Roongroj Bhidayasiri

King Chulalongkorn Memorial Hospital, Krung Thep, Bangkok, Thailand

Are you Roongroj Bhidayasiri?

Claim your profile

Publications (86)179.45 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: The development of secondary non-response (SNR) to botulinum neurotoxin type-A (BoNT-A) is considered a key issue in the management of cervical dystonia (CD). This case-controlled study was performed to systematically identify factors influencing SNR during BoNT-A therapy.Methods This was a retrospective, international, non-interventional study of CD patients. Patients with SNR were matched with up to three responder patients (control) on the basis of duration of therapy and number of injection cycles. Factors influencing the development of SNR were screened using a univariate logistic regression model and confirmed using a multivariate conditional logistic regression model.Results216 patients were enrolled, and 201 (SNR=52; responder=149) were matched and subdivided into blocks (doublets, triplets or quadruplets). At baseline, a significantly higher proportion of SNR patients had received previous or concomitant therapies (p=0.038) and surgery for CD (p=0.007) compared with controls. Although disease severity at onset was similar between groups, a significantly higher proportion of SNR patients experienced severe CD at the time of SNR compared with controls at the last documented visit. Multivariate analyses identified five factors that were significantly associated in predicting SNR (odds ratio [OR]>1 indicated higher chances for being SNR): previous surgical procedure for CD (OR 9.8, p=0.013), previous BoNT-A related severe adverse event (AE) (OR 5.6 p=0.027), physical therapy (OR 4.6, p=0.028), neuroleptic use (OR 3.3, p=0.019) and average BoNT-A dose (OR 2.7, p=0.010).Conclusions These findings suggest that SNR may not reflect true pharmacological resistance to BoNT-A therapy, but may be related to underlying disease severity.
    Parkinsonism & Related Disorders 11/2014; · 3.27 Impact Factor
  • Neurology 06/2014; 82(24):2238-2240. · 8.30 Impact Factor
  • Roongroj Bhidayasiri, Onanong Jitkritsadakul, Carlo Colosimo
    [Show abstract] [Hide abstract]
    ABSTRACT: Although nocturnal disturbances are increasingly recognized as an integral part of the continuum of daytime manifestations of Parkinson's disease (PD), there is still little evidence in the medical literature to support the occurrence of these complex phenomena in patients with atypical parkinsonian disorders (APDs). Based on the anatomical substrates in APDs, which are considered to be more extensive outside the basal ganglia than in PD, we might expect that patients with APDs encounter the whole range of nocturnal disturbances, including motor, sleep disorders, autonomic dysfunctions, and neuropsychiatric manifestations at a similar, or even greater, frequency than in PD. This article is a review of the current literature on the problems at nighttime of patients with progressive supranuclear palsy, multiple system atrophy, corticobasal degeneration, and dementia with Lewy bodies. MEDLINE, life science journals and online books were searched by querying appropriate key words. Reports were included if the studies were related to nocturnal manifestations in APDs. Forty articles fulfilled the selection criteria. Differences between these symptoms in APDs and PD are highlighted, given the evidence available about each manifestation. This analysis of nocturnal manifestations of APDs suggests the need for future studies to address these issues to improve the quality of life not only of patients with APDs but the caregivers who encounter the challenges of supporting these patients on a daily basis.
    Journal of Parkinson's disease. 04/2014;
  • Priya Jagota, Angela Vincent, Roongroj Bhidayasiri
    [Show abstract] [Hide abstract]
    ABSTRACT: A confused and agitated 18-year-old woman presented to the emergency unit with orolingual movements, eye deviation, and a temperature of 38°C. The symptoms had begun 2 weeks prior to the admission when she developed a severe headache associated with pathologic laughing and intermittent episodes of upgaze deviation. A urine pregnancy test was positive and a transvaginal ultrasonography showed a 9-week-old fetus. An MRI of the brain was unremarkable and results of the CSF analysis were also unremarkable apart from a CSF pleocytosis (62 lymphocytes) and slightly elevated protein (55 mg/dL; normal range 0-45 mg/dL). Extensive microbiologic and serologic studies with CSF were all negative. She gradually lost consciousness, experienced respiratory failure, and was intubated. There were semirhythmic movements consisting of complex patterns of mouth opening, chewing, facial grimacing, synchronous flexion-extension, and supination-pronation limb movements, which persisted during the period of unresponsiveness. She also had generalized hyperreflexia, persistent hyperthermia, and a full bladder. Three EEGs showed diffuse slow waves with no epileptic discharges. A diagnosis of anti-NMDA receptor (NMDAR) encephalitis was made on clinical grounds and strongly positive serum NMDAR antibodies.
    Neurology 04/2014; · 8.30 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Parkinson's disease (PD) imposes a burden on those who care for the person afflicted. The objective of this study was to assess and analyze the main determinants of caregivers' burden, especially the nocturnal manifestations of PD. This multi-center, national, cross-sectional study included 89 patient-caregiver pairs. Caregiver self-assessments were performed with Hospital Anxiety and Depression Scale (HADS) and Zarit Caregiver Burden Interview (ZCBI). Patient self-assessments were performed with Modified Parkinson's Disease Sleep Scale (MPDSS), Nocturnal Akinesia Dystonia and Cramp Score (NADCS), HADS and Parkinson's Disease Quality of Life Questionnaire (PDQ-8). Most of the caregivers were employed women, and the majority had been permanently taking care of the patient for 6.8 ± 5.4 years. The study found that the ZCBI mean score of the caregivers significantly worsened as patients became more dependent (HY: 4-5, p = 0.036), and the mean ZCBI score of spousal caregivers (19.4; SD 15.5) was significantly higher than that of the offspring group (11.7; SD 7.9) (p = 0.008). Disease duration (r = 0.22), NADCS (r = 0.38), MPDSS (r = -0.36), PDQ-8 SI (r = 0.39) and HADS (total, anxiety and depression) scores (r = 0.46-0.49), and HADS (total, anxiety and depression scores (r = 0.37-0.52), had significant negative effect on caregivers' burden. Moderate association was found on MPDSS item 14 (r = 0.38) and NADCS akinesia score (r = 0.37). Patients' anxiety, nocturnal akinesia and the feeling of tiredness and sleepiness upon awakening in the morning were independent predictors of caregivers' burden (adjusted R (2) = 0.46). Based on these findings, treatment of early mood symptoms of the patients and caregivers at risk may be helpful for the effective management of PD and it is also important to have well-designed psycho-educational and multicomponent interventions in the community for caregivers of persons with PD.
    Journal of Neural Transmission 03/2014; · 3.05 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Nocturnal manifestations of Parkinson's disease (PD) are myriad, have diverse etiologies and include motor, sleep, urinary, and neuropsychiatric symptoms which are often associated with daytime somnolence. While most patients perceive these symptoms as troublesome, the recognition of nocturnal problems related to PD is still low in clinical practice. We conducted a survey using semi-structured interviews and self-rated questionnaires of 215 consecutive patients with PD enrolled in three centers in Thailand to determine the prevalence and risk factors of nocturnal disabilities and their relationship to daytime symptoms. We found that 96.6 % of patients reported the presence of nocturnal symptoms as determined by the modified version of Parkinson's Disease Sleep Scale (MPDSS). Our survey indicated that the most frequent and distressing symptom was the interruption of sleep to pass urine (56.7 %, 4.4 ± 3.9). The severity of symptoms revealed in the MPDSS increased along with the disease duration (p < 0.05) and Hoehn and Yahr stages (p = 0.01). There were similar to findings of the Nocturnal Akinesia Dystonia and Cramp Score (NADCS) where patients with advanced disease had significantly higher NADCS scores than early/moderate disease (p < 0.001). There was a significant correlation of total MPDSS scores with the total scores of the 9-item Wearing-Off Questionnaire (WOQ-9); (r = -0.43, p < 0.05) [motor (r = -0.35, p < 0.05) and nonmotor subscores (r = -0.43, p < 0.05)]; total nonmotor symptoms (NMS) scores (r = -0.55, p < 0.05); Parkinson's Disease Questionnaire-8 Summary Index (PDQ-8 SI) (r = -0.52, p < 0.05); and the total NADCS (r = -0.35, p < 0.05). Multiple regression analysis identified PDQ-8 SI (β = -0.27, p = 0.005) as the most significant predictor of nocturnal manifestations of PD, followed by the nonmotor subscore of WOQ (β = -0.24, p = 0.006), and the NMS item 20 (feeling light-headed, dizzy, or weak when standing from sitting or lying) (β = -0.22, p = 0.003). Our study found that nocturnal symptoms of PD are very common and we suggest that good clinical practice should include a comprehensive review of nighttime manifestations, particularly for those patients who already experience "wearing-off" symptoms.
    Journal of Neural Transmission 03/2014; · 3.05 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: While nocturnal disturbances of Parkinson's disease (PD) are increasingly recognized as being part of a continuum that includes daytime manifestations, there is still little analysis in the medical literature that assesses these complex phenomena in patients with atypical (AP) and vascular parkinsonisms (VP). The objective of our study was to determine the prevalence of these disturbances in patients with AP and VP and to determine the range of nighttime symptoms that occur compared with those in patients with PD. This comparison was done using a semi-structured interview and self-rated questionnaires in 63 AP and VP patients (PSP 24, MSA 24, CBD 5, and VP 10), and 208 PD patients. 61 AP and VP patients (96.8 %) and 201 PD patients (96.6 %) reported at least one nocturnal symptom with a score of less than 6 on the Modified Parkinson's Disease Sleep Scale (MPDSS). Nocturnal akinesia, as measured on the Nocturnal Akinesia, Dystonia, and Cramp Score, was found to be significantly greater in patients with PSP (p = 0.006), MSA (p = 0.002), and CBD (p = 0.012) than PD patients, but not VP patients (p = 0.428). Like those with PD, patients with AP and VP identified the problem of getting up at night to urinate (MPDSS item 8) as being the most frequent and troublesome nocturnal symptom. MSA and PSP patients reported more frequent (p = 0.001) and troublesome (p < 0.001) urinary incontinence (MPDSS item 9) than PD patients and MSA patients had more severe problems with unexpectedly falling asleep during the day (MPDSS item 15) than PD patients (p = 0.003). In summary, our study determined that nocturnal manifestations are commonly experienced by patients with AP and VP and highlighted specific nocturnal symptoms, which are more prevalent and troublesome in certain AP syndromes. The concept of 24-h control of symptoms should not be limited to only PD and we recommend that all who are involved in the care of AP and VP patients should realize that many nocturnal symptoms are experienced by these patients and a multidisciplinary approach should be utilized to address these problems.
    Journal of Neural Transmission 03/2014; · 3.05 Impact Factor
  • Heinz Reichmann, Roongroj Bhidayasiri
    Journal of Neural Transmission 03/2014; · 3.05 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background: Tremors are common clinical complaints among the elderly and non-specialist physicians frequently are challenged by the need to provide an accurate diagnosis of various tremor syndromes, particularly Parkinson's disease and essential tremor in their busy practices. Objective: We sought to develop an easy-to-use, mobile robust, accurate, and cost-effective instrument that can objectively quantify tremors. Method: The low-cost, 3-dimension, inertial sensors were developed for automated tremor assessment. The main sensor unit consists of a 3-axis accelerometer and a 3-axis gyroscope for the purpose of measuring the tilting angle relative to the gravity, linear acceleration, and angular velocity of the body segments affected by tremors. The transmitter consists of five main modules, including a microcontroller, power management module, sensor module, external memory interface module, and Bluetooth™ communication interface module, which connects to the sensors by a thin wire. The signal processing utilized fast Fourier transform analysis to include RMS angular rate, RMS angle, RMS rate, RMS velocity, peak frequency, peak frequency magnitude, and dispersion of frequency as variables. Result: The prototype was tested with a tremor simulator at programmable angular rates of 2-, 4-, and 8-Hz confirming its accuracy. Twenty subjects (10 PD and 10 age-matched ET patients) participated as part of the experimental verification to perform three tremor tasks, including rest, postural, and kinetic tremor according to the teaching videotape of the motor section of the UPDRS. The mean peak frequency was significantly lower in PD than ET patients at rest on the x- (p < 0.01) and z-axis (p < 0.01). In PD patients, the RMS angular rate, RMS angle, RMS rate, RMS velocity, and peak magnitude were all significantly higher than those values in ET patient at rest while the data was not significantly difference during postural and kinetic actions. ET patients had significantly higher peak frequency during postural action in the y-axis than PD patients (p < 0.05). Conclusion: The study provides the technical development of an accurate, inexpensive, and simple method to measure the kinematics of tremor in humans. Further studies are warranted to confirm the validity of each parameter and the diagnostic accuracy in each tremor syndrome.
    Journal of Parkinson's disease. 03/2014;
  • Clinical neurology and neurosurgery 01/2014; 116:1-3. · 1.30 Impact Factor
  • Onanong Jitkritsadakul, Priya Jagota, Roongroj Bhidayasiri
    [Show abstract] [Hide abstract]
    ABSTRACT: Introduction: Cultural sensitivities tend to limit assessments of sexual dysfunction (SD) in Parkinson's disease (PD). Objective: To assess the validity and reliability of the Thai translation (ASEX-Thai) of the Arizona Sexual Experiences Scale (ASEX). Method: The validity and reliability of ASEX-Thai were assessed with a random sample of 40 PD patients. Back translation and cross-cultural modifications assured content validity. Criterion validity used DSM-IV-TR criteria and receiver operating characteristics (ROC) analysis was calculated for cutoff points plus sensitivity and specificity. Internal consistency was assessed with Cronbach's alpha coefficient. Test-retest reliability was assessed by Pearson's correlation at baseline and at a 2-month follow-up. Result: Criterion validity was conducted with a positive correlation between the clinical diagnosis of SD and DSM-IV-TR (r = 0.601; p < 0.001). The ROC analysis differentiated between SD and non-SD patients (p < 0.001). The cutoff point of ASEX-Thai at ≥16 points effectively screened for SD (sensitivity 96.2%, specificity 92.9%). Reliability was documented with the Cronbach's alpha of all items at baseline and at a 2-month follow-up with values of 0.948 and 0.962 respectively. The Pearson's correlation also showed highly significant test-retest reliability [Item 1 (r = 0.959, p < 0.001), Item 2 (r = 0.914, p < 0.001), Item 3 (r = 0.944, p < 0.001), Item 4 (r = 0.992, p < 0.001), Item 5 (r = 0.930, p < 0.001), and total ASEX-Thai score (r = 0.883, p < 0.001)]. Conclusion: ASEX-Thai is a valid and reliable instrument for the assessment of sexual dysfunction in Thai PD patients.
    Journal of Parkinson's disease. 12/2013;
  • Pattamon Panyakaew, Roongroj Bhidayasiri
    [Show abstract] [Hide abstract]
    ABSTRACT: Patients with early Parkinson's disease (PD) may not complain of gait difficulties but subtle gait abnormalities may be revealed as part of a "preclinical gait syndrome" when they are challenged by dual tasks. 21 early PD patients (n = 21, mean age 63.5 years, H&Y 1.62, disease duration <5 years, mean UPDRS-III 7.7) who did not have gait complaints were as compared to age- and gender-matched healthy controls (n = 21). Memory function was not different between the two groups. Under normal walking conditions, there were no significant differences in gait parameters between the patients and the control group. In both groups, normalized gait velocity decreased in response to dual tasking in a parallel fashion (p < 0.001). Similarly, gait variability increased in both groups with dual tasking although not statistically significant. In PD patients, the performance of an additional task resulted in an increased number of cadences (p = 0.04), a reduction in swing time (p = 0.02) and cycle time (p = 0.04) compared with the control group but there was no significant reduction in normalized velocity. Stride width also increased in the PD patients. The addition of a cognitive task may affect certain aspects of gait and is able to elicit subclinical deficits in early PD patients. In an attempt to maintain velocity, early PD patients develop compensatory mechanisms by increasing cadence and decreasing swing time and cycle time. Increased step width helps support balance, and prevents going beyond the base-of-support which may predispose to unsteadiness and falls. We propose that these findings occur as part of a spectrum of a "preclinical gait syndrome" and longitudinal studies are needed to assess the predictive values of these early markers of gait deficits.
    Journal of Neural Transmission 06/2013; · 3.05 Impact Factor
  • Roongroj Bhidayasiri, Heinz Reichmann
    [Show abstract] [Hide abstract]
    ABSTRACT: As there are no definite diagnostic tests or reliable biomarkers for Parkinson disease (PD), its diagnosis still relies on the presence of a combination of cardinal motor features, along with the exclusion of other causes of Parkinsonism and the presence of some of supportive features. To date, several diagnostic criteria have been developed for different purposes through expert opinions or comprehensive review of the literature. However, none of them are without limitations. In this article, we review different diagnostic criteria for PD which have been published in the English medical literature, highlighting specific limitations and pitfalls. With considerable progress in the understanding of PD, particularly in a view of diverse clinical symptomatology and its evolution, it will be difficult to establish a single criterion that is capable of capturing all cases at different disease stages. Rather, we should aim to develop a set of criteria which include a consensus on clinical gold standard or reliable biomarkers at different levels of diagnostic certainty for different purposes. Despite a more refined set of criteria that may aid in the recognition of PD, the accuracy of its diagnosis still largely depends on the observational skills and clinical sensitivity of the treating physician.
    Journal of Neural Transmission 03/2013; · 3.05 Impact Factor
  • Movement Disorders 02/2013; · 5.63 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The paper proposed a method for tremor assessment of the Archimedean spiral based on spiral analysis in the time-frequency domain. Spiral analysis is a method of analyzing the drawing of Archimedean spiral to quantify motor activity and evaluate the possible movement disorder symptom such as tremor, an involuntary trembling or shaking movements in one or more parts of the body. One of the most common degenerative disorders of the central nervous system that causes the tremor is Parkinson's disease (PD). It is usually a slowly progressing disease which affects the patient with the following symptoms: tremor, rigidity, slowness of movement, and postural instability. Clinical observation is needed to diagnose the tremor, which requires a trained specialist. Thus, an additional method is desirable to help in the diagnosis process and possibly improve the early detection as well as the measurement of disease severity. Many studies have reported that the spiral analysis may be useful in the diagnosis of motor dysfunction in PD and other movement disorder patients. Moreover, the spiral drawing test can easily be performed using a mobile tablet from anywhere not limited to a hospital. We propose a method for classification of spiral drawing based on spiral analysis in the time-frequency domain. The preliminary result of the selected feature in the time-frequency domain shows that this method could potentially be used to distinguish between movement disorder patient and healthy control.
    Southeastcon, 2013 Proceedings of IEEE; 01/2013
  • Movement Disorders 10/2012; 27(12):1495-7. · 5.63 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Benign Adult Familial Myoclonic Epilepsy (BAFME) is an autosomal dominant disorder characterized by adult-onset cortical tremor or action myoclonus predominantly in the upper limbs, and generalized seizures. We investigated a Thai BAFME family. Clinical and electrophysiological studies revealed that 13 were affected with BAFME. There were a total of 24 individuals studied. Genetic analysis by genome-wide linkage study (GWLS) was performed using 400 microsatellite markers and excluded linkage of the previous BAFME loci, 8q23.3-q24.1, and 2p11.1-q12.2. GWLS showed that the disease-associated region in our Thai family was linked to a newly identified locus on chromosome 3q26.32-3q28. This locus represents the fourth chromosomal region for BAFME.European Journal of Human Genetics advance online publication, 20 June 2012; doi:10.1038/ejhg.2012.133.
    European journal of human genetics: EJHG 06/2012; · 3.56 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objective Stable walking is problematical for many Parkinson's disease (PD) patients, sometimes experienced as “Freezing of Gait” (FOG), a brief interruption of their natural walking rhythm usually limited to advanced stages of PD. Visual cues have been found to reduce FOG so that patients are able to continue their walking without interruption, thereby reducing falls. This study assessed the difference in the impact on FOG with a group of PD patients receiving visual cues from an innovative “laser cane” and with a traditional cane with no cues.Methods This study of 30 PD patients compares the impact on FOG of a cane that provided visual cues from a laser beam with a cane providing no cues during both ‘on’ and ‘off’ responses to medications. For each test the individual subjects were videotaped walking two rounds on a 5-meter track and their footsteps were printed on paper tracking sheets.ResultsThe visual cues of the laser beam cane significantly increased both stride length and velocity during the ‘off’ medication period in all of the participating patients. Greater improvements of the gait parameters were experienced in PD patients with the moderate stage (H & Y = 3) (17 patients) than those in the mild stage (H & Y = 2) (13 patients); with the biggest differences in reduced FOG and increased stride length.Conclusions This study demonstrates that an effective, low-cost intervention can be designed and implemented in low and middle-income countries for solving the problem of FOG in PD patients using locally available technology.
    European geriatric medicine 04/2012; 3(2):126–130. · 0.63 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Characterize potential risk factors and the relationship of dopamine agonist (DA) withdrawal syndrome (DAWS), dopamine dysregulation syndrome (DDS), and impulse control disorders (ICDs) in Parkinson's disease (PD). A retrospective chart review categorized cases into three groups: DAWS, DDS, and ICDs. A total of 1,040 subjects met inclusion criteria. There were 332 subjects with a history of tapering DAs and 26 (7.8%) developed DAWS. Fourteen (1.3%) and 89 (8.6%) met the criteria for both DDS and ICD. Subjects with DAWS, DDS, and ICDs had a higher baseline dose of DA, levodopa, and total dopaminergic medication (p < .05), compared to those without the three conditions. DDS was found to be related to the DAWS group (p < .001). When comparing to the PD population without DDS, younger age at onset of PD (p = .027), presence of DAWS (p < .001), ICDs (p = .003), and punding (p = .042) were all correlated with the DDS group, while male sex (p = .045), younger age at onset of PD (p < .001), presence of DAWS (p < .001), and presence of DDS (p = .001) and punding (p < .001) were related to the ICD group. There was a strong relationship between DAWS, DDS, and ICD in this large PD cohort. Dopaminergic therapy in a subset of PD patients was strongly associated with addiction-like behavioral issues.
    The International journal of neuroscience 03/2012; 122(3):145-53. · 0.86 Impact Factor
  • Parkinsonism & Related Disorders 02/2012; 18(5):694-6. · 3.27 Impact Factor

Publication Stats

371 Citations
179.45 Total Impact Points

Institutions

  • 2010–2013
    • King Chulalongkorn Memorial Hospital
      Krung Thep, Bangkok, Thailand
  • 2005–2012
    • Chulalongkorn University
      • • Faculty of Medicine
      • • Department of Medicine
      Bangkok, Bangkok, Thailand
  • 2008
    • Fountain Valley School
      Fountain Valley, California, United States
    • University of California, Los Angeles
      • Department of Neurology
      Los Angeles, California, United States
    • Bangkok Hospital Medical Center
      Krung Thep, Bangkok, Thailand
  • 2007
    • Long Beach Memorial Medical Center
      Long Beach, California, United States
  • 2002–2007
    • Harbor-UCLA Medical Center
      Torrance, California, United States