Title : Study the issue of sleep disturbance in Parkinson's disease
Objective: One of the most frequent non-motor manifestations of parkinson (PD) - pain. The frequency of chronic pain in PD lasting more than three months, according to different authors, is from 40 to 70% and exceeds it in general population from 20 to 44%. Assume pain in patients may be associated with new symptoms of parkinsonism, before general muscle stiffness associated with pathology of the musculoskeletal system or an independent symptom reflecting dysfunction of the nociceptive system with PD. All this makes it relevant comprehensive clinical analysis of chronic diseases left-sided syndromes in patients with PD.
Aim: Study the issue of sleep disturbance in Parkinson's disease.
Materials and methods: The study included 130 patients (57 men and 73 women, mean age 63.5 years). ± 9.1 years, Hoehn-Yar score 2.4 ± 0.7 points, disease duration 3.8 ± 2.3 years, UPDRS score (46.7 ± 15.6 points). Diagnosis PD was set according to clinical head bank diagnostic criteria brain of the PD Society of Great Britain. Criterion selection of patients was carried out in the absence of dementia according to ICD-10 criteria. patients with pain syndrome in PD were 68 patients, including 31 men and 37 women. Age of patients included in the main group ranged from 40 to 79 years and amounted to mean age 63.1 ± 9.1 years, mean score on the scale UPDRS was 49.3±15.9 points. Painful syndrome lasting more than 1 year was detected in 39 (57.4%) of 68 patients. Persistent variant of chronic pain syndrome chen in 45 (66.1%) patients with recurrent pain syndrome with remissions no more than 3 months suffered 23 (33.9%) patients were ill for months. From 68 patients with chronic pain syndrome 25 (36.7%) happened almost simultaneously with the appearance of movement disorders or not long before them, in 43 (63.3%) it developed later, as the disease progresses Vanity. Within a year from the onset of the disease left syndrome, occurred in 25 patients (36.7%), after a year or more in 43 patients (63.3%). Patients were examined by us VAS Scales (Visual Analogue Scale)
Results: In 43 (63%) patients, pain syndrome was detected or was more intense on the side of more pronounced motor manifestations (hypokinesia and rigiditysti). In 9 (13%) patients pain syndrome was on the opposite side on the side of onset of Parkinson's symptoms. In a quarter of patients 17 (24%) pain syndrome the syndrome was recorded on both sides. More- howling syndrome was more often localized in the proximal upper limbs in 31 (43.9%) patient than in the distal in 9 (16.3%) patients unlike the symptoms of parkinsonism, which which, with PD, is initially to a greater extent affect the distal parts of the upper extremities stay. Pain in the upper limbs more often localized in the shoulder region in 31 (43.9%) patient, less often in the arm in 9 (16.3%) patients. Pain in the lumbar region was noted by 23 (32.8%) a patient. Pain in the hip joint was found in 17 people. (25.1%) patients, in the shin area - in 12 (17.6%) patients, feet - in 10 (14.7%) patients. comrade Multiple localization of pain syndrome was registered in 21 (31%) patients. The severity of the pain syndrome during different current. According to diary analysis pain syndrome was more common in patients with morning and afternoon hours 27 (39.7%) patients, less often - in the morning and evening hours 24 (35.3%) Patients. Pain, mostly in the evening and night time disturbed 17 patients (25%).The severity of the pain syndrome according to VAS, which ranged from 1.7 to 8.3 points and averaged la 5.5 ± 1.6 points. In patients with chronic pain syndrome, the total mean score on the DOB-BP scale was 49.3 ± 15.9 points. In the group of patients comrade without pain syndrome total average The DOB-BP index was lower - 40.2±12.6. points (table 2). Average score for Part III and UPDRS in patients with pain syndrome vila 30.9±10.4 points, and in patients without pain syndrome - 25.5±8.8 points (Table 2). Scores on the UPDRS scale part III in patients with pain syndrome were higher, mainly due to hypokinesia and postural disorders stability, while there was no between groups lo revealed a significant difference in the expressed tremor and rigidity (p<0.05). The intensity of the pain syndrome is assessed according to VAS, correlates with the grade for the third part and UPDRS (11=0.43, p<0.01), as well as the score hypokinesia (11=0.5, p<0.01). In patients with PD pain threshold using pressalgometry lower than in the control group py (p<0.05). In PD patients with pain syndrome decrease in pain threshold reliability than in patients without pain syndrome (Table 3). Engine expression violations are assessed on the third part of the scale UPDRS correlates with pain threshold significance (R=0.22, p<0.05). In 36 patients with pain syndrome in PD, in 31 patients without pain syndrome and in 30 control group conducted a vibration study noah sensitivity. In patients with PD, the duration vibration perception was lower than compared with the control group. AT patients with duration of pain syndrome vibration perception was lower compared to patients without pain.
Conclusions: Patients with pain syndrome showed a more significant decrease sensitivity to vibration compared to in patients without pain, The only exception was the olecranon, where vibration sensitivity value was within the normal range. Vibration suppression detected rational sensitivity indicates the presence latent sensory disturbances in patients PD, which may contribute to the formation chronic pain syndrome. Chronic pain syndrome is observed in 52% of patients with PD, while in a third of patients is directly related to BP, thirdly conditionally associated with this disease, in a third of pa-of patients is not associated with PD and predominantly due to concomitant damage to the musculoskeletal system.
pathology. chronic pain syndrome the early stage of the disease was detected in 36% of patients. patients, onset of pain at a late stage observed in 64% of patients.