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J Korean Neurol Assoc. 1995 Sep;13(3):584-592. Korean. Original Article.
Im JH , Lee MC .
Department of Neurology, College of Medicine, University of Ulsan, Asan Medical Center, Korea.

FitzGerald and Jankovic(1989)' reported 10 patients with marked gait difficulty and no or only minimal upper limb involvement and coined the term 'lower body parkinsonism' (LBP). They further suggested that LBP was a homogeneous subgroup of parkinsonism, distinct from idiopathic Parkinson's disease (IPD), attributable to vascular etiology. In order to verify the validity of this clinical entity, five cases with LBP were compared with 44 cases with typical idiopathic Parkinson's disease (IPD) with respect to their clinical and neuroradiological findings. Mean age at onset was significantly older in LBP group (63.2*6.3 years) than IPD group (53.9*5.9 years). Gait disturbance was the initial motor symptom in 80% of LBP cases and 16% of IPD cases. Duration of symptoms tended to be shorter in LBP group than IPD group (3.2*2.7, 5.2*3. Lyears, respectively), although statistically not significant. Response to, L-dopa was poor in all but one case with LBP, while most cases with IPD showed good response (43 of 44 cases). On brain MRI in LBP group, four of five cases had multiple small ischernic lesions in both periventricular white matter and basal ganglia. However, one case with LBP showed normal brain MR finding and improved with L-dopa treatment, whose diagnosis proved to idiopathic Parkinson's disease. We conclude that LBP is unusual but not rare, and may be a part of clinical spectrum of either vascular parkinsonism or idiopathic Parkinson's disease. Although LBP is a heterogeneous group, most cases may be caused by multiple lacunar infarctions.

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