STUDY OF SPECTRUM OF MOVEMENT DISORDER IN CHRONIC KIDNEY DISEASE

*Dr. Pinaki Mukhopadhyay, Dr. Pragateshnu Das and Dr. Gautam Guha

ABSTRACT

Aims and Objective: To study the spectrum of movement disorder in chronic kidney disease patients and the clinical and laboratory parameter of various movement disorders. Also to correlate the severity of parkinsonism according to modified UPDRS score with estimated glomerular filtration rate. Lastly, to compare features of parkinsonism in CKD patients with those of idiopathic Parkinson disease. Methodology: Results: The study had a preponderance of male (64%) to female (32%) percentage. Various movement disorder were found namely myoclonus (40%), parkinsonism (50%), rest tremor (8%), bradykinesia (50%), restless leg syndrome (10%), postural tremor (8%). The severity of parkinsonism and eGFR showed negative correlation. Clinical comparison between idiopathic Parkinson disease and CKD patients with parkinsonism showed rest tremor (p value <0.006) being less prevalent, with pyramidal features (p<0.001), gait abnormality (p<0.006) more prevalent. Comorbidity like diabetes (p<0.04) more common in CKD parkinsonism patients. Imaging study showed white matter hyperintensity (p<0.001) more common in CKD. CKD patients were less responsive to levodopa (p<0.001). Conclusion: The spectrum of movement disorder seen in patients with chronic kidney disease is quite varied. It spans from cortical disorder like myoclonus to basal ganglia disorder like parkinsonism. The severity of Parkinsonism has no correlation with eGFR. Pyramidal sign and gait problem were more common in CKD patient with parkinsonism and rest tremor is less common. Comorbidity like hypertension and diabetes mellitus are more common in parkinsonism patients with CKD than those without. Imaging abnormality is more common in CKD patients. White matter hyperintensity being most common. CKD patients are also less responsive to levodopa therapy.

Keywords: Movement disorder, Chronic kidney disease, Parkinsonism, India.