| Abstract | Cilj istraživanja: Cilj ovog istraživanja bio je ispitati učestalost wearing off-a u našoj populaciji tj. u pacijenata oboljelih od PB-a Splitsko Dalmatinske županije. Također, željeli smo prikazati učestalost pojedinih motoričkih i nemotoričkih simptoma u razdoblju wearing off-a te istražiti povezanost wearing off-a s brojnim čimbenicima.
Ispitanici i metode: Ovo istraživanje po tipu je presječno, a provedeno je u razdoblju od listopada 2017. godine do svibnja 2018. u Klinici za Neurologiju, KBC Split. Istraživanje je obuhvatilo 39 pacijenata oboljelih od PB-a. U istraživanju su korišteni uvid u medicinsku dokumentaciju te upitnici WOQ-9, PDQ-39, UPDRS, NMS upitnik, Schwab i England skala svakodnevnih aktivnosti, MoCA te Hoehn i Yahr ocjenska ljestvica. U statističkoj obradi podataka korišteni su Mann-Whitney U test, T-test, Pearsonov koeficijent korelacije, χ2 test, Fisherov egzaktni test i ANOVA test.
Rezultati: Učestalost wearing off-a zabilježena WOQ-9 upitnikom iznosila je 84%, dok je učestalost wearing off-a zabilježena UPDRS 36. pitanjem iznosila 71,% posto. Između muškaraca i žena nismo ustanovili statistički značajnu razliku u učestalosti wearing off fenomena. Motorički simptomi bili su učestaliji od nemotoričkih u razdoblju wearing off-a. Najčešći simptom u razdoblju wearing off-a je bio bilo kakva usporenost pokreta (76,92%), a slijedili su ga tremor (53,85%) i smanjena spretnost (53,85%). Najrjeđi motorički simptom su bili grčevi mišića (25,64%), koji su ujedno imali i najlošiji odgovor na terapiju levodopom. Najčešći nemotorički simptom bile su promjene raspoloženja (29,51%), a najrjeđi tjeskobnost/anksioznost (15,38%). Dokazali smo statistički značajnu pozitivnu povezanost 39. pitanja UPDRS upitnika tj. jačine wearing off-a i ukupne doze levodope (p=0,384, P=0,016), dok povezanost jačine wearing off-a s trajanjem liječenja, trajanjem bolesti i dobi pacijenta te dobi pacijenta pri dijagnozi nismo dokazali. Značajnu pozitivnu povezanost pronašli smo i između WOQ-9 zbroja tj. broja simptoma na WOQ-9 upitniku i ukupne doze levodope (p=0,398, P=0,012), između WOQ-9 zbroja i rezultata na PDQ-39 upitniku (p=0,430, P=0,006) te WOQ zbroja i ukupnog rezultata na UPDRS upitniku (p=0,482, P=0,002). Značajnu povezanost WOQ-9 zbroja i duljine bolesti, liječenja, trenutne dobi pacijenta i dobi pacijenta pri dijagnozi nismo našli. UPDRS ukupni rezultat razlikovao se također između pacijenata s wearing off-om i onih bez wearing off-a (U=43, p=0,029) s većim prosječnim rezultatom u skupini pacijenata s wearing off-om.
Zaključci: Wearing off fenomen česta je komplikacija liječenja levodopom, koja se pojavljuje u najmanje 50% pacijenta u prvih 5 godina liječenja. WOQ-9 upitnik bolje je sredstvo za identifikaciju wearing off-a nego 36. pitanje UPDRS-a. Motorički simptomi češći su od nemotoričkih u razdoblju wearing off-a, a najčešća je bilo kakva usporenost pokreta. Najrjeđi simptom je tjeskobnost/napadi panike, a grčevi mišića najlošije reagiraju na terapiju. S povećanjem ukupne dnevne doze levodope povećava se jačina wearing off-a i broj simptoma zahvaćenih wearing off-om. S povećanjem broja simptoma wearing off-a opada kvaliteta života. |
| Abstract (english) | Objectives: The aim was to examine the frequency of wearing off phenomenon in our population, ie in patients with Parkinson's disease in Split-Dalmatia County. We also wanted to show the frequency of some motor and nonmotor symptoms in the wearing off period and to investigate the correlation between wearing off and number of factors.
Patients and Methods: A cross-sectional study was conducted in the period from October 2017 to May 2018, at the Department of Neurology, Clinical Hospital Center Split. The study included 39 patients with Parkinson's disease.. The medical documentation, questionnaires WOQ-9, PDQ-39, UPDRS, NMS questionnaire, Schwab and England daily activity scales, MoCA, Hoehn and Yahr score charts were used. In statistical data processing, the Mann-Whitney U test, T-test, Pearson correlation coefficient, χ2 test, Fisher's exact test and ANOVA test were used.
Results: The frequency of wearing off according to the WOQ-9 questionnaire was 84%, the frequency of wearing off according to 36th question of UPDRS questionnaire was 71%. Statistically significant difference in the frequency of wearing off phenomenon among men and women was not found. Motor symptoms were more common than non-motor in the period of wearing off. The most common symptom in the period of wearing off was any slowness of movement (76.92%), followed by tremor (53.85%) and reduced dexterity (53.85%). The rarest motor symptoms were muscle cramps (25.64%), which also had the worst response to levodopa therapy. The most common non-motor symptom were mood changes (29.51%), and least common anxiety/panic attacs (15.38%). There was a statistically significant positive correlation between the 39th question of UPDRS questionnaire, ie the severity of wearing off and the total daily levodopa dose (p = 0.384, P = 0.016), while the correlations between wearing off severity and treatment duration, disease duration and patient's age and patient's age at the time of diagnosis were not found. Significant positive correlations were also found between the WOQ-9 sum, ie the number of symptoms detected by the WOQ-9 questionnaire and the total daily levodopa dose (p = 0.398, P = 0.012); between the WOQ-9 sum and the results on the PDQ-39 questionnaire (p = 0.430, P = 0.006) and between the WOQ sum and the total results on the UPDRS questionnaire (p = 0.482, P = 0.002). Significant correlations between the WOQ-9 sum and the disease duration, the treatment, the current age of the patient, and the age of the patient at the time of diagnosis were not found. The UPDRS score also differed between patients with and without wearing off (U = 43, p = 0.029), with a higher average score in the wearing off group.
Conclusions: Wearing off phenomenon is a common complication of levodopa treatment, occurring in at least 50% of patients in the first 5 years of treatment. The WOQ-9 questionnaire is a better tool for identifying wearing off than the 36th question of UPDRS. Motor symptoms are more frequent than non-motor in the period of wearing off and the most common is any slowness of movement. The rarest symptom is anxiety / panic attacks. Muscle cramps have the worst response to the treatment. Increasing the total daily dose of levodopa increases the severity of wearing off and the number of symptoms affected by wearing off. With the increase in the number of symptoms of wearing off, the quality of life decreases. |
