| BACKGROUND:Parkinson’s disease (PD) is a common neurodegenerative disease and its clinical course, manifestation, drug use and complication varies. Although there were speculations that Chinese patients with PD had a later diagnosis, delayed use of Levodopa, and less drug-induced complications, no published data support these claims. To characterize the features of clinical manifestation, pattern of drug use and drug-induced complications in Chinese PD patients will help us to better understand the disease and guide the diagnosis and treatment for PD patients.OBJECTIVES:To understand the clinical manifestations, current status of treatment and the propotions of motor and nonmotor complications in patients with Parkinson’s disease of different geographical conditions and economic levels. The specific aims of this study is, in Chinese PD patients, to investigate 1) the clinical characteristics and prognosis;2) the pattern of drug use; 3) the incidence and associated risk factors for drug-induced motor complications; 4) the incidence and associated risk factors for NMS(Non-motor symptoms).METHODS:A retrospective clinical epidemiological method was applied in the study. Stratified by geographical conditions and economic levels,7 capital cities from north, east, west, south, central China were randomly enrolled in the survey according to multistage sampling technique. From Jan 2007 to May 2007, a total of 901 outpatients or inpatients with Parkinson’s disease in the 7 cities were recruited and analyzed. In the 7 capital cities,5 were drawn from each region of north, west, south, central China; 3 were drawn from east china because of increasing population and unbalance economy.RESULTS:1. Clinical characteristics:We analyzed 901 patients with Parkinson’s disease. The mean age at study was 59.74±11.02 years; mean disease duration was 5.69±4.24 years; mean time from onset to diagnosis was 19.40±29.42 monthes (1～323 monthes). They were well matched in the 4 regions. The symptoms of majority patients started on one side of the body and progressed to the other side after an average of two years.2. The pattern of drug use:Currently, levodopa (89.44%) and dopamine agonists (36.52%) are the most common therapy for Parkinson’s disease. As monotherapy, Levodopa is the most frequently used treatment and 244 patients (29.61%) received this drug. The next is anticholinergics used in 18 patients (6.29%), followed by amantadine, which is used in 12 patients (4.19%). As combination therapy, levodopa in combination with artane or amantadine are the most common therapy and 156 patients (18.93%) received this treatment. The next most common group is levodopa plus dopamine angonists used in 143 patients (17.35%). During the treatment of Parkinson’s disease for 5-7 years, the mean dosage of levodopa is 485.31 mg.3. Incidence and associated risk factors for motor complications:The dyskinesia incidence was 6.64% and 10.00% for patients with L-dopa treatment less than 4 years and 4-6 years respectively. In parallel, the incidence of motor fluctuation was 32.78% and 32.00%. The daily L-dopa dosage of patients with dyskinesia (537.29±180.30mg) and motor fluctuation (549.60±236.50mg) was significantly higher than that of patients without dyskinesia (113.94mg) and motor fluctuation (143.87mg) after adjusted by treatment and disease duration, and onset age. Logistic regression analysis showed that onset age, Hoehn-Yahr Staging, Levodopa dosage, time of Levodopa use dose were related to the development of motor complications.4. The most common non-motor complications are:constipation(60.93%)、difficulty getting to sleep at night or staying asleep at night(46.73%)、urgency of urine(40.73%)、dribbling saliva(33.85%)、sweating(33.07%)、Orthostatic hypotension(26.53%)。 CONCLUSION:1. There is a great heterogeneity in clinical features and prognosis among the Chinese PD patients.2. Levodopa still is the most effective drug. Levodopa plus artane or amantadine, and Levodopa plus Dopamine agonist are the most two common combination of drug use. However, the drug dosage is much lower in Chinese patients than that reported for Western PD patients.3. The incidence of L-dopa-induced dyskinesia was lower in Chinese patients as compared to Western PD patients but the motor fluctuation incidence was similar. The incidence of motor complications often reach its peak at 5 years of treatment and is associated with drug dosage, time of drug use and disease duration. Delaying the start of use of levodopa may not necessarily delay the onset of motor complications.4. The most common non-motor complications are:constipation, difficulty getting to sleep at night or staying asleep at night, urgency of urine, dribbling saliva, sweating, Orthostatic hypotension。... |
PDF Full Text Request