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PO24-TH-23 The challenge of movement disorders management in Thailand: results of a Thai University Practice
S292
19th World Congress of Neurology, Poster Abstracts / Journal of the Neurological Sciences 285 S1 (2009) S155–S339
PO24-TH-23 The challenge of movement disorders management in Thailand: results of a Thai University Practice R. Bhidayasiri, H. Ling, L. Kaewwilai. Chulalongkorn Comprehensive Movement Disorders Center, Chulalongkorn University, Bangkok, Thailand Objective: To determine the frequency of different types of movement disorders in a tertiary referral university practice in Thailand. Methods: We performed a medical record review of all patients seen in a university-based movement disorder clinic at Chulalongkorn university hospital in Bangkok, Thailand to determine the frequency of movement disorders, disease characteristics, etiologies, diagnostic evaluations and treatment. Chulalongkorn Comprehensive Movement Disorders Center was established in 2006 by the Thai Red Cross Society as the first center in the country specialized in the treatment, research, and education in the field of movement disorders. Results: From January 2006 to May 2009, 1550 patients were seen in the movement disorder clinic. Of these, most were parkinsonism (984 patients, 63.5%), followed by dystonia (9.5%), tremor syndromes (8.3%), myoclonus (1.7%), chorea (1.5%) and the rest accounted for patients with mixed movement disorders. Among those with parkinsonism, 821 (53%) were diagnosed with Parkinson’s disease (PD). Tremor at rest was the most common presenting symptom (50.7%), followed by asymmetric rigidity (31.2%), bradykinesia (22.6%) and postural instability (8.5%). In a group of patients with dystonias, 142 (84.5%) were of focal dystonias, of whom cervical dystonia being the most common (42.3%), followed by Meige syndrome (10.7%) and blepharospasm and oromandibular dystonia (9.5%). Conclusion: The field of movement disorders rapidly expands in Thailand. More patients with movement disorders are increasingly diagnosed and have been referred for specialist care in the university hospital setting. This finding underlines the need for adequate training of movement disorder specialists and the establishment of more movement disorders center in Thailand. PO24-TH-24 Pergolide and cardiac valvulopathy in Parkinson disease N. Jaruchawalit, P. Boonkongchuen. Neurology, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand Objective: To assess and compared the frequency of cardiac valvulopathy in the patients with Parkinson’s disease (PD) treated with and without pergolide. Materials and methods: Echocardiography was performed on 20 PD patients who used pergolide for a minimum of 1 year and 20 PD patients, non treated with pergolide and without prior exposure to any dopamine agonist. Valvular regurgitation was graded as mild, moderate and severe. Two groups were compared with regard to demographic features, drug profile and valvulopathy. Results: The pergolide group had a mean age of 60.6 years, median agonist duration of 36 months, agonist equivalent dose of 0.5 mg/day and cumulative dose of 848.63 mg. Valvulopathy was present in 3 (15%) in 20 patients on pergolide group, and in 1 (5%) of 20 patients on non user groups. The daily dose, cumulative dose and duration of treatment did not significantly influence the frequency of valvulopathy in the pergolide group. Conclusion: Although the statistical was not significance due to small sample sizes. The valvulopathy on the pergolide group was present higher (15%) than non-user group (5%), that show 3 fold increased risk of cardiac valvulopathy.
PO24-TH-25 Hand-held electronic diary for self-assessment of motor function and medication compliance in Thai patients with Parkinson’s disease R. Bhidayasiri, H. Ling, L. Kaewwilai. Chulalongkorn Comprehensive Movement Disorders Center, Chulalongkorn University, Bangkok, Thailand Background: Assessment of motor symptoms and medication compliance in Parkinson’s disease are the essential components for therapeutic management in both clinical and experimental settings. Fluctuations in motor functions (“On”, “Off”) in individual PD patient represents a challenge for treating physician to obtain a full record of motor performance for medication adjustments. Frequently, patients miss their entries in paper diary, or even miss their medications. Objective: To develop a new method with a hand-held electronic diary to assess motor performance as well as medication compliance in patients with PD. Methods and results: A special program has been developed in a hand-held device to record patient responses electronically on a hand-held computer. The questionnaires consist of a full-day PD diary and the patient’s medication schedule. Patients will be asked to indicate their response every 2 hours for motor performance (“On”, “Off”, or “In bed”). Regarding the assessment of medication compliance, no reminders will be provided for patients to take their medications, but a predefined time schedule will be set and the patients will be asked to enter the time at which they really took their medications. Then, the program will calculate the percentage of “On”, “Off”, and “In bed” time per day as well as the medication compliance. Conclusion: With the complexity of PD symptomatology, the selfadministered PD hand-held electronic diary is a new method, designed to ease the difficulties of the interpretation of patient’s fluctuating symptoms during the physician consultation. The results can be reviewed by physicians at the next visit or transmitted wirelessly through the web applications. PO24-TH-26 The efficacy of laser/auditory-guided walking device in Parkinson’s disease patients with predominant gait freezing W. Bauted1 , M. Sriyudthsak2 , R. Bhidayasiri1 . 1 Chulalongkorn Comprehensive Movement Disorders Center, Chulalongkorn University, Bangkok, Thailand; 2 Faculty of Engineering, Chulalongkorn University, Bangkok, Thailand Background: Freezing of gait (FOG) is a common and very disabling symptom in Parkinson’s disease (PD). It is characterized by a difficulty in stepping forward, which appears either in the initiation of or during gait, with the inability to lift the foot from the floor and trembling of the legs. Considered to be one of the most common causes of falls in patients with PD, FOG is usually dopaminergic-resistant. Despite being a difficult problem to manage pharmacologically, sensory cueing is often quoted as being very helpful in alleviating FOG. Objective: To develop and evaluate the efficacy of a laser/auditoryguided walking device in PD patients with predominant gait freezing. Methods and Results: A laser/auditory-guided walking cane has been designed and developed. During the episode of gait freezing, laser beam will be automatically switched on in front of the patient, acting as visual cues. Alternatively, auditory sound can be created connected to a stimulator, which produces a sound of approximately 40 ms duration. Thirty PD patients with predominant gait freezing participated in the study to walk on a 20-ft track with each of four walking conditions in a randomized order: no device, visual cues, auditory, and a combined visual/ auditory cues. The number of freezes, stride length, velocity and cadence were measured in different conditions. There was a
19th World Congress of Neurology, Poster Abstracts / Journal of the Neurological Sciences 285 S1 (2009) S155–S339
PO24-TH-23 The challenge of movement disorders management in Thailand: results of a Thai University Practice R. Bhidayasiri, H. Ling, L. Kaewwilai. Chulalongkorn Comprehensive Movement Disorders Center, Chulalongkorn University, Bangkok, Thailand Objective: To determine the frequency of different types of movement disorders in a tertiary referral university practice in Thailand. Methods: We performed a medical record review of all patients seen in a university-based movement disorder clinic at Chulalongkorn university hospital in Bangkok, Thailand to determine the frequency of movement disorders, disease characteristics, etiologies, diagnostic evaluations and treatment. Chulalongkorn Comprehensive Movement Disorders Center was established in 2006 by the Thai Red Cross Society as the first center in the country specialized in the treatment, research, and education in the field of movement disorders. Results: From January 2006 to May 2009, 1550 patients were seen in the movement disorder clinic. Of these, most were parkinsonism (984 patients, 63.5%), followed by dystonia (9.5%), tremor syndromes (8.3%), myoclonus (1.7%), chorea (1.5%) and the rest accounted for patients with mixed movement disorders. Among those with parkinsonism, 821 (53%) were diagnosed with Parkinson’s disease (PD). Tremor at rest was the most common presenting symptom (50.7%), followed by asymmetric rigidity (31.2%), bradykinesia (22.6%) and postural instability (8.5%). In a group of patients with dystonias, 142 (84.5%) were of focal dystonias, of whom cervical dystonia being the most common (42.3%), followed by Meige syndrome (10.7%) and blepharospasm and oromandibular dystonia (9.5%). Conclusion: The field of movement disorders rapidly expands in Thailand. More patients with movement disorders are increasingly diagnosed and have been referred for specialist care in the university hospital setting. This finding underlines the need for adequate training of movement disorder specialists and the establishment of more movement disorders center in Thailand. PO24-TH-24 Pergolide and cardiac valvulopathy in Parkinson disease N. Jaruchawalit, P. Boonkongchuen. Neurology, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand Objective: To assess and compared the frequency of cardiac valvulopathy in the patients with Parkinson’s disease (PD) treated with and without pergolide. Materials and methods: Echocardiography was performed on 20 PD patients who used pergolide for a minimum of 1 year and 20 PD patients, non treated with pergolide and without prior exposure to any dopamine agonist. Valvular regurgitation was graded as mild, moderate and severe. Two groups were compared with regard to demographic features, drug profile and valvulopathy. Results: The pergolide group had a mean age of 60.6 years, median agonist duration of 36 months, agonist equivalent dose of 0.5 mg/day and cumulative dose of 848.63 mg. Valvulopathy was present in 3 (15%) in 20 patients on pergolide group, and in 1 (5%) of 20 patients on non user groups. The daily dose, cumulative dose and duration of treatment did not significantly influence the frequency of valvulopathy in the pergolide group. Conclusion: Although the statistical was not significance due to small sample sizes. The valvulopathy on the pergolide group was present higher (15%) than non-user group (5%), that show 3 fold increased risk of cardiac valvulopathy.
PO24-TH-25 Hand-held electronic diary for self-assessment of motor function and medication compliance in Thai patients with Parkinson’s disease R. Bhidayasiri, H. Ling, L. Kaewwilai. Chulalongkorn Comprehensive Movement Disorders Center, Chulalongkorn University, Bangkok, Thailand Background: Assessment of motor symptoms and medication compliance in Parkinson’s disease are the essential components for therapeutic management in both clinical and experimental settings. Fluctuations in motor functions (“On”, “Off”) in individual PD patient represents a challenge for treating physician to obtain a full record of motor performance for medication adjustments. Frequently, patients miss their entries in paper diary, or even miss their medications. Objective: To develop a new method with a hand-held electronic diary to assess motor performance as well as medication compliance in patients with PD. Methods and results: A special program has been developed in a hand-held device to record patient responses electronically on a hand-held computer. The questionnaires consist of a full-day PD diary and the patient’s medication schedule. Patients will be asked to indicate their response every 2 hours for motor performance (“On”, “Off”, or “In bed”). Regarding the assessment of medication compliance, no reminders will be provided for patients to take their medications, but a predefined time schedule will be set and the patients will be asked to enter the time at which they really took their medications. Then, the program will calculate the percentage of “On”, “Off”, and “In bed” time per day as well as the medication compliance. Conclusion: With the complexity of PD symptomatology, the selfadministered PD hand-held electronic diary is a new method, designed to ease the difficulties of the interpretation of patient’s fluctuating symptoms during the physician consultation. The results can be reviewed by physicians at the next visit or transmitted wirelessly through the web applications. PO24-TH-26 The efficacy of laser/auditory-guided walking device in Parkinson’s disease patients with predominant gait freezing W. Bauted1 , M. Sriyudthsak2 , R. Bhidayasiri1 . 1 Chulalongkorn Comprehensive Movement Disorders Center, Chulalongkorn University, Bangkok, Thailand; 2 Faculty of Engineering, Chulalongkorn University, Bangkok, Thailand Background: Freezing of gait (FOG) is a common and very disabling symptom in Parkinson’s disease (PD). It is characterized by a difficulty in stepping forward, which appears either in the initiation of or during gait, with the inability to lift the foot from the floor and trembling of the legs. Considered to be one of the most common causes of falls in patients with PD, FOG is usually dopaminergic-resistant. Despite being a difficult problem to manage pharmacologically, sensory cueing is often quoted as being very helpful in alleviating FOG. Objective: To develop and evaluate the efficacy of a laser/auditoryguided walking device in PD patients with predominant gait freezing. Methods and Results: A laser/auditory-guided walking cane has been designed and developed. During the episode of gait freezing, laser beam will be automatically switched on in front of the patient, acting as visual cues. Alternatively, auditory sound can be created connected to a stimulator, which produces a sound of approximately 40 ms duration. Thirty PD patients with predominant gait freezing participated in the study to walk on a 20-ft track with each of four walking conditions in a randomized order: no device, visual cues, auditory, and a combined visual/ auditory cues. The number of freezes, stride length, velocity and cadence were measured in different conditions. There was a