Objective: To describe the frequency and clinical characteristics using standardized scales in patients with movement disorders (MD) recruited by a referral system in Tegucigalpa, Honduras.

Background:  ​ Access to public neurologic consultation in Honduras is scarce and no formal Movement Disorders clinic exists. Recently, a public hospital incorporated neurologic consultation with the first neurologist with MD training. Demographic characteristics of MD in Honduras are insufficient and assessment using clinical rating scales is lacking.

Methods: A prospective study was conducted from June to December 2016 in the San Felipe Hospital. A referral system between the two public entities that provide neurologic consultation was established; all patients were referred by general physicians from outpatient clinics and residents from the neurology training program. A total of 123 patients were recruited using the MD referral system, of which 12 were excluded because of lack of follow up visits. Best medical therapy was initiated with monthly follow up visits. Patients were evaluated using validated scales. A percentage of improvement based on the difference from the initial score and the six months score was calculated.

Results:  At all, 63% of patients were female (mean age was 65.8±14.1 years, 54,4%. Parkinsonism was the most common MD, with a frequency of 64.83%, of which 91.4% were idiopathic. Mean disease onset was 64.8 ± 12.5 years. Gap between onset of disease and making the diagnosis was 3.7±3.9 years, 27,14% were drug naive. Mean initial LEDD of 458,88±433,15, increased to 606.7±386.5 after intervention. Mean initial “ON” MDS-UPDRS-III was 36.8±16.0, reduced to 20.7±12.6 after intervention (35.45%±21.0% improvement). Tremor were 18,50% of patients, ET was the most frequent (20%) with improvement in the TETRAS part B scale of 31%±8%. Other tremors corresponded to enhanced physiological, drug induced, dystonic among others. Dystonias were 11.98%; focal dystonias accounted for 76.9%, hemifacial spasm  improvement in the Tolosa-Martin scale was 47% ±29% with botulinum toxin injections (BTI). Improvement of cervical dystonia was 33±7% with BTI. Choreas were 4.69% all secondary.

Conclusions:  After follow up patients had a better outcome and standardized evaluation was implemented. Public awareness with a referral system warrants early diagnosis and treatment to MD in Honduras.

References: 1.Cilia R, Akpalu A, Sarfo FS, Cham M, Amboni M, Cereda E, Fabbri M, Adjei P, Akassi J, Bonetti A, Pezzoli G. The modern pre-levodopa era of Parkinson’s disease: insights into motor complications from sub-Saharan Africa. Brain. 2014 Oct;137(Pt 10):2731-42. doi: 10.1093/brain/awu195.

2.Winter, Y., Bezdolnyy, Y., Katunina, E., Avakjan, G., Reese, J. P., Klotsche, J., Oertel, W. H., Dodel, R. and Gusev, E. (2010), Incidence of Parkinson’s disease and atypical parkinsonism: Russian population-based study. Mov. Disord., 25: 349–356. doi:10.1002/mds.22966.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/experience-and-outcomes-of-the-first-movement-disorders-clinic-in-honduras/