Publication: Esansiyel tremor ve parkinson hastalığı olan hastalarda nöropsikolojik ve klinik değerlendirme
Abstract
Esansiyel tremor (ET) ve Parkinson hastalığı (PH) en sık görülen hareket hastalıkları olup, tremor bu iki hastalığın ortak bulgusudur. Ancak ET hastalarında parkinsonizm bulguları, ya da Parkinson hastalarında ET bulguları bu iki hastalığın tanısı ve tedavisi aĢamasında zorluklara neden olabilmektedir. Son yıllarda iki hastalığın birlikteliği ve olası iliĢkisi daha fazla tartıĢılmaktadır. ET ve PH klinik bulgularının aynı hastada gözlemlenmesi ile ortaya çıkan ET-PH tablosunun farklı bir sendrom mu yoksa rastlantısal olarak ortaya çıkan bir birliktelik mi olduğu soruları yanıtlanmaya çalıĢılmaktadır. Biz de bu çalıĢmada ET-PH hasta grubunun özelliklerini ayrıntılı olarak incelemek amacı ile 9 ET-PH, 9 ET ve 10 Parkinson hastasının demografik, klinik ve kognitif fonksiyonlarını ayrıntılı olarak inceledik. ÇalıĢmanın sonunda ET-PH hastalarında tremor Ģiddetinin, özellikle frontal iĢlevlerini değerlendiren kognitif fonksiyonlarındaki etkilenmenin ve parkinsonizm ile iliĢkilendirilen; RDB, konstipasyon öyküsünün ET hastalarına göre daha fazla olduğunu belirledik. Parkinson hastaları ile karĢılaĢtırdığımızda ise bu hastaların (ET-PH), ailede tremor öyküsünün daha fazla olduğu ve levodopa yanıtlarının PH grubuna göre daha zayıf olduğu belirlenmiĢtir. Bu bulgular; çalıĢmada incelenen ET-PH grubunun, daha belirgin bir nörodejeneratif süreci iĢaret edecek Ģekilde kognitif fonksiyonlarının ET grubuna göre daha bozuk olduğunu göstermiĢtir. Ailede tremor öyküsü ve levodopa yanıtlarının farklı olması ile parkinson hastalarından ayrılan bu hastalarda ET üzerine eklenen parkinsonizm bulgularının daha yaygın ve PH ile benzer bir nörodejeneratif süreç ile iliĢkili olabileceği düĢünülmüĢtür. ÇalıĢma populasyonun küçük bir populasyon olması nedeni ile bu bulguların genellenebilmesi için daha büyük hasta populasyonlarında sonuçların tekrarlanması gerekmektedir. INGĠLĠZCE
PD and ET are the most common movement disorders and tremor is the mutual clinical manifestation of these two disorders. Parkinsonism in ET patients and ET findings in PD patients sometimes cause diagnostic problems and difficulties during treatment. Several studies in literature discuss the relationship between Parkinson disease and essential tremor for the last couple of years. Is the co-occurance of ET and PD might ocur by chance? or whether these patients belongs to a seperate syndrome or an overlap syndrome are still questions which are being discussed. In this study we aimed to investigate ET-PD patients in a detailed manner. Hence we compared clinical features and cognitive functions of 9 Essential Tremor – Parkinson Disease (ET-PD), 10 Essential tremor (ET) and 10 Parkinson disease (PD) patients. We have found that, ET-PD patients were different from ET patients in terms of tremor intensity, some cognitive functions pointing out an effect in the frontal area and RBD and constipation story. These patients had more tendency of having familial tremore history than PD patients. Although both ET-PD patients and PD patients had levodopa response, response degree was better in PD patients. ET-PD patients had worse cognitive performance than ET patients pointing out a higher neurodegenerative process in their brain. These patients were different from pure PD patients in levodopa response and familial tremor history which made us to think that, additive parkinsonism signs in ET patients are the result of a more severe neurodegenerative interval which has similarities with PD. This is a small sample sized study and these features should be cofirmed with larger population studies to comprehend the clinical features of ET-PD group.
PD and ET are the most common movement disorders and tremor is the mutual clinical manifestation of these two disorders. Parkinsonism in ET patients and ET findings in PD patients sometimes cause diagnostic problems and difficulties during treatment. Several studies in literature discuss the relationship between Parkinson disease and essential tremor for the last couple of years. Is the co-occurance of ET and PD might ocur by chance? or whether these patients belongs to a seperate syndrome or an overlap syndrome are still questions which are being discussed. In this study we aimed to investigate ET-PD patients in a detailed manner. Hence we compared clinical features and cognitive functions of 9 Essential Tremor – Parkinson Disease (ET-PD), 10 Essential tremor (ET) and 10 Parkinson disease (PD) patients. We have found that, ET-PD patients were different from ET patients in terms of tremor intensity, some cognitive functions pointing out an effect in the frontal area and RBD and constipation story. These patients had more tendency of having familial tremore history than PD patients. Although both ET-PD patients and PD patients had levodopa response, response degree was better in PD patients. ET-PD patients had worse cognitive performance than ET patients pointing out a higher neurodegenerative process in their brain. These patients were different from pure PD patients in levodopa response and familial tremor history which made us to think that, additive parkinsonism signs in ET patients are the result of a more severe neurodegenerative interval which has similarities with PD. This is a small sample sized study and these features should be cofirmed with larger population studies to comprehend the clinical features of ET-PD group.