Effects of Korean Medicine on Postural Instability and Gait Difficulty in Patient with Parkinsonism: Retrospective Study

Seung-Bo Yang; Yeon-Jin Kim; Hyung-Min Lee; Sang-Hwa Lee; Seung-Yeon Cho; Jung-Mi Park; Chang-Nam Ko; Seong-Uk Park; Yang, Seung-Bo; Kim, Yeon-Jin; Lee, Hyung-Min; Lee, Sang-Hwa; Cho, Seung-Yeon; Park, Jung-Mi; Ko, Chang-Nam; Park, Seong-Uk

doi:10.13048/jkm.17028

JKM > Volume 38(3); 2017 > Article

Yang, Kim, Lee, Lee, Cho, Park, Ko, and Park: Effects of Korean Medicine on Postural Instability and Gait Difficulty in Patient with Parkinsonism: Retrospective Study

Original Article

The Journal of Korean Medicine 2017; 38(3): 96-102.

Published online: September 30, 2017

DOI: https://doi.org/10.13048/jkm.17028

Effects of Korean Medicine on Postural Instability and Gait Difficulty in Patient with Parkinsonism: Retrospective Study

Seung-Bo Yang¹, Yeon-Jin Kim¹, Hyung-Min Lee¹, Sang-Hwa Lee¹, Seung-Yeon Cho¹^{, 2}

, Jung-Mi Park¹^{, 2}, Chang-Nam Ko¹^{, 2}, Seong-Uk Park¹^{, 2}^{, *}

¹Department of Cardiology and Neurology of Clinical Korean Medicine, Graduate School, Kyung Hee University, Seoul, Korea

²Department of Cardiology and Neurology of College of Korean Medicine, Kyung Hee University, Seoul, Korea

Correspondence to：박성욱(Seong-Uk Park) 서울시 강동구 동남로 892 강동경희대학교병원 뇌신경센터 한방내과 Tel：+82-440-6217, Fax：+82-440-7171, Tel : +82-440-6217, Fax : +82-440-7171, E-mail : seonguk.kr@gmail.com

Received August 16, 2017 Revised September 12, 2017 Accepted September 13, 2017

Abstract

Objectives

The purpose of this study was to investigate the effects of Korean Medicine on postural instability and gait difficulty(PIGD) in patient with parkinsonism.

Methods

We reviewed the charts of patients with parkinsonism who were admitted to the department of Korean internal medicine, stroke and neurological disorders center, Kyung Hee University Hospital at Gangdong from October 2009 to May 2017. We analyzed the data of UPDRS (Unified Parkinson’s disease rating scale) and calculated PIGD related UPDRS before and after the admission.

Results

The average of PIGD score for the 23 patients of Parkinsonism significantly decreased from 8.35 ± 5.13 to 4.52 ± 3.68 after treatment. The average of PIGD score for the 16 patients of idiopathic parkinson’s disease and 7 patients of atypical Parkinsonism decreased from 9.13 ± 4.46 to 4.63 ± 4.15 and from 6.57 ± 6.45 to 4.29 ± 2.56 after treatment, respectively.

Conclusions

These results provide that Korean Medicine has an effect on the motor function of patients who suffer from Parkinsonism with Postural Instability and Gait Difficulty. Furthermore it could be effective for improving activities of daily life.

Keywords: Parkinsonism, Idiopathic Parkinson’s Disease, atypical Parkinsonism, Postural instability and gait difficulty, Korean Medicine, Unified Parkinson’s disease rating scale

Table 1

General Characteristics of Patients.

Characteristics		Total (n=23)	IPD* (n=16)	Atypical Parkinsonism (n=7)
Mean of age (year)		66.43 ± 9.80	66.44 ± 11.06	66.43 ± 6.80
Sex (N)	Man	3	0	3
Sex (N)	Woman	20	16	4
Duration of disease (year)		4.39 ± 2.55	5.31 ± 2.44	2.29 ± 1.25
Duration of treatment (day)		19.70 ± 11.67	18.00 ± 9.81	23.57 ± 15.28
Subtype (N)				MSA-P† (5)
				MSA-C‡ (2)

Values are mean ± standard deviation or number

* IPD : Idiopathic Parkinson’s Disease

† MSA-P : Multiple System Atrophy-Parkinsonian subtype

‡ MSA-C : Multiple System Atrophy-Cerebellar dysfunction subtype

Table 2

Changes in Postural Instability and Gait Difficulty related Unified Parkinson’s Disease Rating Scale after Treatment in Parkinsonism Patients.

	Before	After	p-value
Total PIGD* score	8.35 ± 5.13	4.52 ± 3.68	0.000†
Falling	1.41 ± 1.30	0.61 ± 0.94	0.002‡
Freezing	1.44 ± 1.31	0.74 ± 0.92	0.005†
Walking	1.80 ± 0.83	1.05 ± 0.49	0.001‡
Gait	1.50 ± 1.05	0.91 ± 0.61	0.002‡
Postural stability	1.70 ± 1.19	1.04 ± 0.93	0.001‡

Values are mean ± standard deviation

* PIGD : Postural Instability and Gait Difficulty

† p-value is calculated by paired t-test

‡ p-value is calculated by Wilcoxon signed rank test

Table 3

Changes in Postural Instability and Gait Difficulty related Unified Parkinson’s Disease Rating Scale after Treatment in Idiopathic Parkinson’s Disease Patients.

	Before	After	p-value
Total PIGD* score	9.13 ± 4.46	4.63 ± 4.15	0.000†
Falling	1.67 ± 1.18	0.63 ± 1.03	0.003‡
Freezing	1.63 ± 1.09	0.69 ± 1.01	0.002‡
Walking	2.00 ± 0.88	1.07 ± 0.46	0.006‡
Gait	1.73 ± 1.10	0.93 ± 0.70	0.004‡
Postural stability	1.75 ± 1.13	1.06 ± 1.00	0.004‡

Values are mean ± standard deviation

* PIGD : Postural Instability and Gait Difficulty

† p-value is calculated by paired t-test

‡ p-value is calculated by Wilcoxon signed rank test

Table 4

Changes in Postural Instability and Gait Difficulty related Unified Parkinson’s Disease Rating Scale after Treatment in Atypical Parkinsonism Patients.

	Before	After	p-value
Total PIGD* score	6.57 ± 6.45	4.29 ± 2.56	0.224†
Falling	0.86 ± 1.46	0.57 ± 0.79	0.457†
Freezing	1.00 ± 1.73	0.86 ± 0.69	0.679‡
Walking	1.33 ± 0.52	1.00 ± 0.58	0.047†
Gait	0.80 ± 0.45	0.86 ± 0.38	0.280†
Postural stability	1.57 ± 1.40	1.00 ± 0.81	0.102‡

Values are mean ± standard deviation

* PIGD : Postural Instability and Gait Difficulty

† p-value is calculated by paired t-test

‡ p-value is calculated by Wilcoxon signed rank test

참고문헌

1. Aminoff MJ, Greenberg DA, Simon RP. Clinical Neurology. 6th ed. New York. Lange Medical books/McGraw-Hill Medical;(2005). p. 241-5.

2. Samii, A, Nutt, JG, & Ransom, BR. Parkinson’s disease. Lancet, (2004). 363(9423), 1183-93.

3. Tolosa, E, Wenning, G, & Poewe, W. The diagnosis of Parkinson’s disease. Lancet Neurol, (2006). 5, 75.

4. Pickering, RM, Grimbergen, YAM, Rigney, U, Ashburn, A, Mazibrada, G, & Wood, B, et al. A meta analysis of six prospective studies of falling in Parkinson’s disease. Movement Disorders, (2007). 22, 1892-1900.

5. Balash, Y, Peretz, C, Leibovich, G, Herman, T, Hausdorff, JM, & Giladi, N. Falls in outpatients with Parkinson’s disease: frequency, impact and identifying factors. Journal of Neurology, (2005). 252, 1310-5.

6. Wood, BH, Bilclough, JA, Bowron, A, & Walker, RW. Incidence and prediction of falls in Parkinson’s disease: a prospective multidisciplinary study. Journal of Neurology, Neurosurgery, and Psychiatry, (2002). 72, 721-5.

7. Ashburn, A, Stack, E, Pickering, RM, & Ward, CD. A community-dwelling sample of people with Parkinson’s disease: characteristics of fallers and non-fallers. Age & Ageing, (2001). 30, 47-52.

8. Ganz, DA, Bao, Y, Shekelle, PG, & Rubenstein, LZ. Will my patient fall? JAMA, (2007). 297, 77-86.

9. Marras, C, McDermott, MP, Rochon, PA, Tanner, CM, Naglie, G, & Lang, AE, et al. Predictors of deterioration in health-related quality of life in Parkinson’s disease: results from the DATATOP trial. Movement Disorders, (2008). 23, 653-9.

10. Tinetti, ME, & Williams, CS. Falls, Injuries Due to Falls, and the Risk of Admission to a Nursing Home. The New England Journal of Medicine, (1997). 337, 1279-84.

11. Kwakkel, G, de Goede, CJ, & van Wegen, EE. Impact of physical therapy for Parkinson’s disease: a critical review of the literature. Parkinsonism Relat Disord, (2007). 13, 478-87.

12. Moretti, DV. Are there treatments for atypical parkinsonism? An update on actual options. Rev Neurosci, (2015). 26(5), 547-53.

13. Yang, SB, Kim, YJ, Lee, HM, Lee, HJ, Cho, SY, & Park, JM, et al. Effects of Korean Medicine on Patients with Idiopathic Parkinson’s Disease: A Retrospective Study. J Int Korean Med, (2016). 37(4), 653-660.

14. Thenganatt, MA, & Jankovic, J. Parkinson disease subtypes. JAMA Neurol, (2014). 71(4), 499-504.

15. Koh, SB, Park, KW, Lee, DH, Kim, SJ, & Yoon, JS. Gait Analysis in Patients With Parkinson’s Disease: Relationship to Clinical Features and Freezing. (2008). 1(2), 59-64.

16. Zhang, G, Xiong, N, Zhang, Z, Liu, L, Huang, J, & Yang, J, et al. Effectiveness of traditional Chinese medicine as an adjunct therapy for Parkinson’s disease: a systematic review and meta-analysis. PLoS One, (2015). 10(3), e0118498.

17. Lee, SH, & Lim, S. Clinical effectiveness of acupuncture on Parkinson disease: A PRISMA -compliant systematic review and meta-analysis. Medicine, (2017). 96(3), e5836.

18. Kim, SN, Doo, AR, Park, JY, Bae, H, Chae, Y, & Shim, I, et al. Acupuncture enhances the synaptic dopamine availability to improve motor function in a mouse model of Parkinson’s disease. PLoS One, (2011). 6(11), e27566.

19. Cho, SY, Shim, SR, Rhee, HY, Park, HJ, Jung, WS, & Moon, SK, et al. Effectiveness of acupuncture and bee venom acupuncture in idiopathic Parkinson’s disease. Parkinsonism Relat Disord, (2012). 18(8), 948-52.

20. Doo, KH, Lee, JH, Cho, SY, Jung, WS, Moon, SK, & Park, JM, et al. A Prospective Open-Label Study of Combined Treatment for Idiopathic Parkinson’s Disease Using Acupuncture and Bee Venom Acupuncture as an Adjunctive Treatment. J Altern Complement Med, (2015). 21(10), 598-603.

21. Hartmann, A, Müllner, J, Meier, N, Hesekamp, H, van Meerbeeck, P, & Habert, MO, et al. Bee Venom for the Treatment of Parkinson Disease - A Randomized Controlled Clinical Trial. PLoS One, (2016). 11(7), e0158235.

22. Awad, K, Abushouk, AI, AbdelKarim, AH, Mohammed, M, Negida, A, & Shalash, AS. Bee venom for the treatment of Parkinson’s disease: How far is it possible? Biomed Pharmacother, (2017). 91, 295-302.