Objective: Olfactory dysfunction is present in the majority of patients with early-stage Parkinson disease (PD) and can precede the onset of motor symptoms by many years. We performed this study to evaluate whether normosmic patients with PD had different clinical features compared to hyposmic patients. Methods: We analyzed the data of 208 de novo patients with PD (mean age, 65.4 ± 9.7 years; range, 38–85 years; 104 men) who underwent both olfactory function tests and dopamine transporter (DAT) scans. Results: Normosmic patients were significantly younger and had fewer motor deficits than hyposmic patients with PD. Striatal subregional DAT activities were comparable between the 2 groups, but intersubregional gradients were significantly higher in normosmic than hyposmic PD. A general linear model showed that normosmic patients with PD showed significantly fewer motor deficits after controlling the patient9s age, sex, symptom duration, and DAT activity in the posterior putamen (p = 0.016). Levodopa-equivalent dose at approximately 2.5 years follow-up tended to be lower in normosmic than in hyposmic PD (p = 0.055). Conclusions: These results suggest that normosmic PD is a unique clinical phenotype with a more benign course, compared to hyposmic PD. Either less pathologic involvement in the olfactory system or a greater potential for olfactory neurogenesis in normosmic PD may contribute to this benign process compared to hyposmic PD.

We aimed to investigate the prevalence of low back pain (LBP) and its associated agricultural work-related, biomechanical factors among this population. We analyzed initial survey data from the Safety for Agricultural Injury of Farmers cohort study involving adult farmers in Jeju Island. The prevalence of LBP was calculated with associated factors. In total, 1,209 participants were included in the analysis. The overall prevalence of LBP was 23.7%. Significant associations for LBP were the type of farming activity, length of farming career, prior agricultural injury within 1 year, and stress levels. Multivariate logistic regression analysis revealed three biomechanical factors significantly related to LBP: repetitive use of particular body parts; the inappropriate posture of the lower back and neck. Some occupational, and biomechanical risk factors contribute to LBP. Therefore, postural education, injury prevention education, and psychological support will be needed to prevent LBP.

Anxiety, depression, and insomnia are highly prevalent among migraineurs and are associated with negative health consequences. Anxiety and depression, however, unlike insomnia, are usually underdiagnosed, due to less self-reporting of these two conditions. The aim of the present study was to evaluate the risk of anxiety and depression in migraineurs with self-reported insomnia, using a general population-based sample. We used data from a nationwide population-based survey on headache and sleep, the Korean Headache-Sleep Study. Of all 2,695 participants, 143 (5.3%), 268 (10.0%), 116 (4.3%), and 290 (10.8%) were classified as having migraine, anxiety, depression, and self-reported insomnia, respectively. The risk of anxiety (odds ratio [OR] = 7.0, 95% confidence interval [CI] = 3.0–16.7) and depression (OR = 3.3, 95% CI = 1.3–8.5) was significantly increased in migraineurs with self-reported insomnia. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for anxiety in migraineurs with self-reported insomnia were 46.5%, 89.0%, 64.5%, and 79.5%, respectively. For depression, the sensitivity, specificity, PPV, and NPV were 41.7%, 82.4%, 32.3%, and 87.5%, respectively. Self-reported insomnia is likely to be comorbid with anxiety and depression in migraineurs and could thus be a useful predictor of anxiety and depression in migraine.

Summary: Objective: We performed a retrospective, prognostic analysis of a cohort of patients with epilepsy according to time of relapse after four seizure‐free years.Methods: Planned withdrawal of antiepileptic drugs (AEDs) and at least 3 years of follow‐up after AED discontinuation were performed. The following two groups were assessed: (1) an early relapse (ER) group of patients who experienced recurrence during AED withdrawal and (2) a late relapse (LR) group of patients who experienced recurrence after completion of the AED discontinuation process. After dichotomization, the relapse rate, prognostic factors, and their impacts for each group were compared with those of a group of patients who continued to be seizure‐free after AED withdrawal (SF group) using multiple logistic regression analysis. The AED intake mode was also analyzed.Results: Two hundred seventeen (64.6%) of the 336 total patients experienced relapse. One hundred thirty‐nine patients (41.4%) and 78 patients (23.2%) were included in the LR and ER groups, respectively. Symptom duration >120 months showed the strongest negative prognostic impact as demonstrated by the 4.7‐fold higher risk of recurrence in the ER group compared with the SF group. Additional factors with a negative prognostic impact included an age at epilepsy onset of ≤20 years and the presence of localization‐related epilepsy. No reliable predictor between the SF and LR groups was revealed. After exclusion of the SF group, post hoc analysis according to age at epilepsy onset and symptom duration showed that the above‐mentioned negative prognostic factors significantly affected the relapse patterns of the LR and ER groups.Significance: The results suggest that longer symptom duration, which could be associated with intrinsic reactivation of epilepsy, is the strongest negative prognostic factor for relapse. Relapse after AED withdrawal in prolonged follow‐up of seizure‐free patients is one aspect of the natural history of epilepsy.