essential for preventing carpal tunnel syndrome in Parkinson's disease tremor patients