Alpha-Synuclein Expression in Patients with Parkinson’s Disease: A Clinician’s Perspective

김한준 한국뇌신경과학회 2013 Experimental Neurobiology Vol.22 No.2

Although physiological function of alpha-synuclein is not yet clearly understood, accumulating evidence strongly suggests it plays a crucial role in the pathogenesis of Parkinson disease. Pathologically, alpha-synuclein is a major component of Lewy bodies, which is the pathological hallmark of Parkinson disease. Alpha-synuclein pathology is observed in the brainstem nuclei, including the dorsal motor nucleus of the vagus nerve, the locus ceruleus, and the substantia nigra in the early phase of Parkinson disease and it may ‘spread’ to cerebral cortical areas in the advanced Parkinson disease and appears to have a role in the cognitive decline in Parkinson disease. Recently, it is suggested that alpha-synuclein pathology in Parkinson disease starts in the olfactory bulb or enteric nervous system and then spreads to the brainstem. In accordance with this hypothesis, alpha-synuclein pathology has been found in gastric mucosa and colonic mucosa of patients with Parkinson disease. Genetically, SNCA mutations including point mutation and copy number variation are known to cause familial Parkinson disease, further supporting the assumption that alpha-synuclein plays a crucial role in Parkinson disease pathogenesis. In addition, recent GWAS studies consistently show that the SNPs in SNCA genes are associated with risk for sporadic Parkinson disease. It is also known that variations in the promoter region or 3’UTR of SNCA, which increases the expression of SNCA, are associated with the risk for Parkinson disease. Collectively, these findings suggest that further studies on alpha-synuclein will lead to the elucidation of the mechanism of and therapy for Parkinson disease.

Risk for Parkinson’s disease in patients with Behcet’s Disease: A nationwide population-based dynamic cohort study in Korea

( Min Ji Kang ),( Ji Min Seo ),( Joo Hee Lee ),( Dong Soo Yu ),( Young Bok Lee ) 대한피부과학회 2019 대한피부과학회 학술발표대회집 Vol.71 No.2

Background: Although several studies have reported a correlation between Behcet’s disease and Parkinson’s disease, this association has not yet been clarified. Objectives: The aim of this study is to determine the risk of Parkinson’s disease in patients with Behcet’s disease. Methods: Behcet’s disease patients (n = 17,179; mean age, 51.12±8.09 years; male, 34.95%) without known previous diagnosis of Parkinson’s disease were selected from the Korean National Health Insurance Database between 2010 and 2013. An age and gender-matched control population of individuals without Behcet’s disease was randomly sampled at a ratio of 3:1 (n = 34,575). Both cohorts were followed for development of Parkinson’s disease until 2015. Results: Among a total of 11,525 Behcet’s disease patients, 50 (0.43%) developed Parkinson’s disease, whereas only 51 among the 34,575 individuals in the non- Behcet’s disease group developed Parkinson’s (0.15%, P < 0.0001). The incidence of Parkinson’s disease was significantly higher in Behcet’s disease patients than in controls. In addition, during the follow-up period, patients with Behcet’s disease were more likely to be diagnosed with Parkinson’s disease than those in the non- Behcet’s disease group. Conclusion: Behcet’s disease patients had a higher risk of Parkinson’s disease compared to non- Behcet’s disease controls. Physicians should carefully monitor patients with Behcet’s disease for potential development of Parkinson’s disease.

Surgical Outcomes of Spine Disorders in Patients with Parkinson's Disease

박상혁,오재근,김태엽,김의현,이효상,유남규,최귀현,이성,하윤,윤도흠,김긍년 대한척추신경외과학회 2011 Neurospine Vol.8 No.3

Purpose: Patients with Parkinson’s disease also commonly have movement disorders, osteoporosis, and other comorbidities. These patients are more likely to have complications after spinal surgery. The aim of the present study is to show the relation ship between complications of spinal surgery and Parkinson's disease. Methods: A computerized search using diagnostic and procedural codes identified 13 patients with Parkinson's disease who underwent spinal surgery between January 1998 and December 2010. Their medical records and imaging studies were reviewed and recent updatesfor all patients were done by telephone interview. Results: Retrospectively, 13 consecutive patients were reviewed. The mean age was 63.8 (range 44~87) years old and the mean durationof Parkinson's disease was 7.6 (range 1~22) years at the time of the index procedure. The mean T score of the lumbar spine on Dual-energy X-ray absorptiometry (DEXA) scan bone mineral density (BMD) was -2.5 (range -1.0~-5.1). These patients had nine lumbar lesions, two thoracic lesions, one cervical lesion, and one thoracolumbar lesion. Nine patients required no more surgical treatment for lesions which had been previously operated on (index level). However, four patients (30.8%) needed at least one more operation related to their index procedure; segmental degeneration on the adjacent levels in two, retropulsion of an intervertebral cage with screw loosening in one, and pedicle fracture in one. Conclusion: It has been reported that patients with Parkinson's disease have high complication rates in spinal surgery. Spine surgeons should be aware of the risk of complications and need to conduct careful follow-up after the surgery. Purpose: Patients with Parkinson’s disease also commonly have movement disorders, osteoporosis, and other comorbidities. These patients are more likely to have complications after spinal surgery. The aim of the present study is to show the relation ship between complications of spinal surgery and Parkinson's disease. Methods: A computerized search using diagnostic and procedural codes identified 13 patients with Parkinson's disease who underwent spinal surgery between January 1998 and December 2010. Their medical records and imaging studies were reviewed and recent updatesfor all patients were done by telephone interview. Results: Retrospectively, 13 consecutive patients were reviewed. The mean age was 63.8 (range 44~87) years old and the mean durationof Parkinson's disease was 7.6 (range 1~22) years at the time of the index procedure. The mean T score of the lumbar spine on Dual-energy X-ray absorptiometry (DEXA) scan bone mineral density (BMD) was -2.5 (range -1.0~-5.1). These patients had nine lumbar lesions, two thoracic lesions, one cervical lesion, and one thoracolumbar lesion. Nine patients required no more surgical treatment for lesions which had been previously operated on (index level). However, four patients (30.8%) needed at least one more operation related to their index procedure; segmental degeneration on the adjacent levels in two, retropulsion of an intervertebral cage with screw loosening in one, and pedicle fracture in one. Conclusion: It has been reported that patients with Parkinson's disease have high complication rates in spinal surgery. Spine surgeons should be aware of the risk of complications and need to conduct careful follow-up after the surgery.

포스트 코로나 시대, 파킨슨 환자를 위한 미디어 무용교육의 방안

이은형 ( Eun-hyoung Lee ),이선경 ( Sun-kyoung Lee ) 기독교학문연구회 2021 신앙과 학문 Vol.26 No.1

This study was conducted t o s eek measures for media dance education for patients with Parkinson's disease in the Post-COVID-19 Age. Entering an aging society, in South Korea, the population of the aged has further increased, and accordingly, patients with senile diseases have increased, too. The prevalence of Parkinson’s disease, one of the big three senile diseases in the cerebral nervous system, increases as the population of the aged increases each year. Since the cause of the occurrence of Parkinson’s disease has not yet been revealed, it is treated through medication, operative treatment, and exercise therapy for the suppression of its progress and the alleviation of its symptoms. Thus, for patients with Parkinson's disease, continuous medication and exercise therapy are very important. As it has been reported that dance enhances the physical functions of patients with Parkinson's disease and has positive effects on the alleviation of depression and stress, patients with Parkinson's disease also actively participate in dance programs. The occurrence o f C OVID-19 h as c hanged m any p arts of human life. Untact methods such a s telecommuting, remote learning, and online classes, etc. have been revitalized, and it is expected that in the Post-COVID-19 Age after the end of COVID-19 in the future, the online methods utilizing media will further be revitalized. Thus, it is judged that it is necessary to investigate measures utilizing media also in dance education for patients with Parkinson's disease. Therefore, this study presented three methods and the positive expected effects of this to explore ways of dance education for Parkinson's patients.

파킨슨병 환자의 정량적 뇌파분석 -비선형분석을 이용한 정상인 및 본태성 진전 환자와의 비교

조은경,최병옥,김용재,박기덕,김응수,최경규,Cho, Eun-Kyoung,Choi, Byung-Ok,Kim, Yong-Jae,Park, Ki-Duck,Kim, Eung-Su,Choi, Kyoung-Gyu 대한임상신경생리학회 2006 Annals of Clinical Neurophysiology Vol.8 No.2

Background: Parkinson's disease is movement disorder due to dopaminergic deficiency. It has been noted that cognitive dysfunction also presented on Parkinson's disease patients. But, it is not clear whether such a cognitive dysfunction was a dopaminergic dysfunction or cholinergic dysfunction. Using linear and non-linear analyses, we analysed the effect of cognitive and motor symptom on EEG change. Methods: EEGs were recorded from patients with Parkinson's disease and essential tremor, and normal controls during rest. We calculated the power spectrum, correlation dimension and Lyapunov exponent by using 'Complexity'program. The power spectrum, correlation dimension, and Lyapunov exponent were compared between Parkinson's disease patients and essential tremor patients. Results: Theta power was increased in Parkinson's disease patient group. Correlation dimension was increased in Parkinson's disease patients. Positive correlation was noted between MMSE and correlation dimension, and negative correlation was noted between MMSE and Lyapunov exponent. Lyapunov exponent was decreased in Parkinson's disease patient. Conclusions: We conclude that the state of Parkinson's disease patient is characterized by increased correlation dimension and decreased Lyapunov exponent.

Parkinson’s Disease in Sub-Saharan Africa- A Review of Epidemiology, Genetics and Access to Care.

Uduak Williams,Olivier Bandmann,Richard Walker 대한파킨슨병및이상운동질환학회 2018 Journal Of Movement Disorders Vol.11 No.2

A low prevalence of Parkinson’s disease has been reported in the Sub-Saharan Africa region. Genetic causes and indeed the clinical features of Parkinson’s disease are poorly described. Very few reports have examined the availability and access to evidence-based quality care for people living with Parkinson’s disease in the region. We reviewed all publications focusing on idiopathic Parkinson’s disease from Sub-Saharan Africa published up to May 2016 and observed a prevalence of Parkinson’s disease ranging between 7/100,000 in Ethiopia to 67/100,000 in Nigeria. The most recent community based study reported a mean age at onset of 69.4 years. Infrequent occurrence of mutations in established Parkinson’s disease genes was also observed in the region. Treatments were non-existent or at best irregular. There is also a lack of well trained medical personnel and multidisciplinary teams in most countries in the region. Drugs for treating Parkinson’s disease are either not available or unaffordable. Large-scale genetic and epidemiological studies are therefore needed in Sub-Saharan Africa to provide further insight into the role of genetics and other aetiological factors in the pathogenesis Parkinson’s disease. The quality of care currently available also needs urgent improvement to meet the basis level of care required by Parkinson’s disease patients.

파킨슨병을 앓고 있는 노인의 질병경험에 관한 현상학적 연구

김수영,한진태,최말옥 한국노인복지학회 2015 노인복지연구 Vol.0 No.68

Concerns on chronic degenerative diseases and caring for the long-term care elderly are increasing as progresses in a highly compressive aging society. Parkinson's disease brings difficulties in daily living activities, accompanying muscle stiffening, hand trembling, while the disease brings less impairment in cognitive functions, which on the other hand increases mental stress for patients and family burden as well. The purpose of this study is to investigate essential meaning of the experience going through the Parkinson's disease by discovering the feelings of the elderly with Parkinson's disease. By drawing 6 patients with Parkinson's disease, we conducted 2~3 sessions of interview from April to September in 2012. The study is conducted by analyzing interview recordings and observation note of their exercise program with phenomenological methodology. The results indicate the central phenomenon of elderly with Parkinson's disease as a process of 'Searching for attitude to the life by looking back upon one's life'. 26 subcategories and 7 topics are deducted throughout the process. Topics are classified as the time sequence, and each topic is correlated. Experience of disease according to the time sequence were classified as follows; ‘Discovering oneself different from the past.', ‘fatal diagnosis', ‘Trying to make efforts on putting back myself as in the past’, ‘Ashamed of own incompetence’, ‘Finding coping method of own’, ‘Finding hope out of dispair’, ‘Still remaining task’. Based on the fact, the study suggests practical and political alternatives on self management of elderly with Parkinson's disease and increasing quality of life. Through suggested measures, elderly with Parkinson's disease are expected to live within the community as a whole member of society. 우리나라는 압축적인 고령화가 진행되면서 만성 퇴행성질병과 장기요양보호 대상자들의 돌봄에 대한 관심이 증가하고 있다. 그 중 하나인 파킨슨병은 질병이 진행되면서 근육경직, 손떨림 등 여러 증상으로 인해 일상생활 수행이 어려워지지만, 인지기능의 손상은 없는 편이어서 환자들의 정신적인 스트레스와 가족부담이 다른 만성질환보다 많은 편이다. 현재 발병율은 높지 않지만, 발병율 증가속도가 치매 등에 비해 더 빠르다는 것을 감안한다면 사회적 지원 대상으로 관심을 높일 필요가 충분하다. 그러한 필요성을 토대로 본 연구에서는 파킨슨병을 앓고 있는 노인의 질병체험을 통한 본질의 의미를 탐구하고자 하였다. 2012년 4월~9월까지 약 5개월간 6명의 파킨슨병 환자를 대상으로 2~3회에 걸쳐 면접한 녹취록과, 그들의 운동프로그램 참여정도를 관찰한 관찰노트 등으로 현상학적 연구방법에 의해 연구하였다. 그 결과 파킨슨병을 앓고 있는 노인의 질병체험의 중심현상은 ‘되돌려 보는 여정을 통한 남은여생의 삶의 좌표 찾기’과정이었다. 그 과정에서 26개의 하위범주와 7개의 주제가 도출되었다. 파킨슨병을 앓고 있는 노인의 질병경험의 본질을 찾기 위하여 시간차원의 순서로 주제를 분류하였으며, 각각의 주제는 서로 연관되어있다. 시간차원에 의한 질병경험의 주제는‘이전과 다른 나의 발견’,‘하늘이 무너지는 진단명’,‘이상한 나를 이전의 나로 만들려는 노력’,‘아무 것도 할 수 없는 부끄러운 나’,‘나만의 대처방법 찾아가기’,‘절망속의 희망찾기’, ‘아직도 남아있는 숙제’로 분류되었다. 분석결과를 바탕으로 파킨슨병 환자인 노인들의 내면을 이해하고, 질병관리 및 삶의 질 향상을 위한 실천적, 정책적 과제를 제시하였다. 여러 대안들은 파킨슨병을 가진 노인들이 질병이 진행되어도 지역 공동체 속에서 사회구성원으로 함께 살 수 있는 방안을 모색하는 데 도움이 될 것이다.

일개 한방병원에 파킨슨병으로 내원한 환자의 사상의학적 특성에 관한 고찰

김소형,이슬,이용재,배나영,이정윤,Kim, So-Hyoung,Lee, Seul,Lee, Yong-Jae,Bae, Na-Young,Lee, Jeong-yun 사상체질의학회 2018 사상체질의학회지 Vol.30 No.3

Objectives The aim of this study was to make an analysis of clinical characteristics and status of Sasang constitutional medicine of patients with Parkinson's Disease who visited a Korean medicine hospital. Methods We studied 129 patients with Parkinson's Disease who visited a Korean medicine hospital from September 1, 2012 to June 30, 2018. We retrospectively collected medical history and characteristics of subjects using data of EMR (electronic medical record). Results The proportion of female was higher than male. The average age was 60s. The patients visited a hospital more than one year after the occurrence of symptoms. And they were mostly under western medicine treatment. Among the 129 patients, 56 persons(43.4%) were Taeeumin, 45 persons(34.9%) Soyangin and 28 persons Soeumin(21.7%). In the distribution of prescription according Sasang Constitutional Medicine symptomatology, there was no significant difference in the proportion of exterior cold disease(48.9%) and interior heat disease(51.1%) in Soyangin. Meanwhile the proportion of heat disease's prescription was higher than cold disease in Taeeumin(73.2%) and Soeumin(84.1%). The majority of disease were Dry-febrile symptom(73.2%) of heat disease in Taeeumin, Yang depletion-syndrome(64.3%) of heat disease in Soeumin, and Gyolhyung-symptom(33.3%) of exterior cold disease and Wasting thirst-syndrome(22.2%) of interior heat disease in Soyangin, Conclusions By Developing of guideline for treatment of Parkinson's Disease through analyzing on clinical characteristics and distribution of Sasang Constitutional Medicine symptomatology could contribute to the improvement of the cure rate and accuracy of constitution pattern.

Clinical Aspects of the Differential Diagnosis of Parkinson’s Disease and Parkinsonism

신혜원,홍상욱,윤영철 대한신경과학회 2022 Journal of Clinical Neurology Vol.18 No.3

Parkinsonism is a clinical syndrome presenting with bradykinesia, tremor, rigidity, and postural instability. Nonmotor symptoms have recently been included in the parkinsonian syndrome, which was traditionally associated with motor symptoms only. Various pathologically distinct and unrelated diseases have the same clinical manifestations as parkinsonism or parkinsonian syndrome. The etiologies of parkinsonism are classified as neurodegenerative diseases related to the accumulation of toxic protein molecules or diseases that are not neurodegenerative. The former class includes Parkinson’s disease (PD), multiple-system atrophy, progressive supranuclear palsy, and corticobasal degeneration. Over the past decade, clinical diagnostic criteria have been validated and updated to improve the accuracy of diagnosing these diseases. The latter class of disorders unrelated to neurodegenerative diseases are classified as secondary parkinsonism, and include drug-induced parkinsonism (DIP), vascular parkinsonism, and idiopathic normal-pressure hydrocephalus (iNPH). DIP and iNPH are regarded as reversible and treatable forms of parkinsonism. However, studies have suggested that the absence of protein accumulation in the nervous system as well as managing the underlying causes do not guarantee recovery. Here we review the differential diagnosis of PD and parkinsonism, mainly focusing on the clinical aspects. In addition, we describe recent updates to the clinical criteria of various disorders sharing clinical symptoms with parkinsonism.

파킨슨 환자의 사상체질 및 UPDRS 분포 연구

정지철,김건형,박상민,이상훈,장대일,이윤호 대한침구의학회 2005 대한침구의학회지 Vol.22 No.4

Objective: In order to find Sasang constitutional therapies on Parkinson's disease and to make a fundamental basis for clinical application, this study was performed . Method : We recruit thirty five person as the disease group and we test them by QSCCII. also, We estimate them by UPDRS scale. Results : In the distribution of sasang constitution among parkinson's disease patients and controls, we can know that in the distribution of sasang constitution among parkinson's disease patients, Taeumin has a large division. but we don't find out significantly difference statistically. In the distribution of UPDRS Std. score of sasang constitution, we find out significantly difference statistically. Conclusions : Unfortunately, we fail to lead significantly difference statistically in the sasang constitution among parkinson's disease patients and controls. But, in the distribution of UPDRS Std. score of sasang constitution, we find out significantly difference statistically. Consequencely, it is necessary that further study on the theme in the more sample