ABSTRACT:To evaluate the patients of Parkinson's disease in the Indian tertiary setup it was necessary to weigh the multivaried presentation of PD for the motor disorders as well as neurocognitive and various grades of psychophysiological inadequacies with emphasis on cognitive deficits. Two groups of patients consisting of 41 subjects in each of case and control group were analyzed for the psycho-neurophysiological functions using AIIMS battery (in Hindi) and MMSE scoring system. The case and controls had appreciable difference in MMSE scoring with almost 2.5% of patients having very low score (<10) compared to none in control scoring less than 10.80% of cases presented with disease in upper or lower limbs. Disability scoring on Hoehn & Yahr scoring was stage 2(34%) or stage 3(27%) for most of the patients in the study. 85.4% patients presented with tremors, 13% patients had history of early falls and 63% patients had urinary bladder involvement at the time of presentation. 20% (6/35) of the cases categorized as Idiopathic Parkinson's disease presented with conspicuous gaze abnormality. The different lobes were evaluated categorically for dysfunction in both the hemispheres and an estimate of dysfunction distribution was obtained. Right frontal lobe had the highest psychocognitive score while the right parietoccipital had the least score of all the lobar regions evaluated on AIIMS neuropsychiatric battery scoring. The score differences of cases with controls the RSM-right sensorimotor and LT-left temporal were the maximum. In overall hemispherical comparison, right lobe scored 335.50 as compared to 315.90 of left lobe. All four subdomains of MMSE were subnormal in cases as compared to controls with remarkable impairment of execution functions and memory. The AIIMS test battery was more sensitive for cognitive evaluation in this study with 70% cases of impaired patient had scored normal on MMSE scoring system.
A need still exists to determine the clinical and neurophysiological characteristics of leprosy neuropathy at distinct times of the disease by different methods that measure the various nerve fiber functions. A prospective clinical study was performed 100 patients of clinically proven Hansen's will take in study and given diagnosis is made by dermatologist and neurologist. For Study of Clinical, Neuropathological, Neurophysiological Pattern of leprous neuropathy and results shows that Peripheral neuropathy is common neurological disorder, although population based studies are scarce. It is a diverse group of disorder with varying etiologies. Many of these are amenable to treatment while others are not. It affects all age groups are different etiologies in various age groups. Disorder is more common in males. Leprosy is still most common cause of peripheral neuropathy in this part of world. GBS is commonest cause in acutely presenting patients of peripheral neuropathy. Vacuities is also common especially in undiagnosed peripheral neuropathy patients and revealed by nerve biopsy. Tingling and numbness are two most common sensory complains. On objective sensory examination impairment of pain/temperature was most common. Evidence of large fiber dysfunction was less common. Almost half of leprous neuropathy had impaired joint position and vibration. Anesthetic patches and thickened nerve are two commonest indicators of leprous neuropathy. Among DTRs ankle jerk was most commonly affected. Almost half of GBS patients had history of preceding illness. Overall sensorimotor polyneuropathy was most common type of pattern after clinical-electrophysiological evaluation. Multiple mononeuropathy was most common in leprous neuropathy. Most patients had axonal type of involvement. In GBS patients predominantly motor neuropathy was found Skin smear examination is readily available and easy test to diagnosed leprosy, if done carefully. Sural nerve biopsy is useful in doubtful diagnosis. Around 16. 47% patient remains undiagnosed even after all investigation. Further population based studies are need of the day for evaluating the changing epidemiology of peripheral neuropathy.
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