Objective: To evaluate clinical spectrum and management of the parkinson disease(PD) among Pakistani population.

Background: Parkinson, an idiopathic, slowly progressive neuro-degenerative syndrome characterized by bradykinesia, rigidity and postural instability.Underdeveloped countries have scarce facilities and access for the management of the disorder.

Methods: This one and a half year study(January 2015 to December 2016), was conducted in a local neurology clinic visited by many local and adjacent cities referred patients. Evaluation was based on Hoehn and Yahr rating scale. Informed written consent was obtained from all patients or their guardians for proper identification and assessment of symptoms, radiological investigations,demographic distribution and management.

Results: A total of 225 patients excluding secondary cases visited the clinic; among them 179 were male and 46 female. Mean age of disease onset was 59 years. Among 225, 195(86.6%) patients belong to rural area and 35(15%) have urban residence. According to rating scale, presenter checked most patients with or without medication were at stage 3. As our data illustrates, 6(2.6%) patients at stage 0, 43(19.11%) at stage 1, 59(26.2%) at stage 2,75(33.3%) at stage 3, 30(13.3%) at stage 4 and 12(5.3%) at stage 5. Magnetic resonance imaging and computed tomography showed significant basal ganglia calcification in only 5%, 25(11.11%) having mild cerebral atrophy and 20(8.8%) exhibit cerebral and cerebellar atrophy and remaining have other major factors like ageing, positive family history, and rural residency. Effective pharmacological management is done by the combination of levodopa, carbidopa,ropinirole HCl, amantadine hemisulphate and for anti parkinsonism, procyclidine used. Levodopa monotherapy comprise 48.4%. A vertical increasing trend is seen in use of levodopa plus carbidopa with dopamine agonist(ronirol) for young onset Parkinson. None of the patient had gone through surgery for PD. Non-pharmacological management is overlooked as seen by our data exercise and physiotherapy(2%), speech, language and swallowing(0%), occupational therapy(0%), gait and aerobic training(0.5%) is paid least attention by physicians as well as care takers.

Conclusions: This study adds a valuable data to existing literature for better evaluation and management of PD.PD, prevalent among males than females with most patients at stage 3. Levodopa is the gold standard therapy.Non-pharmacotherapy, should be given more consideration for improving quality of life.

References: C. Warren Olanow, Matthew B. Stern and Kapil Sethi. 2009.The scientific and clinical basis for the treatment of Parkinson disease (2009) DOI: https://doi.org/10.1212/WNL.0b013e3181a1d44c.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/prevalence-distribution-and-management-of-parkinson-among-pakistani-population/