Incidence of Parkinson's disease in Norway: the Norwegian ParkWest study

OBJECTIVE

To present the incidence of Parkinson's disease (PD) in Norway and to explore gender influences on incidence and age at onset, as well as severity and pattern of parkinsonism at the time of diagnosis in a representative drug naïve cohort with newly diagnosed PD.

METHODS

In four Norwegian counties comprising a base population of 1 052 075 inhabitants, multiple sources of case ascertainment and a four step diagnostic procedure were used to establish a representative cohort of patients with incident PD at a high level of diagnostic accuracy. Of a total of 604 subjects referred to the study, 265 individuals fulfilled the clinical research criteria of PD at their latest clinical visit, at a mean 28 months after identification.

RESULTS

The incidence of PD in the study area, age standardised to the 1991 European standard population, was 12.6/10(5yr-1) (95% CI 11.1 to 14.2). The overall age standardised male to female ratio was 1.58 (95% CI 1.22 to 2.06), with a consistent male preponderance throughout all age groups. Clinical onset of PD was later in women than in men (68.6 vs 66.3 years; p = 0.062) whereas severity and pattern of parkinsonism in drug naïve patients was not different between genders at the time of diagnosis.

CONCLUSION

Incidence rates of PD in Norway are similar to those in other Western European and American countries. Female gender was associated with a considerably lower risk of PD and slightly delayed motor onset but had no impact on severity of parkinsonism or clinical phenotype in incident drug naïve PD, suggesting that the female gender influences on the nigrostriatal system are most pronounced in the preclinical phase of the disease.

Carbamazepine therapy in restless legs. Discrimination between responders and non-responders

One hundred and seventy-four patients suffering from restless legs were included in a double-blind trial. Eighty-four patients were treated with carbamazepine (CBZ) and 90 with placebo. Discrimination analysis was carried out in order to characterize the patients who did not benefit from the treatment. Patients treated with CBZ were divided into responders and non-responders. A discriminant function classified 15 out of 19 actual non-responders as non-responders and 60 out of 65 actual responders as responders. By using the "leaving-one-out" technique, 14 of the non-responders and 57 of the responders were still correctly classified. The probability of erroneously classifying a patient increased from about 10 to 15% by this correction. The discriminant function classified approximately 80% of the patients in the placebo group as responders to CBZ.

Ropinirole in the treatment of restless legs syndrome: results from the TREAT RLS 1 study, a 12 week, randomised, placebo controlled study in 10 European countries

OBJECTIVE

To assess the efficacy, safety, and tolerability of ropinirole in the treatment of patients with restless legs syndrome.

METHODS

A 12 week, prospective, double blind, randomised comparison involving 284 patients from 10 European countries. All participants had a score of > or =15 on the international restless legs scale (IRLS). Patients were randomised (1:1) to receive either ropinirole 0.25-4.0 mg once daily or placebo. The primary efficacy end point was mean change from baseline to week 12 in total IRLS score. Global improvements (clinical global impression (CGI) scale) and improvements in sleep, health related quality of life (QoL; using generic and disease specific measures), work, and other activities were also assessed.

RESULTS

112/146 patients (76.7%) taking ropinirole and 109/138 (79.0%) taking placebo completed the study. Improvement in IRLS at week 12 with ropinirole (mean (SD) dose, 1.90 (1.13) mg/day) was greater than with placebo (mean (SE): -11.04 (0.719) v -8.03 (0.738) points; adjusted difference = -3.01 (95% confidence interval (CI), -5.03 to -0.99); p = 0.0036). More patients in the ropinirole group (53.4%) showed improvement on the CGI scale at week 12 than in the placebo group (40.9%; adjusted odds ratio = 1.7 (1.02 to 2.69); p = 0.0416). Significant differences on both IRLS and CGI scales favouring ropinirole were apparent by week 1. Ropinirole was also associated with significantly greater improvements in sleep and QoL end points. The most common adverse events were nausea and headache.

CONCLUSIONS

Ropinirole improves restless legs syndrome compared with placebo, with benefits apparent by week 1. It is generally well tolerated.

A group-based training programme for general practitioners: a Norwegian experience

There are approximately 3000 general practitioners in Norway, serving a population of slightly above four million people. A three year postgraduate education scheme for general practitioners has been in effect since 1973, to be replaced by a five year vocational training programme from January 1985, making general practice a fully recognized specialty from that date. The educational requirements consist of one year of hospital training, four years of training in general practice, and a total of 400 hours of course education, mainly in clinical subjects. The core element of the training is attendance at a group-based structured educational programme of two years' duration. This article describes the concepts and content of this decentralized group-based education, as well as some of the conflicting considerations which eventually led to this new Norwegian model of general practice training. The first evaluation studies indicate that the educational programme has met a long standing need among general practitioners.

Treatment of the restless legs syndrome with carbamazepine: a double blind study

One hundred and seventy four patients suffering from the restless legs syndrome were examined in a double blind, between patient, placebo controlled study in general practice for five weeks to investigate the effects of carbamazepine and placebo on the syndrome. The syndrome was more common among middle aged women with relatively low systolic blood pressure. The median haemoglobin concentration was about average for the population, but the severity of the symptoms seemed to increase with decreasing concentrations of haemoglobin. Both placebo and carbamazepine showed a significant therapeutic effect (p less than 0.01). Carbamazepine was significantly more effective than placebo (p less than or equal to 0.03). The significant therapeutic effect of placebo in restless legs showed that only double blind controlled trials can confirm the efficacy of suggested treatments.