Pistacchi Michele, Gioulis Manuela, Sanson Flavio, Marsala Sandro Z
Department of Neurology, Santorso Hospital, via Garziere 73, 36014 Santorso, Italy.
Department of Neurology, San Martino Hospital, Belluno, Neurology Service, Viale Europa 22, 32100, Belluno, Italy.
Neurol India. 2017 Nov-Dec;65(6):1271-1279. doi: 10.4103/0028-3886.217959.
'Wearing off' refers to the phenomenology of movement disorders in Parkinson's disease (PD) that appears early and is much commoner than generally believed. It may be present in the form of either motor symptoms or non-motor symptoms.
To investigate the utility of wearing-off questionnaire (WOQ-19, Italian version) in the outpatient clinical practice to assess the suitability of different combinations of treatment, in various stages of PD.
73 consecutive patients (58% male and 42% female) suffering from PD were recruited through the Santorso Hospital and San Martino Hospital from September 2012 to March 2014. The patients were asked to indicate whether or not they experienced any of the 19 symptoms listed in the questionnaire during the day; if one or more of these referred symptoms relating to PD improved after taking an additional dose of levodopa; and, if these variations were present routinely. Furthermore, we also evaluated the possible correlation between the presence of motor and non-motor symptoms that were listed in the WOQ 19 with the motor impairment assessed by the Hoehn and Yahr stage (HY) and the Unified Parkinson's Disease Rating Scale (UPDRS) part III motor section, in the whole patient cohort as well as in different subgroups undergoing therapy.
Among the 73 patients, 22% were receiving levodopa (a mean daily dose of 300 ± 121.3 mg), 38.3% levodopa and dopamine agonists, 12.3% levodopa/rasagiline, 8.2% levodopa/selegiline, and 19.2% a combination of levodopa/dopamine agonists (DA)/monoamine oxidase inhibitors (MAOI). The most prevalent symptoms were the non-motor symptoms included in the WOQ-19. A significant correlation between the scores obtained on the different motor and non-motor items recorded by the WOQ-19 and the UPDRS motor section and HY scores was found. The therapeutic benefit was especially related to the motor symptoms.
In clinical practice, this simple and easily administered questionnaire may be useful for the early detection of fluctuations in symptomatology in patients with PD. It will, therefore, help to improve the quality of the global care of patients with PD detected in various stages of the disease.
“剂末现象”指帕金森病（PD）中运动障碍的一种表现，出现较早且比普遍认为的更为常见。它可能以运动症状或非运动症状的形式出现。
研究剂末现象问卷（WOQ - 19，意大利语版）在门诊临床实践中的效用，以评估帕金森病不同阶段不同治疗组合的适用性。
2012年9月至2014年3月期间，通过桑托索医院和圣马蒂诺医院招募了73例连续的帕金森病患者（男性占58%，女性占42%）。患者被要求指出他们在白天是否经历了问卷中列出的19种症状中的任何一种；如果服用额外剂量的左旋多巴后，一种或多种这些与帕金森病相关的症状有所改善；以及这些变化是否经常出现。此外，我们还评估了WOQ - 19中列出的运动和非运动症状的存在与由霍恩和雅尔分期（HY）以及统一帕金森病评定量表（UPDRS）第三部分运动评分评估的运动障碍之间的可能相关性，在整个患者队列以及接受治疗的不同亚组中进行评估。
在73例患者中，22%正在接受左旋多巴治疗（平均每日剂量为300±121.3毫克），38.3%接受左旋多巴和多巴胺激动剂治疗，12.3%接受左旋多巴/雷沙吉兰治疗，8.2%接受左旋多巴/司来吉兰治疗，19.2%接受左旋多巴/多巴胺激动剂（DA）/单胺氧化酶抑制剂（MAOI）的联合治疗。最常见的症状是WOQ - 19中包含的非运动症状。发现WOQ - 19记录的不同运动和非运动项目得分与UPDRS运动评分和HY评分之间存在显著相关性。治疗益处尤其与运动症状相关。
在临床实践中，这种简单且易于使用的问卷可能有助于早期发现帕金森病患者症状的波动。因此，它将有助于提高在疾病不同阶段检测出的帕金森病患者整体护理的质量。
