الفهرس 
acknowledgement
Epidemiology of movement disordersOnly 14 pages are availabe for public view
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Abstract
Movement disorders are neurologic syndromes in which there is either an excess of movement (hyperkinesias) or a paucity of voluntary and automatic movements, unrelated to weakness or spasticity (hypokinesias). (1) The growing proportion of elderly people makes the occurrence of neurological disorders and, above all, movement disorders a growing concern, as age is, for most of them, the strongest risk factor.(3)
This is a hospital based study in Assiut University hospital in neurology department and outpatient clinic, aiming to detect awareness of different involuntary movements, their pattern and frequency, the study also assessed possible risk factors, and primary causes of different involuntary movements, promoting genetic studies and investigations for environmental causes.
Methods
All participants were assessed by full medical, therapeutic and family history, full clinical evaluation; general, systematic, neurological and psychiatric, and the diagnosis of movement disorder was assessed by two specialists of neurology each separately and assurance of diagnosis by video record, based on clinical assessment, brain imaging or other needed investigations, and clinical diagnostic
Severity and clinical features was evaluated by related scales, including:
• MDS- Unified Parkinson’s Disease Rating Scale (MDS-UPDRS) (Goetz et al., 2008) for PD. (parts 1,2,3,4) Part I:Non-Motor Experiences of Daily Living, which includes thirteen items: six rater-based and seven for patient self-assessment; Part II Motor experiences of daily living, with 13 patient-based items; Part III Motor examination, including 18 items (33 scores); and Part IV Motor complications, formed of six items on dyskinesia and fluctuations. Each item scores from 0 (normal) to 4 (severe) and for each part, total scores are obtained from the sum of the corresponding item scores (88).
• The Hoehn and Yahr staging (HY) (88)
• Tremor assessment form (TAF) for tremor: A questionnaire related to hand tremor consisting of 12 items was applied to patients with ET.
• Fahn-Marsden rating scale (FMRS), for dystonia:
The FMDRS is composed of two clinician-rated subscales: a movement subscale, based on patient examination, and a disability subscale, based on the patient’s report of disability in activities of daily living. The movement subscale rates dystonia severity and provoking factors in nine body areas. All items have a 5-point score. (92)
140 patients were assessed with multiple types of movement disorders, parkinsonism, dystonia, tremor, chorea, athetosis, tics, stereotypies and ataxia, duration of the study was 6 months.
Results:
Regarding socioeconomic data, involuntary movements were more in males, most cases were from 20 to 60 years old, more in illetrate, rural and married population, with negative family history and consanguinity in most cases. Most cases were diagnosed by neurologists, 2 thirds of cases had tremors, followed by parkinsonism, chorea, dystonia, then athetosis.
Parkinson’s disease was tha most common cause of parkinsonism, followed by drug induced parkinsonism, then vascular parkinsonism. Most of PD patients were males, above 40 years, mean of MDS-UPDRS total score was 62±43.66, most of cases were in Hoehn and Yahr stages 1 and 2. Sleep problems were the most reported symptoms among patients, followed by depressed mood and anxious mood, all items were more in males. Almost all cases had tremors, bradykinesia, and rigidity.
Regarding tremors, Parkinsonian tremor was the most common cause of tremors. Drug induced tremor was the second common cause of tremor. Essential tremor was reported in 12.5 % of cases, no significant sex difference among them, most were above 60 years old, with positive family history, and negative impact on daily activities, all cases had bilateral postural and kinetic tremors.
Most cases of dystonia were secondary type, either cerebral palsy, drug induced or post encephalitic. Most cases were presented with generalized and focal dystonias, most of cases were males.20% of cases were primary dystonia, mean of Fahn-Marsden rating scale (FMRS), for dystonia was 35± 24.53
Considering chorea and athetosis, most cases were males, and most were due to secondary causes, mostly vascular and CP. Genetic chorea cases were mostly clinically diagnosed as Huntington’s disease and neuroacanthocytosis.
Few cases were found with tics or stereotypies, and all cases of ataxia in the study were secondary; 40 % of them were secondary to multiple sclerosis with cerebellar lesion. There was no significant difference in sex in cases of tics, stereotypies or ataxia.