• Journal of Acupuncture Research
• /
• 제40권1호
• /
• pp.78-89
• /
• 2023

This paper presents the clinical outcome of an 82-year-old female who experienced sudden back pain combined with lower limb paresthesia and weakness after epidural steroid injection. The magnetic resonance imaging of the thoracolumbar spine showed a spinal epidural hematoma (SEH) extending from T8 to L4. She was treated non-operatively in the traditional Korean medicine (TKM) hospital. The patient's progress was assessed using the Numerical Rating Scale (NRS), American Spinal Injury Association (ASIS), Spinal Cord Independence Measure version III (SCIM III), and self-reported symptoms. During the 22-day hospitalization period,the NRS score decreased from 7 to 2 points, the motor score on the ASIS scale increased from 65 to 95 points. The subjective sense of lower extremities was felt by 1 increased to 8. The SCIM III score increased from 32 to 69 points. These results suggest that TKM could effectively reduce pain and aid the rehabilitation of patients with SEH.

• 동의생리병리학회지
• /
• 제35권2호
• /
• pp.71-80
• /
• 2021

Parkinson's disease is one of the typical neurodegenerative disease and it is caused by the destruction of substantia nigra in brain leading to lack of dopamine secretion, and it presents 4 major motor symptoms such as tremor, bradykinesia, stiffness, postural instability. Furthermore, it causes many non-motor symptoms such as anosmia, REM sleep conduct disorder, orthostatic hypotension, dementia and autonomic ataxia such as lack of adjusting blood pressure, hyperhydrosis, constipation. Dopaminergic therapy is the most commonly used strategy, but long term treatment of levodopa induce various adverse effects. Thus, many people are focusing on new therapies other than established therapies, and there are many tries and approaches with paradigm shift. Our medical team was able to get 4 cases of PD patients who are hospitalized in our hospital, treated by Whole Body Gi-Hyeol Therapy consisting of acupuncture therapy, herbal therapy, and mental therapy, and their conditions improved in perspective of Unified Parkinson's Disease Rating Scale(UPDRS), Heart Rate Variability(HRV), and Quality of life. Among all 4 cases, UPDRS score and quality of life score is gotton better, and among 2 cases SDNN, RMS-SD, TP, LF, HF scores are finely increased. And PDQ-39 score which shows quality of life is also improved. However, in spite of these improvements and positive results, there were no meaningful improvement in a hurt from a fall which is important to the aged, muscular atrophy which causes bone fracture and SMI(Skeletal Muscle Mass Index) which is indicator of osteoporosis. Thus, supplementary treatment about Whole Body Gi-Hyeol Therapy such as more active nutrition intervention, safe and effective kinesitherapy is needed, and from now on continuous case reports and systematic clinical research which has control group must be carried out.

• 정신신체의학
• /
• 제11권1호
• /
• pp.25-35
• /
• 2003

연구목적: 파킨슨병 환자에서 다양한 정신증상이 동반되는 것으로 보고되고 있으며, 특히 우울증상의 동반율이 매우 높다고 보고되고 있다. 특히 파킨슨병은 완치가 어렵고, 치료의 초점이 질병의 진행 억제나 증상의 완화에 있기 때문에 파킨슨병 환자에서의 우울증상에 대한 관심과 치료는 중요하다. 본 연구는 통원치료 중인 파킨슨병 환자들을 대상으로 파킨슨병 관련 임상요인들과 우울증상 사이의 관련성을 조사하는데 목적이 있다. 연구대상 및 방법: 일 대학교병원 신경과 파킨슨병 클리닉에서 특발성 파킨슨병으로 진단 받고 치료중인 환자들 중 본 연구에 참여하기로 동의한 118명의 환자를 대상으로 하였다. 일반적인 인구통계학적 자료, 파킨슨병 관련 자료[발병연령, 치료약물 용량, 임상양상, Hoehn과 Yahr의 단계(Hoehn and Yahr stage, H&Y stage), 일상생활 평가척도(Modified Schwab and England Activities of Daily Living, ADL)], 파킨슨병 환자의 삶의 질 설문지(Parkinson's Disease quality of Life questionnaire, PDQL), 스필버그 상태/특성 불안척도, 간이정신 검사 등을 조사하였고, 우울증상의 평가는 Beck 우울척도(Beck Depression Inventory, BDI)를 이용하였다. 결 과: 대상군의 평균 연령은 $60.4\pm7.1$세(범위:34-73세)였고, 남성이 56명(47.5%), 여성이 62명(52.5%)이었다. 대상군은 BDI 점수에 따라 비우울군 39명(33.1%), 경도 우울군 15명(12.7%), 중등도 우울군 16명(13.6%), 중증 우울군 48명(40.7%)으로 분류되었다. 파킨슨병 환자의 우울증상은 H & Y stage(r=0.34, p<0.001) 및 파킨슨병 증상의 정도(r=0.35, p<0.001), 스필버그 특성 불안 척도(TAI)(r=0.33, p<0.001)와 양의 상관관계가 있었고, 교육정도(r=-0.34, p<0.001), ADL(r=-0.37, p<0.001), PDQL(r=-0.69, p<0.001)과 음의 상관관계를 보였다. 본 연구에서 사용한 검사도구 중 우울증을 예측하는데 가장 의미있는 척도는 PDQL(p<0.005)이었다. 결 론: Beck 우울척도를 이용한 평가에 의하면 본 연구 대상 환자 118명 중 79명(67%)이 주관적인 우울증상을 호소하고 있었다. 본 연구 결과는 파킨슨병 증상이 심할수록, 그리고 H & Y stage가 높을수록 우울증상이 심각함을 보여준다. 또한 BDI 점수가 높을수록 일상생활에서의 활동에 제한이 많으며, 삶의 질이 저하되어 있음을 시사한다. 따라서 본 연구결과는 파킨슨병 환자의 신체증상에 대한 치료 이외 우울증상에 대한 정신의학적 관심과 치료가 중요함을 뒷받침한다.

• 동의생리병리학회지
• /
• 제22권4호
• /
• pp.896-902
• /
• 2008

Yukmijihwang-tang(YM) is used in Oriental medicine for treatments of diverse systemic symptoms including neurological dosorders. The present study was performed to examine potential effects of YM on growth-promoting activity of injured sciatic nerve axons. YM treatment in the injured sciatic nerve induced enhanced distal elongation of injured axons when measured 3 and 7 days after injury. Retrograde tracing of sciatic nerve axons showed YM-mediated increases in the number of DiI-labeled dorsal root ganglion (DRG) sensory neurons and spinal cord motor neurons at 3 days after injury. Hoechst nuclear staining showed that non-neuronal cell population was largely elevated by YM treatment in distal nerve area undergoing axonal regeneration. Furthermore, phospho-Erk1/2 protein levels were upregulated by YM treatment in the injured nerve area. These data suggest that YM may play a role in facilitated axonal regeneration in injured peripheral nerves. Further investigations of individual herbal components would be useful to explore effective molecular components and develop therapeutic strategies.

• Journal of Korean Neurosurgical Society
• /
• 제55권6호
• /
• pp.370-374
• /
• 2014

To present a case of cauda equina syndrome (CES) caused by chronic inflammatory demyelinating polyneuropathy (CIDP) which seemed clinically similar to Charcot-Marie-Tooth disease type1 (CMT1). CIDP is an immune-mediated polyneuropathy, either progressive or relapsing-remitting. It is a non-hereditary disorder characterized by symmetrical motor and sensory deficits. Rarely, spinal nerve roots can be involved, leading to CES by hypertrophic cauda equina. A 34-year-old man presented with low back pain, radicular pain, bilateral lower-extremity weakness, urinary incontinence, and constipation. He had had musculoskeletal deformities, such as hammertoes and pes cavus, since age 10. Lumbar spine magnetic resonance imaging showed diffuse thickening of the cauda equina. Electrophysiological testing showed increased distal latency, conduction blocks, temporal dispersion, and severe nerve conduction velocity slowing (3 m/s). We were not able to find genetic mutations at the PMP 22, MPZ, PRX, and EGR2 genes. The pathologic findings of the sural nerve biopsy revealed thinly myelinated nerve fibers with Schwann cells proliferation. We performed a decompressive laminectomy, intravenous IgG (IV-IgG) and oral steroid. At 1 week after surgery, most of his symptoms showed marked improvements except foot deformities. There was no relapse or aggravation of disease for 3 years. We diagnosed the case as an early-onset CIDP with cauda equine syndrome, whose initial clinical findings were similar to those of CMT1, and successfully managed with decompressive laminectomy, IV-IgG and oral steroid.

• 대한신경과학회지
• /
• 제36권4호
• /
• pp.302-309
• /
• 2018

Background: Although orthostatic hypotension (OH) and cognitive impairment (CI) are common non- motor symptoms of Parkinson's disease (PD), the relationship between OH and CI remains to be clarified. This study was aimed to investigate the relationship between OH and CI in PD. Methods: We recruited 192 patients who were diagnosed as PD based on the UK Brain Bank diagnostic criteria. The Hoehn & Yahr stages were ranged I to III and patients underwent extensive clinical evaluation, including brain magnetic resonance imaging (MRI) for cerebral white matter hyperintensity (WMH), tilt table test, the Korean version of Montreal Cognitive Assessments and the Korean version of Mini-Mental Status Examination in one month from the first clinic visit. The participants were divided into two groups according to the presence of OH (OH+ vs. OH-) and cognitive function (cognitive normal, CN vs. CI), respectively. Results: Significant relationship between OH and cognitive function (p=0.04) was found in our patients. The patients with OH+ had higher risk of CI by 2.6 times than that of OH- patients. Maximum heart rate change during tilt table test was correlated with cognitive function and white matter changes, whereas blood pressure change during tilt table test showed no correlation with those parameters. Conclusions: There was significant relationship between OH and CI in PD. Therefore, PD patients with either symptom may need periodic evaluation and proper management for OH and cognitive functions.

• 대한한의학회지
• /
• 제43권4호
• /
• pp.8-19
• /
• 2022

Objectives: Parkinson's disease (PD) patients experience various non-motor symptoms, among which constipation is the second most common after anosmia. However, there are no clear guidelines or effective treatment for constipation in PD. Methods: To investigate the efficacy of Majainhwan (MH) on constipation in patients with PD, we conducted a retrospective chart review study of PD or Parkinsonism patients with constipation who received outpatient or inpatient treatment and whose previous laxatives were replaced by MH from August 2016 to July 2019. Results: In this study, a total of 68 patients' medical records were reviewed. Among the 44 outpatients with MH treatment, "effective" results were observed in 86.4% patients. Similarly, among the 24 inpatients, "effective" results were noted in 95.8% patients. The adverse effect was "diarrhea" reported in five cases. Conclusion: Based on these findings, we could suggest that MH is relatively safe and may be effective in the treatment of constipation in patients with PD.

• Clinical Pain
• /
• 제18권2호
• /
• pp.88-91
• /
• 2019

Unexplained pain and weakness, i.e., without obvious predisposing factors, are often encountered by physiatrists and efforts should be made to determine the cause. A 63-year-old male presented with radiating pain in his right arm and mild weakness of the right hand. An electrodiagnostic examination revealed distal symmetric sensory polyneuropathy in the upper and lower extremities, and denervation potentials in the forearm muscles, which were inconsistent with the cervical spine MRI images and symptoms. A predisposing undiscovered disease was revealed, i.e., squamous cell carcinoma in the lung; brain metastasis affecting the left primary motor cortex was also detected. Therefore, we concluded that the pain and weakness were related to paraneoplastic syndrome and brain metastases of the hand knob. The observed denervation potentials were characterized as trans-synaptic changes in the brain metastasis. This case highlights the importance of unexplainable focal pain and weakness in the increasing prevalence of cancer.

• 대한한방내과학회지
• /
• 제35권1호
• /
• pp.12-23
• /
• 2014

Objectives : The purpose of this study was to report possibility of acupuncture or moxibustion for the treatment of Parkinson's disease (PD) by reviewing literature about its effectiveness. Methods : In this review, PubMed, SCOPUS, Science Direct and CINAHL of EBSCOhost were used to search medical journals, using keywords "Parkinson's disease and acupuncture" and "Parkinson's disease and moxibustion". The search range included randomized controlled trials (RCT) about Parkinson's disease combined with another disease and other treatments with acupuncture or moxibustion. Non-randomized controlled trial (nRCT), case study, animal experiment, human experiment, review, survey, essay, letter, and protocol for review were excluded. Results : From 311 studies, 111 were selected during the title and the screening. Finally, 16 RCTs (15 for acupuncture research and one for moxibustion) were included in this review, after scanning and matching the inclusion and exclusion criteria. The number of patients varied between 5 and 88. A total of 12 studies using electroacupuncture (EA) were classified into acupuncture studies. The body acupuncture studies numbered 4, scalp acupuncture 4, body and scarp acupuncture mixed studies 4, and bee venom, ear and abdomen acupuncture were each one study. In evaluation methods, total effective rate method was used in 9 studies, the Unified Parkinson's Disease Rating Scale (UPDRS) was used in 8, and the Webster score in 2. In addition, the Berg balance scale (BBS), 30 m walking time, steps to walk 30 m, PD motor function score, and Motor Performance Series by Schoppe (MLS) method were used for evaluation. In 15 of the 16 studies, the verum acupuncture group showed significant improvement compared with the control. In 9 studies using total effective rate method, the effective rate was reported as 80.0-97.3% in verum acupuncture groups and 52.6-86.4% in controls. Conclusions : Acupuncture may be a plausible alternative method to care for the long term symptoms and treat movement impairment of Parkinson's disease. However, to confirm this result, high quality studies including randomized, placebo-controlled double-blind trials are warranted.

• 대한한방내과학회지
• /
• 제40권2호
• /
• pp.220-227
• /
• 2019

Objectives: Parkinson's disease is the neurodegenerative disease that affects both motor and non-motor function, including postural instability. Camptocormia is an abnormal condition in which the thoracolumbar spine bends forward during walking or standing. However, the treatment options are limited and often not effective. The purpose of this study was to report on the Korean medical treatment of a Parkinson's disease patient with postural instability who presented with camptocormia. Methods: We used Korean medical treatment including herbal medicine (Jemageopung-tang), acupuncture and pharmacopuncture therapy to the patient who was admitted to the hospital for 21 days. The clinical symptoms were assessed with the Unified Parkinson's Disease Rating Scale (UPDRS) and walking time without assistance. Results: After treatment, the UPDRS Parts 2 and 3 scores were decreased from 5 to 3 and 20 to 9, respectively. Also, the walking time without assistance was improved. Conclusion: This study suggested that Korean medical treatment could be an effective option for treating Parkinson's disease with postural instability.