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Original Articles
Cognition, Olfaction and Uric Acid in Early de novo Parkinson’s Disease
Hwa Reung Lee, Joong Hyun Park, Sang Won Han, Jong Sam Baik
J Mov Disord. 2018;11(3):139-144.   Published online September 30, 2018
DOI: https://doi.org/10.14802/jmd.18037
  • 5,411 View
  • 138 Download
  • 4 Citations
AbstractAbstract PDF
Objective
Cognitive impairment is one of the nonmotor symptoms in Parkinson’s disease (PD), and olfactory dysfunction is used as a marker to detect premotor stages of PD. Serum uric acid (sUA) levels have been found to be a risk factor for PD. Our objective in this study was to examine whether sUA levels are associated with cognitive changes and olfactory dysfunction in early de novo PD patients.
Methods
The study participants included 196 de novo PD patients. We assessed cognitive function by the Korean versions of the Mini-Mental State Examination and the Montreal Cognitive Assessment and assessed olfactory function by the Korean version of the Sniffin’ Sticks test.
Results
The mean sUA level was 4.7 mg/dL and was significantly lower in women than in men. Cognitive scores were lower in women, suggesting that sUA levels were related to cognitive function. The olfactory functions were not related to sUA level but were clearly associated with cognitive scores. Olfactory threshold, odor discrimination, and odor identification were all significantly related to cognitive scores.
Conclusion
We conclude that lower sUA levels were associated with cognitive impairment, not olfactory dysfunction, in de novo PD patients. This finding suggests that UA is neuroprotective as an antioxidant in the cognitive function of PD patients.

Citations

Citations to this article as recorded by  
  • International consensus statement on allergy and rhinology: Olfaction
    Zara M. Patel, Eric H. Holbrook, Justin H. Turner, Nithin D. Adappa, Mark W. Albers, Aytug Altundag, Simone Appenzeller, Richard M. Costanzo, Ilona Croy, Greg E. Davis, Puya Dehgani‐Mobaraki, Richard L. Doty, Valerie B. Duffy, Bradley J. Goldstein, David
    International Forum of Allergy & Rhinology.2022; 12(4): 327.     CrossRef
  • Association of serum uric acid and non-motor symptoms in Parkinson's disease: A cross-sectional study from a movement disorders clinic in Lagos, Nigeria
    OlanikeA Odeniyi, OluwadamilolaO Ojo, IfedayoAdeola Odeniyi, NjidekaUlunma Okubadejo
    Journal of Clinical Sciences.2022; 19(3): 104.     CrossRef
  • What substance P might tell us about the prognosis and mechanism of Parkinson's disease?
    Paola Tirassa, Tommaso Schirinzi, Marcello Raspa, Massimo Ralli, Antonio Greco, Antonella Polimeni, Roberta Possenti, Nicola Biagio Mercuri, Cinzia Severini
    Neuroscience & Biobehavioral Reviews.2021; 131: 899.     CrossRef
  • Brain-First versus Gut-First Parkinson’s Disease: A Hypothesis
    Per Borghammer, Nathalie Van Den Berge, Teus van Laar
    Journal of Parkinson's Disease.2019; 9(s2): S281.     CrossRef
Patients and Their Caregivers’ Burdens for Parkinson’s Disease in Korea
Jong Sam Baik, Joong-Seok Kim, Seong-Beom Koh, Jin Whan Cho, Phil Hyu Lee, Hyeo-Il Ma, Yun Joong Kim, Tae-Beom Ahn, Sang Jin Kim, Yong Duk Kim, Seong-min Choi, Ho-Won Lee, Hee Tae Kim
J Mov Disord. 2017;10(3):109-115.   Published online September 22, 2017
DOI: https://doi.org/10.14802/jmd.17053
  • 5,849 View
  • 215 Download
  • 9 Citations
AbstractAbstract PDF
Objective
Many patients with Parkinson’s disease (PD) suffer from motor and non-motor symptoms. According to these variable symptoms of PD, patients or caregivers have a poorer quality of life than patients with other neurodegenerative diseases. Since the difficulties are varied for all patients, prioritizing their difficulties differs among all cases. The goal of this study was to investigate the burdens of PD among the caregivers as well as patients and to identify areas requiring aid from the government.
Methods
We surveyed the awareness and perceptions of PD in patients and caregivers of PD by a face-to-face questionnaire. The questionnaire was divided into three sections: symptoms of PD (part A), desire for policies (part B), and difficulties faced by their caregivers (part C). Part A comprised 8 questions, Part B had 2 questions, and Part C had 3 questions.
Results
In total, 853 subjects (702 patients and 151 caregivers) were enrolled in this study. The major difficulties experienced by PD patients were physical (67%), psychiatric (60%) and socio-economic (52%). Assessing the physical difficulties, more than half the patients experienced severe difficulties (29% very severe, 39% severe). Psychiatric difficulties were assessed as severe (35%) and very severe (21%) among the patients. Severe difficulties were also experienced socio-economically, at 52% in patients and 49% in caregivers, especially among patients in their fifties (58%) and those with their spouse (65%) as caregivers. The topmost need was the introduction of new technology for treatment of PD (62%), followed by relief of costs for treatment (38%) and a family support system (31%). The majority (91%) of the patients were diagnosed with PD within two years after onset of symptoms.
Conclusion
We know that the difficulties of PD and the needs for government assistance are different between patients and caregivers. These results emphasize that perceiving the difficulties and needs of patients and caregivers early can help to prevent and ameliorate the burden of disease.

Citations

Citations to this article as recorded by  
  • Exploring Unmet Information Needs of People with Parkinson’s Disease and Their Families: Focusing on Information Sharing in an Online Patient Community
    Hyeon Sik Chu, Hye Young Jang
    International Journal of Environmental Research and Public Health.2022; 19(5): 2521.     CrossRef
  • Participants' perspective on a COVID-19 online vocal group stimulation for people with Parkinson's disease
    Marie-Christine Hallé, Charline Delorme, Édith Coulombe, Ouswa Rekik, Ingrid Verduyckt
    Frontiers in Rehabilitation Sciences.2022;[Epub]     CrossRef
  • Group singing improves quality of life for people with Parkinson’s: an international study
    J. Yoon Irons, Grenville Hancox, Trish Vella-Burrows, Eun-Young Han, Hyun-Ju Chong, David Sheffield, Donald E. Stewart
    Aging & Mental Health.2021; 25(4): 650.     CrossRef
  • Exploring the perceptions and stigmatizing experiences of Israeli family caregivers of people with Parkinson's disease
    Hanan AboJabel, Einat Argavan, Sharon Hassin-Baer, Rivka Inzelberg, Perla Werner
    Journal of Aging Studies.2021; 56: 100910.     CrossRef
  • Perceived online social support for Parkinson’s disease patients: The role of support type, uncertainty, contentment, and psychological quality of life
    Surin Chung, Eunjin (Anna) Kim, J. Brian Houston
    Communication Quarterly.2021; 69(3): 259.     CrossRef
  • Delivering patient-centered care in Parkinson's disease: Challenges and consensus from an international panel
    Roongroj Bhidayasiri, Pattamon Panyakaew, Claudia Trenkwalder, Beomseok Jeon, Nobutaka Hattori, Priya Jagota, Yih-Ru Wu, Elena Moro, Shen-Yang Lim, Huifang Shang, Raymond Rosales, Jee-Young Lee, Win Min Thit, Eng-King Tan, Thien Thien Lim, Ngoc Tai Tran,
    Parkinsonism & Related Disorders.2020; 72: 82.     CrossRef
  • Understanding patients’ and caregivers’ perspectives and educational needs in Parkinson’s disease: a multi-ethnic Asian study
    Xing Yan Choo, Shen-Yang Lim, Karuthan Chinna, Yan Jing Tan, Voon Wei Yong, Jia Lun Lim, Kar Foo Lau, Jing Yi Chung, Jun Min Em, Hui Ting Tan, Jia Hwa Lim, Seng Beng Tan, Chong Tin Tan, Ai Huey Tan
    Neurological Sciences.2020; 41(10): 2831.     CrossRef
  • Nörolojik Hastalık ve Evlilik
    Mehmet ÖNGER, Tuba AYDIN
    Sakarya Medical Journal.2020;[Epub]     CrossRef
  • The burden of care and the understanding of disease in Parkinson’s disease
    Geum-Bong Lee, Hyunhee Woo, Su-Yoon Lee, Sang-Myung Cheon, Jae Woo Kim, Oscar Arias-Carrion
    PLOS ONE.2019; 14(5): e0217581.     CrossRef
A Comparative Study of Central Hemodynamics in Parkinson’s Disease
Joong Hyun Park, Sang Won Han, Jong Sam Baik
J Mov Disord. 2017;10(3):135-139.   Published online August 31, 2017
DOI: https://doi.org/10.14802/jmd.17035
  • 5,079 View
  • 91 Download
  • 2 Citations
AbstractAbstract PDF
Objective
To explore the central aortic pressure in patients with Parkinson’s disease (PD).
Methods
We investigated central arterial stiffness by measurement of the augmentation index (AIx) in PD patients. Patients were eligible for the study if they were de novo PD and 45 years of age or older. The patients’ demographics, vascular risk factors, and neurologic examinations were collected at baseline. The AIx was measured by applanation tonometry.
Results
A total of 147 subjects (77 in control and 70 in PD groups) were enrolled in the study. While there was no significant difference in peripheral systolic blood pressure (SBP), diastolic blood pressure (DBP), or mean arterial pressure between groups, peripheral pulse pressure (PP) was significantly lower in the PD group than in the control group (p = 0.012). Regarding central pressure, aortic DBP was significantly higher and PP was significantly lower in the PD group (p = 0.001, < 0.0001). Although there was no significant difference in the AIx between the groups, a trend toward a lower AIx was observed in the PD group (31.2% vs. 28.1%, p = 0.074).
Conclusion
This study showed that peripheral and central PP was significantly lower in the PD group than in the control group. Our study suggests that PD patients may have a low risk of a cardiovascular event by reason of a lower PP.

Citations

Citations to this article as recorded by  
  • Central Aortic Pressure and Arterial Stiffness in Parkinson’s Disease: A Comparative Study
    Mehmet Balal, Meltem Demirkiran, Saime Paydas, Seyed-Mohammad Fereshtehnejad
    Parkinson's Disease.2022; 2022: 1.     CrossRef
  • VEGF Signaling in Neurological Disorders
    Joon Shim, Joseph Madsen
    International Journal of Molecular Sciences.2018; 19(1): 275.     CrossRef
Validation of the Korean Version of the Scale for Outcomes in Parkinson’s Disease-Autonomic
Ji-Young Kim, In-Uk Song, Seong-Beom Koh, Tae-Beom Ahn, Sang Jin Kim, Sang-Myung Cheon, Jin Whan Cho, Yun Joong Kim, Hyeo-Il Ma, Mee-Young Park, Jong Sam Baik, Phil Hyu Lee, Sun Ju Chung, Jong-Min Kim, Han-Joon Kim, Young-Hee Sung, Do Young Kwon, Jae-Hyeok Lee, Jee-Young Lee, Ji Sun Kim, Ji Young Yun, Hee Jin Kim, Jin Young Hong, Mi-Jung Kim, Jinyoung Youn, Ji Seon Kim, Eung Seok Oh, Hui-Jun Yang, Won Tae Yoon, Sooyeoun You, Kyum-Yil Kwon, Hyung-Eun Park, Su-Yun Lee, Younsoo Kim, Hee-Tae Kim, Joong-Seok Kim
J Mov Disord. 2017;10(1):29-34.   Published online January 18, 2017
DOI: https://doi.org/10.14802/jmd.16057
  • 12,819 View
  • 329 Download
  • 25 Citations
AbstractAbstract PDFSupplementary Material
Objective
Autonomic symptoms are commonly observed in patients with Parkinson’s disease (PD) and often limit the activities of daily living. The Scale for Outcomes in Parkinson’s disease-Autonomic (SCOPA-AUT) was developed to evaluate and quantify autonomic symptoms in PD. The goal of this study was to translate the original SCOPA-AUT, which was written in English, into Korean and to evaluate its reliability and validity for Korean PD patients.
Methods
For the translation, the following processes were performed: forward translation, backward translation, expert review, pretest of the pre-final version and development of the final Korean version of SCOPA-AUT (K-SCOPA-AUT). In total, 127 patients with PD from 31 movement disorder clinics of university-affiliated hospitals in Korea were enrolled in this study. All patients were assessed using the K-SCOPA-AUT and other motor, non-motor, and quality of life scores. Test-retest reliability for the K-SCOPA-AUT was assessed over a time interval of 10−14 days.
Results
The internal consistency and reliability of the K-SCOPA-AUT was 0.727 as measured by the mean Cronbach’s α-coefficient. The test-retest correlation reliability was 0.859 by the Guttman split-half coefficient. The total K-SCOPA-AUT score showed a positive correlation with other non-motor symptoms [the Korean version of non-motor symptom scale (K-NMSS)], activities of daily living (Unified Parkinson’s Disease Rating Scale part II) and quality of life [the Korean version of Parkinson’s Disease Quality of Life 39 (K-PDQ39)].
Conclusion
The K-SCOPA-AUT had good reliability and validity for the assessment of autonomic dysfunction in Korean PD patients. Autonomic symptom severities were associated with many other motor and non-motor impairments and influenced quality of life.

Citations

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  • Clinical manifestation of patients with isolated rapid eye movement sleep behavior disorder after modest-to-long disease duration
    Jung Kyung Hong, Jong-Min Kim, Ki-woong Kim, Ji Won Han, Soyeon Ahn, In-Young Yoon
    Sleep.2022;[Epub]     CrossRef
  • Associations of cognitive dysfunction with motor and non-motor symptoms in patients with de novo Parkinson’s disease
    Kyum-Yil Kwon, Suyeon Park, Rae On Kim, Eun Ji Lee, Mina Lee
    Scientific Reports.2022;[Epub]     CrossRef
  • Autonomic dysfunction in Parkinson's disease: Results from the Faroese Parkinson's disease cohort
    Aksel Berg, Sára Bech, Jan Aasly, Matthew J. Farrer, Maria Skaalum Petersen
    Neuroscience Letters.2022; 785: 136789.     CrossRef
  • Prevalence of lower urinary tract symptoms, urinary incontinence and retention in Parkinson's disease: A systematic review and meta-analysis
    Fang-Fei Li, Yu-Sha Cui, Rui Yan, Shuang-Shuang Cao, Tao Feng
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    Jung-Ick Byun, Seunghwan Oh, Jun-Sang Sunwoo, Jung-Won Shin, Tae-Joon Kim, Jin-Sun Jun, Han-Joon Kim, Won Chul Shin, Joon-Kyung Seong, Ki-Young Jung
    NeuroImage: Clinical.2022; 36: 103186.     CrossRef
  • Comparison of disease progression between brain-predominant Parkinson's disease versus Parkinson's disease with body-involvement phenotypes
    Dong-Woo Ryu, Sang-Won Yoo, Yoon-Sang Oh, Kwang-Soo Lee, Seunggyun Ha, Joong-Seok Kim
    Neurobiology of Disease.2022; 174: 105883.     CrossRef
  • Association Between Gait and Dysautonomia in Patients With De Novo Parkinson’s Disease: Forward Gait Versus Backward Gait
    Seon-Min Lee, Mina Lee, Eun Ji Lee, Rae On Kim, Yongduk Kim, Kyum-Yil Kwon
    Journal of Movement Disorders.2022;[Epub]     CrossRef
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    Ning-Ning Che, Shuai Chen, Qiu-Huan Jiang, Si-Yuan Chen, Zhen-Xiang Zhao, Xue Li, Rayaz A. Malik, Jian-Jun Ma, Hong-Qi Yang
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    Jung-Ick Byun, Kwang Su Cha, Minah Kim, Woo-Jin Lee, Han Sang Lee, Jun-Sang Sunwoo, Jung-Won Shin, Tae-Joon Kim, Jin-Sun Jun, Han-Joon Kim, Won Chul Shin, Carlos H. Schenck, Sang Kun Lee, Ki-Young Jung
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    Kyum-Yil Kwon, Mina Lee, Hyunjin Ju, Kayeong Im
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    Movement Disorders.2019; 34(11): 1739.     CrossRef
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    Yang-Hyun Lee, Jee-Eun Lee, Dong-Woo Ryu, Yoon-Sang Oh, Kwang-Soo Lee, Sung-Hoo Hong, Joong-Seok Kim
    Journal of Parkinson's Disease.2018; 8(1): 145.     CrossRef
  • Rasch Analysis of the Clinimetric Properties of the Korean Dizziness Handicap Inventory in Patients with Parkinson Disease
    Da-Young Lee, Hui-Jun Yang, Dong-Seok Yang, Jin-Hyuk Choi, Byoung-Soo Park, Ji-Yun Park
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    Dong-Woo Ryu, Si-Hoon Lee, Yoon-Sang Oh, Jae-Young An, Jeong-Wook Park, In-Uk Song, Kwang-Soo Lee, Joong-Seok Kim
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Current Status of Huntington’s Disease in Korea: A Nationwide Survey and National Registry Analysis
Hyun Sook Kim, Chul Hyoung Lyoo, Phil Hyu Lee, Sang Jin Kim, Mee Young Park, Hyeo-Il Ma, Jae Hyeok Lee, Sook Kun Song, Jong Sam Baik, Jin Ho Kim, Myung Sik Lee
J Mov Disord. 2015;8(1):14-20.   Published online January 31, 2015
DOI: https://doi.org/10.14802/jmd.14038
  • 15,179 View
  • 110 Download
  • 14 Citations
AbstractAbstract PDF
Objective Huntington’s disease (HD) is a rare neurological disorder, and its current status in Korea is not well investigated. This study aims to determine the prevalence and incidence of HD and to investigate the clinical features of HD patients in Korea.
Methods We estimated the crude prevalence and annual incidence of HD based on the databases of the Rare Diseases Registry (RDR) and the National Health Insurance (NHI). The clinical data of genetically confirmed HD patients was collected from 10 referral hospitals and analyzed.
Results The mean calculated annual incidence was 0.06 cases per 100,000 persons, and the mean calculated prevalence was 0.38 based on the NHI database. The estimated crude prevalence based on the RDR was 0.41. Of the sixty-eight HD patients recruited, the mean age of onset was 44.16 ± 14.08 years and chorea was most frequently reported as the initial symptom and chief complaint. The mean CAG repeat number of the expanded allele was 44.7 ± 4.8 and correlated inversely with the age of onset (p < 0.001). About two-thirds of the patients have a positive family history, and HD patients without positive family history showed a delay in onset of initial symptoms, a prolonged interval between initial symptom onset and genetic diagnosis and a delay in the age of genetic diagnosis.
Conclusions To the best of our knowledge, this is the first study to estimate the prevalence and incidence of HD in Korea and the largest HD series in the Asian population. Our analyses might be useful for further studies and large-scale investigations in HD patients.

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    Erika Carrassi, Maura Pugliatti, Vittorio Govoni, Mariachiara Sensi, Ilaria Casetta, Enrico Granieri
    Neuroepidemiology.2017; 49(1-2): 18.     CrossRef
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    Hyung Seok Lee, Hye Sun Lee, Ha Young Shin, Young-Chul Choi, Seung Min Kim
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    Sheharyar Sajjad Baig, Mark Strong, Oliver WJ Quarrell
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    Han-Joon Kim, Chae-Won Shin, Beomseok Jeon, Hyeyoung Park
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Case Reports
Attention in Parkinson’s Disease Mimicking Suggestion in Psychogenic Movement Disorder
Jong Sam Baik
J Mov Disord. 2012;5(2):53-54.
DOI: https://doi.org/10.14802/jmd.12012
  • 12,336 View
  • 56 Download
  • 3 Citations
AbstractAbstract PDF

The various reported psychogenic movement disorders (PMDs) include tremor, dystonia, myoclonus, gait disorder, Parkinsonism, tics, and chorea. Although it is not easy to diagnose PMDs, several features such as distractibility, entrainment, suggestion and placebo trial are quite helpful to diagnose. Especially, distractibility or suggestion is a good tool to do in outpatient clinic easily. We describe a patient with parkinsonian features which were improved by internal suggestion to focusing attention. Initially, we suspected her diagnosis as PMDs; however she was confirmed with organic Parkinson’s disease later.

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  • Functional neurological disorder and placebo and nocebo effects: shared mechanisms
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Psychogenic Balance Disorders: Is It a New Entity of Psychogenic Movement Disorders?
Jong Sam Baik, Myung Sik Lee
J Mov Disord. 2012;5(1):24-27.
DOI: https://doi.org/10.14802/jmd.12007
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  • 2 Citations
AbstractAbstract PDF

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.

Citations

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  • Somatization in Parkinson's Disease: A systematic review
    Danilo Carrozzino, Per Bech, Chiara Patierno, Marco Onofrj, Bo Mohr Morberg, Astrid Thomas, Laura Bonanni, Mario Fulcheri
    Progress in Neuro-Psychopharmacology and Biological Psychiatry.2017; 78: 18.     CrossRef
  • Functional movement disorders
    Anita Barbey, Selma Aybek
    Current Opinion in Neurology.2017; 30(4): 427.     CrossRef
Original Article
Psychogenic Gait Disorders after Mass School Vaccination of Influenza A
Jung Ho Ryu, Jong Sam Baik
J Mov Disord. 2010;3(1):15-17.
DOI: https://doi.org/10.14802/jmd.10004
  • 6,636 View
  • 32 Download
  • 5 Citations
AbstractAbstract PDF
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.

Citations

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  • Diagnosing Common Movement Disorders in Children
    Jennifer A. O’Malley
    CONTINUUM: Lifelong Learning in Neurology.2022; 28(5): 1476.     CrossRef
  • Immunization stress-related responses: Implications for vaccination hesitancy and vaccination processes during the COVID-19 pandemic
    Steven Taylor, Gordon J.G. Asmundson
    Journal of Anxiety Disorders.2021; 84: 102489.     CrossRef
  • Functional Neurological Disorder after Vaccination: A Balanced Approach Informed by History
    Stefanie C Linden, Alan J Carson, Simon Wessely
    Journal of the Royal College of Physicians of Edinburgh.2021; 51(4): 330.     CrossRef
  • Psychogenic Gait Disorder Complicating Recovery after Concussion: A Case Series
    Scott I. Otallah
    Pediatric Neurology.2020;[Epub]     CrossRef
  • Psychogenic movement disorders in children and adolescents: an update
    Susan R. Harris
    European Journal of Pediatrics.2019; 178(4): 581.     CrossRef
Case Report
Dopaminergic Medication-Related Repetitive Behaviors in Parkinson’s Disease
Jong Sam Baik, Sang Won Han, Jeong Yeon Kim, Jae Hyeon Park
J Mov Disord. 2008;1(2):101-103.
DOI: https://doi.org/10.14802/jmd.08020
  • 12,487 View
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  • 1 Citations
AbstractAbstract PDF

A set of impulse control and repetitive behaviors presumed to be related to dopaminergic medications has been recognized in Parkinson’s disease (PD). A 68-year-old man presented with compulsive gathering of new towels for 8 months after increasing his medication dosage. After we reduced a dose of Sinemet® and ropinirole as before, and added amantadine, his repetitive behavior was gone and dyskinesia was improved.

Citations

Citations to this article as recorded by  
  • A Case of Dopamine Dysregulation Syndrome and Repetitive Behavior Caused by Levodopa in Parkinson's Disease
    So Young Huh, Min Jeong Kim
    Journal of the Korean Geriatrics Society.2010; 14(3): 171.     CrossRef

JMD : Journal of Movement Disorders