An Evaluation of Right-Sided Symptom Onset as a Predictor of Poor Parkinson's Disease Prognosis.

Asuman Orhan Varoğlu,Adem Aydin

doi:10.7759/cureus.13493

Abstract

ObjectiveThe current study aimed to measure and compare neurological disability in Parkinson’s disease (PD) patients with right-sided symptom onset with that in PD patients with left-sided symptom onset, using the measurements taken at their first and last visits, to determine if right-sided symptom onset was predictive of a poor PD prognosis.MethodsOne hundred and forty-three PD patients were included in the study. The Unified Parkinson’s Disease Rating Scale (UPDRS) and the Hoehn and Yahr Scale were used to measure neurological disability in patients at the first and last visits. The scores for the neurological disability of patients at the first and last visits were compared retrospectively relative to disease onset.ResultsSeventy-six PD patients had right-sided symptom onset (53%), and 67 patients had left-sided symptom onset (47%) (p = < 0.001). The differences between the scores at the first and last visits, measured using the UPDRS and the Hoehn and Yahr Scale, were higher for PD patients with right-sided symptom onset than patients with left-sided symptom onset (p = < 0.001, p = < 0.002, respectively). Similarly, the UPDRS Part II and Part III values, used to evaluate motor function, were higher in PD patients with right-sided symptom onset as compared to those with left-sided symptom onset at the first and last visits (p = < 0.001).ConclusionRight-sided symptom onset was predictive of a poor prognosis in PD patients at follow-up.

Highlights

Parkinson’s disease (PD) is a chronic neurodegenerative disease that occurs due to the progressive loss of dopaminergic neurons in the substantia nigra
One hundred and forty-three PD patients were included in the study
Regardless, the difference in the distribution of dopaminergic neurons between the hemispheres may be insufficient in explaining motor predominance

Summary

Introduction

Parkinson’s disease (PD) is a chronic neurodegenerative disease that occurs due to the progressive loss of dopaminergic neurons in the substantia nigra. The clinical manifestations of PD often begin asymmetrically. In the absence of motor asymmetry in the clinical symptoms of such patients, the differential diagnosis of the condition should include other diseases [1]. After the loss of neurons (50%-70%) in the substantia nigra, clinical symptoms and signs that are contralateral to the affected substantia nigra are observed [2]. The number of dopaminergic neuron cells in the right and left hemispheres of healthy individuals has been reported to differ by 30%. Such a difference was not reported elsewhere [3,4,5,6]. Most research has only randomly described motor predominance in patients with PD [1]

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Results

Conclusion