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Donghwi Park - Top 30 Publications

Usefulness of F-18 FP-CIT PET to predict dopamine-responsive hand tremor in patients other than Parkinson's disease: Two case reports.

Treating the patients with hand tremors is clinically difficult, because a wide range of disorders can result in hand tremors. Therefore, when treatment for hand tremors begins, various pharmacological options have to be considered. In clinical practice, a practical approach is to initially check hand tremor patients for signs of Parkinson's disease (PD), because patients with PD can benefit from dopamine treatment. However, only part of patients with PD tends to show a meaningful improvement in hand tremors for dopamine treatment. On the other hand, dopamine treatment may help with hand tremors of patients with other disorders, but dopamine responsiveness can't be predicted by clinical assessment alone.

Usefulness of polydeoxyribonucleotide as an alternative to corticosteroids in patients with lateral epicondyitis: A case series.

Local corticosteroid injections are commonly used as an easy, cost-effective treatment for patients with lateral epicondylitis (LE). Despite their strong anti-inflammatory effect, repeated injections of corticosteroids are not recommended in LE because they can aggravate tearing of the tendons.

Spastic paraparesis caused by X-linked adrenoleukodystrophy mimicking vacuolar myelopathy in a human immunodeficiency virus patient: A case report.

Vacuolar myelopathy is one of most common cause of spastic paresis in patients with human immunodeficiency virus (HIV) infection. However, X-linked adrenoleukodystrophy (X-ALD), which is a metabolic disorder caused by impairment of peroxisomal beta-oxidation of very-long-chain fatty acids (VLCFA), also manifests as various neurological deteriorations including adult onset spastic paraparesis. To the best of our knowledge, there has been no report of newly developed spastic paresis due to X-ALD in a patient with HIV infection.

Treatment of Ramsay-Hunt's syndrome with multiple cranial nerve involvement and severe dysphagia: A case report.

Ramsay-Hunt's syndrome (RHS) is a disorder characterized by facial paralysis, herpetic eruptions on the auricle, and otic pain due to the reactivation of latent varicella zoster virus in the geniculate ganglion. A few cases of multiple cranial nerve invasion including the vestibulocochlear nerve, glossopharyngeal nerve and vagus nerve have been reported. However, there has been no report about RHS with delayed onset multiple cranial nerve involvement causing severe aspiration, and a clinical course that improved after more than one year of dysphagia rehabilitation and percutaneous endoscopic gastrostomy (PEG). Here, we report on a 67-year old male with delayed onset swallowing difficulty after 16 days of RHS development.

The Importance of Considering Anatomical Variables in High-Resolution Manometry Measurements.

Response to the letter to the editor on the article "Evaluation of Posterosuperior Labral Tear with Shoulder Sonography after Intra-articular Injection".

Verbal auditory agnosia in a patient with traumatic brain injury: A case report.

Verbal auditory agnosia is the selective inability to recognize verbal sounds. Patients with this disorder lose the ability to understand language, write from dictation, and repeat words with reserved ability to identify nonverbal sounds. However, to the best of our knowledge, there was no report about verbal auditory agnosia in adult patient with traumatic brain injury.

Recurrent complex regional pain syndrome type I in a patient with amyotrophic lateral sclerosis: a case report.

A novel CACNA1A mutation associated with episodic ataxia 2 presenting with periodic paralysis.

Effect of Polydeoxyribonucleotide Injection in a Patient with Carpal Tunnel Syndrome: A Case Report.

Ultrasound-guided corticosteroid injection into the carpal tunnel is widely performed for the management of carpal tunnel syndrome (CTS). However, this injection may worsen the condition in patients with type 2 diabetes mellitus (DM). Polydeoxyribonucleotide (PDRN) was recently recognized as a substitute for corticosteroid due to its anti-inflammatory effects. A 41-year-old woman with type 2 DM was admitted to our rehabilitation clinic with a 1-month history of numbness and tingling in her right hand and first 3 fingers tips. She declined corticosteroid treatment because of a previous episode of uncontrolled blood glucose levels following corticosteroid injection. Therefore, ultrasound-guided PDRN injections into the carpal tunnel were carried out. At the 6-month follow-up, the patient demonstrated an improvement in the CTS symptoms without any complications. Thus, PDRN injections into the carpal tunnel can be an alternative to corticosteroid injections for CTS if there are limitations due to side effects of the latter.

Five-year serial follow-up of muscle MRI in adult onset myotonic dystrophy type 1: A case report.

Although several studies have described the involvement pattern of myotonic dystrophy type 1 (DM1) using muscle MRI, most of these studies have limitations as cross-sectional studies. To the best of our knowledge, there have been no reports of longitudinal studies describing muscle involvement patterns in patients with DM1 via serial MRI.

The Correlation Between Clinical Characteristics and Radionuclide Salivagram Findings in Patients With Brain Lesions: A Preliminary Study.

To evaluate the correlation between radionuclide salivagram findings and clinical characteristics in dysphagic patients with brain lesions.

Underweight: another risk factor for cardiovascular disease?: A cross-sectional 2013 Behavioral Risk Factor Surveillance System (BRFSS) study of 491,773 individuals in the USA.

Obesity is a well-established risk factor for cardiovascular disease (CVD), but the underweight population of body mass index (BMI) below 18.5 kg/m has not been an object of concern. The objective of this study is to investigate whether underweight could be an independent risk factor for CVD in a population-based cross-sectional study.Cross-sectional data of 2013 Behavioral Risk Factor Surveillance System (BRFSS) database encompassing 491,773 US adult subjects were used to assess risk for CVD. Primary outcomes were the incidence and relative risks (RRs) of CVD including stroke, heart attack/myocardial infarction, or coronary artery disease according to BMI category. All analyses used weighted sampling probabilities of data source.The underweight population had a 19.7% greater risk of CVD than did the normal-weight, and the overweight and obese population had a 50% and 96% increased risk, respectively. When adjusted with covariates, the relative risk for CVD elevated in underweight population (adjusted RR 1.34 [95% confidence interval (CI) 1.335-1.348]). Conversely, the adjusted relative risk was significantly attenuated in the obese group (adjusted RR 1.149 [95% CI 1.147-1.151]) and it was even insignificant in the overweight group (adjusted RR 1.00 [95% CI 1.000-1.003]). In subanalysis for each CVD category, being underweight among BMI status was the strongest independent risk factor for stroke (adjusted RR 1.441 [95% CI 1.431-1.450]), heart attack/ myocardial infarction (MI) (adjusted RR 1.23 [95% CI 1.217-1.233]), and angina/coronary artery disease (adjusted RR 1.20 [95% CI 1.189-1.206]). Especially among the population below 40-year old, relative risk estimates remained increased in the underweight population; persons who were underweight had a 2.3-fold greater adjusted relative risk of CVD as compared with those with normal weight when we stratified with age.Underweight below BMI 18.5 kg/m may be another risk factor for CVD, and CVD risk of the overweight and obese population largely depended on other comorbidities accompanied by obesity.

The effectiveness of 2 consecutive intra-articular polydeoxyribonucleotide injections compared with intra-articular triamcinolone for hemiplegic shoulder pain: A STROBE-complaint retrospective study.

The aim of this study was to investigate the effects of intra-articular injection of polydeoxyribonucleotide (PDRN), compared with intraarticular triamcinolone (TA) injection, in subacute stroke patients with hemiplegic shoulder pain (HSP).Participants were subacute stroke patients with HSP who had undergone 2 consecutive intra-articular injections of TA or PDRN.Numeric rating scale (NRS) and passive range of motion (PROM) of hemiplegic shoulder were evaluated until 4 weeks after 2nd injection.In the results, there were significant improvements in all PROM measures 2 weeks after the second injection, compared with pre-injection results, in both groups (P < .05). In the PDRN group, however, none of the PROM measures were significantly improved at 3 and 4 weeks after the second injection, compared with pre-injection results (P ≥ .05). When comparing pre-injection results with those at 4 weeks after the second injection, all PROM and NRS measures in the TA group were more improved than in the PDRN group, but this was not statistically significant (P ≥ .05).In conclusion, considering the systemic side effects of steroids, especially among patients with diabetes or metabolic syndrome, PDRN seems to be a worthwhile treatment option for HSP, although PDRN does not seem to have an equivalent persistence effects when compared with TA.

Application of ultrasound-guided C5 nerve root block using polydeoxyribonucleotide in traumatic C5 nerve root injury caused by fracture of the articular process of the cervical spine: A case report.

Cervical nerve root injury is one of the complications of traumatic cervical spine fracture. Although one of the most effective treatments to reduce inflammation in nerve root injuries is the use of corticosteroids or nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids and NSAIDs can inhibit bone healing. So, when nerve injury accompanies bone fractures, corticosteroids and NSAIDs have limitations as therapeutic agents. However, polydeoxyribonucleotide (PDRN) may be useful in the treatment of neuropathy or musculoskeletal pain patients with contraindication of the use of corticosteroids because of its anti-inflammatory effect, as revealed in previous studies. To the best of our knowledge, there has been no report of treatment of traumatic nerve root injury due to an articular process fracture with an ultrasound-guided cervical nerve root block (NRB) using PDRN.

Successful IVIG treatment without discontinuation of TNF-α blocker in Guillain-Barre syndrome induced by adalimumab in patient with Crohn's disease.

Can Ultrasound-Guided S1 Transforaminal Epidural Injection Using the In-plane Approach and Color Doppler Imaging Be a Safer Alternative to Lumbar Inter-laminar Epidural Injection?

Lower limb muscle magnetic resonance imaging in myotonic dystrophy type 1 correlates with the six-minute walk test and CTG repeats.

The aim of this study was to elucidate correlations among clinical, genetic, and magnetic resonance imaging (MRI) data of muscles in myotonic dystrophy type 1 (DM1). We retrospectively reviewed the medical records and images of nineteen patients with DM1 from different families. We retrieved the genetic data (CTG repeats) and the clinical data, which included disease duration, creatine kinase level, sum score of manual muscle testing, modified Medical Research Council sum score, and the six-minute walk test results (6MWT). The correlation analyses showed a statistically significant correlation between the modified Medical Research Council sum score and CTG repeat numbers. Among the lower extremity muscles, 6MWT correlated most with the sum of the ankle plantar-flexors (the soleus, medial, and lateral gastrocnemius muscles). Compared to the other plantar-flexor muscles, the soleus muscle presented the highest correlation with the 6MWT. Additionally, our results showed that the CTG repeat numbers did not correlate with the 6MWT. However, it correlated with the modified Medical Research Council sum score. The ankle plantar-flexor muscles were the most severely affected muscles revealed in the whole body MRI, and presented statistically significant correlation with the 6MWT. Among the plantar-flexor muscles, the soleus muscle most influenced the 6MWT.

Distribution Patterns of the Vulnerable Vessels Around Cervical Nerve Roots: A Computed Tomography-Based Study.

The aim of the study was to evaluate the prevalence of vulnerable vessels around the target of cervical transforaminal epidural steroid injection at the C3-C7 cervical nerve root levels in a clinical setting.

Application of different ventilator modes in patients with amyotrophic lateral sclerosis according to certain clinical situations: A Case Report.

Amyotrophic lateral sclerosis (ALS) is a rapidly progressing neurodegenerative disease that involves limb, axial, bulbar, and respiratory muscles. Fatigue and weakness of the respiratory muscles eventually induce respiratory insufficiency, which is one of the main causes of death in patients with ALS. In ALS patients with respiratory insufficiency, application of a ventilator is indispensable. Although there are various modes of ventilation, these modes are classified roughly into volume-controlled ventilation (VCV) and pressure-controlled ventilation (PCV). There have been several reports that VCV is preferable to PCV in neuromuscular disorder patients, such as ALS patients, but there is still debate on which ventilator mode is better.

Reply to "prolongation of terminal latency of the phrenic nerve in amyotrophic lateral sclerosis - Is it clinically useful, and what are the mechanisms?"

Normal contractile algorithm of swallowing related muscles revealed by needle EMG and its comparison to videofluoroscopic swallowing study and high resolution manometry studies: A preliminary study.

The purpose of this study was to investigate the function and importance of infrahyoid muscles with the suprahyoid muscles during swallowing, and to investigate swallowing sequences using kinematic analysis, high-resolution manometry (HRM) and electromyography (EMG). As a preliminary study, ten healthy subjects were prospectively enrolled. A needle EMG evaluated the onset latency, peak latency and duration of the suprahyoid and infrahyoid muscles. HRM measured the time intervals among the velopharynx, tongue base, and upper esophageal sphincter. We also evaluated hyoid motion using an automated kinematic analysis software® (AKAS). All of these parameters were synchronized with a tilting motion of the epiglottis. In the EMG analysis, the activations of the suprahyoid muscles developed about 300ms earlier than that of the infrahyoid muscles. There was a significant relationship between the differences of suprahyoid and infrahyoid muscles' latency and total duration of the hyoid motion (p<0.05). The interval time of anterior hyoid motion has a significant correlation in the upper esophageal sphincter (UES) opening time. In conclusions, the functions of the infrahyoid muscles are also as important as that of the suprahyoid muscles for prolonged laryngeal elevation and UES opening. Moreover, kinematic analysis of videofluoroscopic swallowing study (VFSS) and HRM studies could reflect results of needle EMG study and replace EMG study.

Serum methylmalonic acid correlates with neuropathic pain in idiopathic Parkinson's disease.

Recent studies have shown a relatively higher prevalence of peripheral neuropathy in idiopathic Parkinson's disease (IPD). The hypothesis is that prolonged levodopa exposure causes vitamin B12 deficiency, which leads to peripheral neuropathy. The aim of our study was to find the relationship between vitamin B12 and its precursor methylmalonic acid (MMA) in IPD patients with neuropathic pain. We performed a cross-sectional study by enrolling consecutive 43 patients who were clinically tested positive for F-18 FP-CIT PET and 15 patients were diagnosed with peripheral neuropathy according to the Toronto clinical scoring system (TCSS). The severity of neuropathic pain was evaluated using total neuropathy scale, revised (TNSr), and Korean Neuropathic Pain Questionnaire (KNPQ). The correlations between age, IPD duration, levodopa equivalent dose (LED), UPDRS III, vitamin B12, MMA, and homocysteine levels were assessed. The prevalence rate of peripheral neuropathy in IPD patients was 35%. Among the serums assessed, MMA levels showed a positive correlation to TNSr and KNPQ in the IPD patients with peripheral neuropathy (TNSr r = 0.882, p < 0.001, KNPQ r = 0.710, p = 0.004), while Vitamin B12 and homocysteine showed no statistically significant correlation. Our study showed a prevalence of peripheral neuropathy in 35% of Korean IPD patients. The serum MMA positively correlated with the severity of neuropathic pain and this can be used as a useful marker in assessment of peripheral neuropathy in Parkinson's disease.

The terminal latency of the phrenic nerve correlates with respiratory symptoms in amyotrophic lateral sclerosis.

The aim of the study was to investigate the electrophysiological parameters in phrenic nerve conduction studies (NCS) that sensitively reflect latent respiratory insufficiency present in amyotrophic lateral sclerosis (ALS).

Pramipexole-induced limb dystonia and its associated complex regional pain syndrome in idiopathic Parkinson's disease: A case report.

This case may be due to basal ganglia dysfunction, which was probably caused by abnormal activation of dopamine 1-like receptor (D1R) boosted by pramipexole binding on dopamine 3-like receptor (D3R) in a situation where D3R was overexpressed by the chronic treatment of L-dopa.

Precise Target Site of Ultrasound-Guided C5 Cervical Root Block.

Extravasation of the Contrast Material During Voiding Cystourethrography in a Chronic Spinal Cord Injury Patient: A Case Report.

Neurogenic bladder is common in most spinal cord injury patients. Voiding cystourethrography (VCUG) is recommended in these patients to detect urinary tract complications. However, rare but serious complications may occur during VCUG, although VCUG is generally safe. There are several case reports of bladder rupture occurring in pediatric patients. Here, we report the first case of iatrogenic bladder rupture in an adult spinal cord injury patient in Korea. Particularly, extravasation of contrast without manual instillation has hardly ever been reported. To the best of our knowledge, this is the first reported case of bladder rupture without manual instillation during VCUG. We report a case of a 59-year-old female with paraplegia due to tuberculous spondylitis who underwent VCUG as a part of routine evaluation of neurogenic bladder. Extravasation of the contrast media during VCUG developed as a complication and the patient recovered spontaneously without any intervention. Therefore, VCUG should be performed properly in chronic spinal cord injury patients.

Ultrasonography of the Transverse Movement and Deformation of the Median Nerve and Its Relationships With Electrophysiological Severity in the Early Stages of Carpal Tunnel Syndrome.

To date, there have been conflicting suggestions regarding the initial pathogenesis of carpal tunnel syndrome (CTS). It has been characterized as either inflammation of the median nerve caused by compression or noninflammatory fibrosis of the subsynovial connective tissue (SSCT).

Ultrasound-Guided S1 Transforaminal Epidural Injection Using the In-Plane Approach and Color Doppler Imaging.

Recently, several studies have investigated the effectiveness of the ultrasound-guided lumbosacral transforaminal epidural injection. However, the ultrasound-guided S1 transforaminal epidural injection using an out-of-plane approach, which was previously reported, may cause an intestinal injury or intravascular injection because the needle tip tends to be invisible in the out-of-plane approach. In this study, therefore, we report a new method of ultrasound-guided S1 transforaminal epidural injection using the in-plane approach and color Doppler. In addition, we also report the usefulness of color Doppler imaging for finding the S1 foramen and confirming the accuracy of the injection.

Correspondence: The pathophysiology of pramipexole-associated dystonia in patients with Parkinson's disease.