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HOW THE FREQUENCY OF PAIN IN THE EARLY STAGES OF PARKINSON’S DISEASE AFFECTS THE SPEED OF DIAGNOSIS

Year 2022, Volume: 85 Issue: 2, 155 - 161, 24.03.2022
https://doi.org/10.26650/IUITFD.1019934

Abstract

Objective: The fact that non-motor symptoms such as pain in Parkinson’s disease (PD) are more associated with musculoskeletal diseases (MSD) suggests that there may be delays in diagnosis. The aim of this study was to review the first symptoms of PD, especially pain, while at the same time reviewing the medical specialists to whom patients first went and examining the effects of these parameters on time to diagnosis and treatment. Materials and Methods: Patients with PD were included. The patients were evaluated in terms of clinical features, initial complaints and onset time, presence and type of pain, the medical specialist they first applied to, and time to diagnosis. Results: Eighty-six patients were included (42 female, 44 male). The first complaints were bradykinesia, tremor, tremor and bradykinesia, shoulder pain, tremor and painful cramps. These complaints started 10.1±5.22 years previously, and the diagnosis of PD was made 8.56±4.87 years previously on average. The first specialist departments to which patients with these complaints applied were Neurology (n=34), Physical Therapy and Rehabilitation (n=34), Neurosurgery (n=10), and Orthopedics (n=8). The first admission to Neurology was 8.7±4.85 years previously. Pain complaints started 7.2±6.69 years before the first admission in 56 patients. Musculoskeletal pain was 86%, dystonic pain was 25%, central pain and neuropathic pain were 11% each in the group of patients who had experienced pain. Conclusion: PD can be confused with MSD due to findings such as pain and rigidity, which may cause a delay in diagnosis and treatment. This delay can be prevented if non-neurology specialists are provided with more detailed training about the disease, and if public awareness is raised about the signs and symptoms of PD.

Supporting Institution

Scientific Research Projects Coordination Unit of Istanbul University.

Project Number

37697

References

  • 1. Chaudhuri KR, Schrag A, Weintraub D, Rizos A, Rodriguez- Blazquez C, Mamikonyan E, et al. The movement disorder society nonmotor rating scale: Initial validation study. Mov Disord 2020;35(1):116-33. [CrossRef]
  • 2. Rodriguez-Blazquez C, Schrag A, Rizos A, Chaudhuri KR, Martinez-Martin P, Weintraub D. Prevalence of non-motor symptoms and non-motor fluctuations in Parkinson’s disease using the MDS-NMS. Mov Disord Clin Pract 2021;8(2):231-9. [CrossRef]
  • 3. DeMaagd G, Philip A. Parkinson’s disease and its management: part 1: disease entity, risk factors, pathophysiology, clinical presentation, and diagnosis. P T 2015;40(8):504-32. ,
  • 4. Dotchin CL, Paddick SM, Longdon AR, Kisoli A, Gray WK, Dewhurst F, et al. A comparison of caregiver burden in older persons and persons with Parkinson’s disease or dementia in sub-Saharan Africa. Int Psychogeriatr 2014;26(4):687-92. [CrossRef]
  • 5. Jankovic J, McDermott M, Carter J, Gauthier S, Goetz C, Golbe L, et al. Variable expression of Parkinson’s disease: a base-line analysis of the DATATOP cohort. The Parkinson Study Group. Neurology 1990;40(10):1529-34. [CrossRef]
  • 6. Schrag A, Ben-Shlomo Y, Quinn N. How valid is the clinical diagnosis of Parkinson’s disease in the community? J Neurol Neurosurg Psychiatry 2002;73(5):529-34. [CrossRef]
  • 7. Hughes AJ, Daniel SE, Kilford L, Lees AJ. Accuracy of clinical diagnosis of idiopathic Parkinson’s disease: a clinico-pathological study of 100 cases. J Neurol Neurosurg Psychiatry 1992;55(3):181-4. [CrossRef]
  • 8. Ford B. Pain in Parkinson’s disease. Mov Disord 2010;25 (Suppl 1):S98-103. [CrossRef]
  • 9. Postuma RB, Berg D, Stern M, Poewe W, Olanow CW, Oertel W, et al. MDS clinical diagnostic criteria for Parkinson’s disease. Mov Disord 2015;30(12):1591-601. [CrossRef]
  • 10. Postuma RB, Berg D. Advances in markers of prodromal Parkinson disease. Nat Rev Neurol 2016;12(11):622-34. [CrossRef] 11. Kalia LV, Lang AE. Parkinson’s disease. Lancet 2015;386(9996):896-912. [CrossRef]
  • 12. Berg D, Postuma RB, Adler CH, Bloem BR, Chan P, Dubois B, et al. MDS research criteria for prodromal Parkinson’s disease. Mov Disord 2015;30(12):1600-11. [CrossRef]
  • 13. Pont-Sunyer C, Hotter A, Gaig C, Seppi K, Compta Y, Katzenschlager R, et al. The onset of nonmotor symptoms in Parkinson’s disease (the ONSET PD study). Mov Disord 2015;30(2):229-37. [CrossRef]
  • 14. O’Sullivan SS, Williams DR, Gallagher DA, Massey LA, Silveira-Moriyama L, Lees AJ. Nonmotor symptoms as presenting complaints in Parkinson’s disease: a clinicopathological study. Mov Disord 2008;23(1):101-6. [CrossRef]
  • 15. Hawkes CH, Del Tredici K, Braak H. A timeline for Parkinson’s disease. Parkinsonism Relat Disord 2010;16(2):79-84. [CrossRef]
  • 16. Barone P, Antonini A, Colosimo C, Marconi R, Morgante L, Avarello TP, et al. The PRIAMO study: A multicenter assessment of nonmotor symptoms and their impact on quality of life in Parkinson’s disease. Mov Disord 2009;24(11):1641-9. [CrossRef]
  • 17. Buhmann C, Wrobel N, Grashorn W, Fruendt O, Wesemann K, Diedrich S, et al. Pain in Parkinson disease: a crosssectional survey of its prevalence, specifics, and therapy. J Neurol 2017;264(4):758-69. [CrossRef]
  • 18. Tolosa E, Compta Y, Gaig C. The premotor phase of Parkinson’s disease. Parkinsonism Relat Disord 2007;13 (Suppl):S2-7. [CrossRef]
  • 19. Valkovic P, Minar M, Singliarova H, Harsany J, Hanakova M, Martinkova J, et al. Pain in Parkinson’s disease: a cross-sectional study of its prevalence, types, and relationship to depression and quality of life. PLoS One 2015;10(8):e0136541. [CrossRef]
  • 20. Lee MA, Walker RW, Hildreth TJ, Prentice WM. A survey of pain in idiopathic Parkinson’s disease. J Pain Symptom Manage 2006;32(5):462-9. [CrossRef]
  • 21. Negre-Pages L, Regragui W, Bouhassira D, Grandjean H, Rascol O, DoPaMi PSG. Chronic pain in Parkinson’s disease: the cross-sectional French DoPaMiP survey. Mov Disord 2008;23(10):1361-9. [CrossRef]
  • 22. Ford B. Pain in Parkinson’s disease. Clin Neurosci 1998;5(2):63-72.
  • 23. Defazio G, Berardelli A, Fabbrini G, Martino D, Fincati E, Fiaschi A, et al. Pain as a nonmotor symptom of Parkinson disease: evidence from a case-control study. Arch Neurol 2008;65(9):1191-4. [CrossRef]
  • 24. Beiske AG, Loge JH, Ronningen A, Svensson E. Pain in Parkinson’s disease: Prevalence and characteristics. Pain 2009;141(1-2):173-7. [CrossRef]
  • 25. Silverdale MA, Kobylecki C, Kass-Iliyya L, Martinez-Martin P, Lawton M, Cotterill S, et al. A detailed clinical study of pain in 1957 participants with early/moderate Parkinson’s disease. Parkinsonism Relat Disord 2018;56:27-32. [CrossRef]
  • 26. Tueth LE, Duncan RP. Musculoskeletal pain in Parkinson disease: a narrative review. Neurodegener Dis Manag 2021;11(5):373-85. [CrossRef]
  • 27. Bonenfant D, Rompre PH, Rei N, Jodoin N, Soland VL, Rey V, et al. Characterization of Burning Mouth syndrome in patients with Parkinson’s disease. J Oral Facial Pain Headache 2016;30(4):318-22. [CrossRef]
  • 28. Blanchet PJ, Brefel-Courbon C. Chronic pain and pain processing in Parkinson’s disease. Prog Neuropsychopharmacol Biol Psychiatry 2018;87(Pt B):200-6. [CrossRef]
  • 29. Hanagasi HA, Akat S, Gurvit H, Yazici J, Emre M. Pain is common in Parkinson’s disease. Clin Neurol Neurosurg 2011;113(1):11-3. [CrossRef]
  • 30. Kim YE, Lee WW, Yun JY, Yang HJ, Kim HJ, Jeon BS. Musculoskeletal problems in Parkinson’s disease: neglected issues. Parkinsonism Relat Disord 2013;19(7):666- 9. [CrossRef]
  • 31. Riley D, Lang AE, Blair RD, Birnbaum A, Reid B. Frozen shoulder and other shoulder disturbances in Parkinson’s disease. J Neurol Neurosurg Psychiatry 1989;52(1):63-6. [CrossRef]
  • 32. Madden MB, Hall DA. Shoulder pain in Parkinson’s disease: a case-control study. Mov Disord 2010;25(8):1105-6. [CrossRef]
  • 33. Yucel A, Kusbeci OY. Magnetic resonance imaging findings of shoulders in Parkinson’s disease. Mov Disord 2010;25(15):2524-30. [CrossRef]
  • 34. Broetz D, Eichner M, Gasser T, Weller M, Steinbach JP. Radicular and nonradicular back pain in Parkinson’s disease: a controlled study. Mov Disord 2007;22(6):853-6. [CrossRef]
  • 35. Etchepare F, Rozenberg S, Mirault T, Bonnet AM, Lecorre C, Agid Y, et al. Back problems in Parkinson’s disease: an underestimated problem. Joint Bone Spine 2006;73(3):298- 302. [CrossRef]
  • 36. Scott B, Borgman A, Engler H, Johnels B, Aquilonius SM. Gender differences in Parkinson’s disease symptom profile. Acta Neurol Scand 2000;102(1):37-43. [CrossRef]
  • 37. Rugbjerg K, Friis S, Jorgensen TL, Ritz B, Korbo L, Olsen JH. Risk for Parkinson’s disease among patients with osteoarthritis: a Danish cohort study. Mov Disord 2010;25(14):2355-60. [CrossRef]
  • 38. Stamey W, Davidson A, Jankovic J. Shoulder pain: a presenting symptom of Parkinson disease. J Clin Rheumatol 2008;14(4):253-4. [CrossRef]
  • 39. Hughes AJ, Daniel SE, Lees AJ. Improved accuracy of clinical diagnosis of Lewy body Parkinson’s disease. Neurology 2001;57(8):1497-9. [CrossRef]
  • 40. Hughes AJ, Daniel SE, Ben-Shlomo Y, Lees AJ. The accuracy of diagnosis of parkinsonian syndromes in a specialist movement disorder service. Brain 2002;125(Pt 4):861-70. [CrossRef]

PARKİNSON HASTALIĞI BAŞLANGICINDA GÖRÜLEN AĞRI SIKLIĞI VE TANI SÜRESİNE ETKİSİ

Year 2022, Volume: 85 Issue: 2, 155 - 161, 24.03.2022
https://doi.org/10.26650/IUITFD.1019934

Abstract

Amaç: Parkinson hastalığında (PH) ağrı gibi non-motor bulguların kas-iskelet sistemi hastalıkları ile daha çok ilişkilendirilmesi tanıda gecikmeler yaşanabileceğini düşündürmektedir. Bu çalışmada PH’de ağrı başta olmak üzere ilk semptomların ve başvurulan branşların gözden geçirilmesi ve bu başvuruların tanı ve tedavi süresine etkisini incelemek amaçlanmıştır. Gereç ve Yöntem: Çalışmaya PH tanılı hastalar dahil edildi. Hastalar klinik özellikleri, ilk yakınmaları ve yakınma başlangıç zamanı, ağrı yakınmasının varlığı ve tipi, ilk başvurdukları branş ve tanı süreleri yönünden değerlendirildi. Bulgular: Çalışmaya 86 hasta dahil edildi (42’si kadın, 44’ü erkek). İlk yakınma hareketlerde yavaşlık, tremor, tremor ve hareketlerde yavaşlık, omuz ağrısı, tremor ve ağrılı kasılma idi. Hastaların ilk yakınmaları 10,1±5,22 yıl önce başlamıştı, PH tanısı ise ortalama 8,56±4,87 yıl önce konmuştu. Yakınmaları nedeniyle ilk başvurulan branş 34 hastada Nöroloji, 34 hastada Fizik Tedavi ve Rehabilitasyon, 10 hastada Beyin ve Sinir Cerrahisi, 8 hastada Ortopedi idi. Nörolojiye ilk başvuru 8,7±4,85 yıl önce idi. Elli altı hastada ilk başvurudan 7,2±6,69 yıl önce ağrı yakınması başlamıştı. Ağrılı hasta grubunda kas-iskelet ağrısı %86, distonik ağrı %25, santral ağrı ve nöropatik ağrının her biri %11 oranındaydı. Sonuç: Parkinson hastalığı ağrı ve katılık gibi bulgular nedeniyle kas-iskelet sistemi hastalıkları ile karışabilmekte, bu durum tanı ve tedavi süresinin gecikmesine neden olabilmektedir. Nöroloji dışı branşlara hastalık hakkında daha detaylı eğitim verilmesi, halkın hastalık bulguları konusunda bilinçlenmesi bu gecikmenin önüne geçebilir.

Project Number

37697

References

  • 1. Chaudhuri KR, Schrag A, Weintraub D, Rizos A, Rodriguez- Blazquez C, Mamikonyan E, et al. The movement disorder society nonmotor rating scale: Initial validation study. Mov Disord 2020;35(1):116-33. [CrossRef]
  • 2. Rodriguez-Blazquez C, Schrag A, Rizos A, Chaudhuri KR, Martinez-Martin P, Weintraub D. Prevalence of non-motor symptoms and non-motor fluctuations in Parkinson’s disease using the MDS-NMS. Mov Disord Clin Pract 2021;8(2):231-9. [CrossRef]
  • 3. DeMaagd G, Philip A. Parkinson’s disease and its management: part 1: disease entity, risk factors, pathophysiology, clinical presentation, and diagnosis. P T 2015;40(8):504-32. ,
  • 4. Dotchin CL, Paddick SM, Longdon AR, Kisoli A, Gray WK, Dewhurst F, et al. A comparison of caregiver burden in older persons and persons with Parkinson’s disease or dementia in sub-Saharan Africa. Int Psychogeriatr 2014;26(4):687-92. [CrossRef]
  • 5. Jankovic J, McDermott M, Carter J, Gauthier S, Goetz C, Golbe L, et al. Variable expression of Parkinson’s disease: a base-line analysis of the DATATOP cohort. The Parkinson Study Group. Neurology 1990;40(10):1529-34. [CrossRef]
  • 6. Schrag A, Ben-Shlomo Y, Quinn N. How valid is the clinical diagnosis of Parkinson’s disease in the community? J Neurol Neurosurg Psychiatry 2002;73(5):529-34. [CrossRef]
  • 7. Hughes AJ, Daniel SE, Kilford L, Lees AJ. Accuracy of clinical diagnosis of idiopathic Parkinson’s disease: a clinico-pathological study of 100 cases. J Neurol Neurosurg Psychiatry 1992;55(3):181-4. [CrossRef]
  • 8. Ford B. Pain in Parkinson’s disease. Mov Disord 2010;25 (Suppl 1):S98-103. [CrossRef]
  • 9. Postuma RB, Berg D, Stern M, Poewe W, Olanow CW, Oertel W, et al. MDS clinical diagnostic criteria for Parkinson’s disease. Mov Disord 2015;30(12):1591-601. [CrossRef]
  • 10. Postuma RB, Berg D. Advances in markers of prodromal Parkinson disease. Nat Rev Neurol 2016;12(11):622-34. [CrossRef] 11. Kalia LV, Lang AE. Parkinson’s disease. Lancet 2015;386(9996):896-912. [CrossRef]
  • 12. Berg D, Postuma RB, Adler CH, Bloem BR, Chan P, Dubois B, et al. MDS research criteria for prodromal Parkinson’s disease. Mov Disord 2015;30(12):1600-11. [CrossRef]
  • 13. Pont-Sunyer C, Hotter A, Gaig C, Seppi K, Compta Y, Katzenschlager R, et al. The onset of nonmotor symptoms in Parkinson’s disease (the ONSET PD study). Mov Disord 2015;30(2):229-37. [CrossRef]
  • 14. O’Sullivan SS, Williams DR, Gallagher DA, Massey LA, Silveira-Moriyama L, Lees AJ. Nonmotor symptoms as presenting complaints in Parkinson’s disease: a clinicopathological study. Mov Disord 2008;23(1):101-6. [CrossRef]
  • 15. Hawkes CH, Del Tredici K, Braak H. A timeline for Parkinson’s disease. Parkinsonism Relat Disord 2010;16(2):79-84. [CrossRef]
  • 16. Barone P, Antonini A, Colosimo C, Marconi R, Morgante L, Avarello TP, et al. The PRIAMO study: A multicenter assessment of nonmotor symptoms and their impact on quality of life in Parkinson’s disease. Mov Disord 2009;24(11):1641-9. [CrossRef]
  • 17. Buhmann C, Wrobel N, Grashorn W, Fruendt O, Wesemann K, Diedrich S, et al. Pain in Parkinson disease: a crosssectional survey of its prevalence, specifics, and therapy. J Neurol 2017;264(4):758-69. [CrossRef]
  • 18. Tolosa E, Compta Y, Gaig C. The premotor phase of Parkinson’s disease. Parkinsonism Relat Disord 2007;13 (Suppl):S2-7. [CrossRef]
  • 19. Valkovic P, Minar M, Singliarova H, Harsany J, Hanakova M, Martinkova J, et al. Pain in Parkinson’s disease: a cross-sectional study of its prevalence, types, and relationship to depression and quality of life. PLoS One 2015;10(8):e0136541. [CrossRef]
  • 20. Lee MA, Walker RW, Hildreth TJ, Prentice WM. A survey of pain in idiopathic Parkinson’s disease. J Pain Symptom Manage 2006;32(5):462-9. [CrossRef]
  • 21. Negre-Pages L, Regragui W, Bouhassira D, Grandjean H, Rascol O, DoPaMi PSG. Chronic pain in Parkinson’s disease: the cross-sectional French DoPaMiP survey. Mov Disord 2008;23(10):1361-9. [CrossRef]
  • 22. Ford B. Pain in Parkinson’s disease. Clin Neurosci 1998;5(2):63-72.
  • 23. Defazio G, Berardelli A, Fabbrini G, Martino D, Fincati E, Fiaschi A, et al. Pain as a nonmotor symptom of Parkinson disease: evidence from a case-control study. Arch Neurol 2008;65(9):1191-4. [CrossRef]
  • 24. Beiske AG, Loge JH, Ronningen A, Svensson E. Pain in Parkinson’s disease: Prevalence and characteristics. Pain 2009;141(1-2):173-7. [CrossRef]
  • 25. Silverdale MA, Kobylecki C, Kass-Iliyya L, Martinez-Martin P, Lawton M, Cotterill S, et al. A detailed clinical study of pain in 1957 participants with early/moderate Parkinson’s disease. Parkinsonism Relat Disord 2018;56:27-32. [CrossRef]
  • 26. Tueth LE, Duncan RP. Musculoskeletal pain in Parkinson disease: a narrative review. Neurodegener Dis Manag 2021;11(5):373-85. [CrossRef]
  • 27. Bonenfant D, Rompre PH, Rei N, Jodoin N, Soland VL, Rey V, et al. Characterization of Burning Mouth syndrome in patients with Parkinson’s disease. J Oral Facial Pain Headache 2016;30(4):318-22. [CrossRef]
  • 28. Blanchet PJ, Brefel-Courbon C. Chronic pain and pain processing in Parkinson’s disease. Prog Neuropsychopharmacol Biol Psychiatry 2018;87(Pt B):200-6. [CrossRef]
  • 29. Hanagasi HA, Akat S, Gurvit H, Yazici J, Emre M. Pain is common in Parkinson’s disease. Clin Neurol Neurosurg 2011;113(1):11-3. [CrossRef]
  • 30. Kim YE, Lee WW, Yun JY, Yang HJ, Kim HJ, Jeon BS. Musculoskeletal problems in Parkinson’s disease: neglected issues. Parkinsonism Relat Disord 2013;19(7):666- 9. [CrossRef]
  • 31. Riley D, Lang AE, Blair RD, Birnbaum A, Reid B. Frozen shoulder and other shoulder disturbances in Parkinson’s disease. J Neurol Neurosurg Psychiatry 1989;52(1):63-6. [CrossRef]
  • 32. Madden MB, Hall DA. Shoulder pain in Parkinson’s disease: a case-control study. Mov Disord 2010;25(8):1105-6. [CrossRef]
  • 33. Yucel A, Kusbeci OY. Magnetic resonance imaging findings of shoulders in Parkinson’s disease. Mov Disord 2010;25(15):2524-30. [CrossRef]
  • 34. Broetz D, Eichner M, Gasser T, Weller M, Steinbach JP. Radicular and nonradicular back pain in Parkinson’s disease: a controlled study. Mov Disord 2007;22(6):853-6. [CrossRef]
  • 35. Etchepare F, Rozenberg S, Mirault T, Bonnet AM, Lecorre C, Agid Y, et al. Back problems in Parkinson’s disease: an underestimated problem. Joint Bone Spine 2006;73(3):298- 302. [CrossRef]
  • 36. Scott B, Borgman A, Engler H, Johnels B, Aquilonius SM. Gender differences in Parkinson’s disease symptom profile. Acta Neurol Scand 2000;102(1):37-43. [CrossRef]
  • 37. Rugbjerg K, Friis S, Jorgensen TL, Ritz B, Korbo L, Olsen JH. Risk for Parkinson’s disease among patients with osteoarthritis: a Danish cohort study. Mov Disord 2010;25(14):2355-60. [CrossRef]
  • 38. Stamey W, Davidson A, Jankovic J. Shoulder pain: a presenting symptom of Parkinson disease. J Clin Rheumatol 2008;14(4):253-4. [CrossRef]
  • 39. Hughes AJ, Daniel SE, Lees AJ. Improved accuracy of clinical diagnosis of Lewy body Parkinson’s disease. Neurology 2001;57(8):1497-9. [CrossRef]
  • 40. Hughes AJ, Daniel SE, Ben-Shlomo Y, Lees AJ. The accuracy of diagnosis of parkinsonian syndromes in a specialist movement disorder service. Brain 2002;125(Pt 4):861-70. [CrossRef]
There are 39 citations in total.

Details

Primary Language English
Subjects Health Care Administration
Journal Section RESEARCH
Authors

Bedia Samancı 0000-0003-0667-2329

Fatma Nazlı Durmaz Çelik 0000-0002-2943-2240

Başar Bilgiç 0000-0001-6032-0856

Serhat Özkan 0000-0002-5874-5270

Haşmet Hanağası 0000-0002-4624-4428

Project Number 37697
Publication Date March 24, 2022
Submission Date November 6, 2021
Published in Issue Year 2022 Volume: 85 Issue: 2

Cite

APA Samancı, B., Durmaz Çelik, F. N., Bilgiç, B., Özkan, S., et al. (2022). HOW THE FREQUENCY OF PAIN IN THE EARLY STAGES OF PARKINSON’S DISEASE AFFECTS THE SPEED OF DIAGNOSIS. Journal of Istanbul Faculty of Medicine, 85(2), 155-161. https://doi.org/10.26650/IUITFD.1019934
AMA Samancı B, Durmaz Çelik FN, Bilgiç B, Özkan S, Hanağası H. HOW THE FREQUENCY OF PAIN IN THE EARLY STAGES OF PARKINSON’S DISEASE AFFECTS THE SPEED OF DIAGNOSIS. İst Tıp Fak Derg. March 2022;85(2):155-161. doi:10.26650/IUITFD.1019934
Chicago Samancı, Bedia, Fatma Nazlı Durmaz Çelik, Başar Bilgiç, Serhat Özkan, and Haşmet Hanağası. “HOW THE FREQUENCY OF PAIN IN THE EARLY STAGES OF PARKINSON’S DISEASE AFFECTS THE SPEED OF DIAGNOSIS”. Journal of Istanbul Faculty of Medicine 85, no. 2 (March 2022): 155-61. https://doi.org/10.26650/IUITFD.1019934.
EndNote Samancı B, Durmaz Çelik FN, Bilgiç B, Özkan S, Hanağası H (March 1, 2022) HOW THE FREQUENCY OF PAIN IN THE EARLY STAGES OF PARKINSON’S DISEASE AFFECTS THE SPEED OF DIAGNOSIS. Journal of Istanbul Faculty of Medicine 85 2 155–161.
IEEE B. Samancı, F. N. Durmaz Çelik, B. Bilgiç, S. Özkan, and H. Hanağası, “HOW THE FREQUENCY OF PAIN IN THE EARLY STAGES OF PARKINSON’S DISEASE AFFECTS THE SPEED OF DIAGNOSIS”, İst Tıp Fak Derg, vol. 85, no. 2, pp. 155–161, 2022, doi: 10.26650/IUITFD.1019934.
ISNAD Samancı, Bedia et al. “HOW THE FREQUENCY OF PAIN IN THE EARLY STAGES OF PARKINSON’S DISEASE AFFECTS THE SPEED OF DIAGNOSIS”. Journal of Istanbul Faculty of Medicine 85/2 (March 2022), 155-161. https://doi.org/10.26650/IUITFD.1019934.
JAMA Samancı B, Durmaz Çelik FN, Bilgiç B, Özkan S, Hanağası H. HOW THE FREQUENCY OF PAIN IN THE EARLY STAGES OF PARKINSON’S DISEASE AFFECTS THE SPEED OF DIAGNOSIS. İst Tıp Fak Derg. 2022;85:155–161.
MLA Samancı, Bedia et al. “HOW THE FREQUENCY OF PAIN IN THE EARLY STAGES OF PARKINSON’S DISEASE AFFECTS THE SPEED OF DIAGNOSIS”. Journal of Istanbul Faculty of Medicine, vol. 85, no. 2, 2022, pp. 155-61, doi:10.26650/IUITFD.1019934.
Vancouver Samancı B, Durmaz Çelik FN, Bilgiç B, Özkan S, Hanağası H. HOW THE FREQUENCY OF PAIN IN THE EARLY STAGES OF PARKINSON’S DISEASE AFFECTS THE SPEED OF DIAGNOSIS. İst Tıp Fak Derg. 2022;85(2):155-61.

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