West Africa Journal of Medicine

A Short Review of Migraine headaches in Nigeria: Epidemiology, Current Challenges, Treatment Approaches, and Future Directions for Improved Management

Ayokunle Osonuga — 2025-09-20

Background and objective: Migraine, a leading cause of global disability, disproportionately burdens low-resource countries like Nigeria, where healthcare inequities, cultural stigma, and infrastructural gaps hinder effective management. Despite global advances in migraine therapeutics, Nigeria's burden remains understudied, with fragmented data on epidemiology, treatment access, and outcomes.

Methods: We conducted a narrative review of the literature on migraines in Nigeria using sources such as PubMed, MEDLINE, African Journals Online (AJOL), and Embase. This review synthesizes a broad range of peer-reviewed articles, regional reports, and gray literature to provide an interpretative overview of the topic.

Results: Available evidence suggests that migraine prevalence in Nigeria is estimated at 15-20%, with urban areas reporting rates as high as 26% and a pronounced gender disparity (3:1 female-to-male ratio). Rural regions experience significant underreporting, often attributed to cultural interpretations of migraine symptoms as spiritual phenomena. Most patients rely on over-the-counter analgesics, with 30% developing medication-overuse headaches. Advanced therapies such as triptans and CGRP inhibitors are largely inaccessible due to prohibitive costs.

Conclusion: Nigeria's approach to migraine care lags significantly behind global standards, underscoring the need for context-specific innovations. Priority areas include the expansion of telemedicine to overcome specialist shortages, incentives for local medication production, and the integration of traditional healers into formal referral networks. Policy reforms and collaborative efforts among stakeholders are essential to align Nigeria's migraine management with evidence-based practices, ultimately reducing the burden on individuals and the economy.

EDITORIAL Addressing the Silent Strain: Unmasking Post-COVID Neurologic Complications in Resource-Limited Settings

Gregory E. Erhabor — 2025-09-20

Welcome to this edition of the journal, where we continue our mission of showcasing high-quality, context-relevant research. With growing interest in evidence-based, locally driven healthcare solutions, WAJM remains committed to amplifying scientific voices from the region. We invite clinicians, researchers, and policymakers to engage with the insights presented here, as we collectively work toward improved health outcomes. This issue presents a diverse collection of original studies, ranging from innovative diagnostic tools and therapeutic trials to the exploration of under-recognized conditions.

Among the diverse collection of articles spanning various medical disciplines, Nwosu et al. highlight the feasibility of diagnosing obstructive sleep apnoea using the WatchPAT® portable monitor-a promising tool in resource-limited settings. However, their findings also underscore the persistent barrier of limited treatment access due to cost constraints. Udoette et al. confirmed the high diagnostic accuracy of the Xpert MTB/RIF assay for pulmonary tuberculosis, including detection of drug resistance. Meanwhile, Olalusi et al. explored the safety and potential efficacy of Peko-D forte, a plant-based formulation, as add-on therapy for Parkinson’s disease in a small, placebo-controlled trial. Collectively, these studies underscore the promise of context-appropriate diagnostic and therapeutic innovations. We also welcome the World Kidney Day editorial by Vassalotti et al. and the World Kidney Day joint steering committee. Their contribution is apt and addresses several critical issues related to the prevention and early detection of kidney disease.

As the world moves into a new phase of the COVID-19 pandemic, the focus is gradually shifting from acute disease management to the long-term sequelae affecting survivors. Among these, post-COVID neurologic complications are emerging as a significant public health concern. In this context, the study by Akase et al. provides a timely and critical exploration of a largely underreported issue in the Nigerian population: the burden of persistent neurological symptoms following SARS-CoV-2 infection. The COVID-19 pandemic initially gained global attention due to its respiratory manifestations. However, as the pandemic progressed, it became evident that the virus has significant effects beyond the lungs, particularly on the nervous system. ^{1, 2}

Post-COVID neurologic complications-often grouped under the umbrella of “long COVID” or “post-acute sequelae of SARS-CoV-2 infection (PASC)”—have emerged as a major health concern. These complications can affect individuals regardless of the severity of their initial illness, and they encompass a wide spectrum of symptoms and disorders involving both the central and peripheral nervous systems.^1-4 Among the most commonly reported neurologic symptoms are persistent headaches, dizziness, and brain fog-a colloquial term describing cognitive impairment, difficulty concentrating, memory issues, and slowed thinking. These symptoms may be mild in some individuals but significantly debilitating in others, affecting daily functioning and quality of life. Fatigue, which often has a neurocognitive component, is also a hallmark of post-COVID syndrome and may persist for weeks or months. Neurological complications can also include more serious disorders. Some patients have developed new-onset seizures, strokes, and transient ischemic attacks (TIAs). Other central nervous system manifestations include encephalopathy, encephalitis, and demyelinating disorders such as acute disseminated encephalomyelitis (ADEM). ^3-5

The peripheral nervous system is not spared. Cases of Guillain-Barré syndrome (GBS), a post-infectious autoimmune polyneuropathy, have been reported following COVID-19 infection.^5-6 Other peripheral neuropathies, including small fiber neuropathy and dysautonomia—characterized by symptoms such as orthostatic intolerance, palpitations, and abnormal sweating—are increasingly recognized. Anosmia (loss of smell) and ageusia (loss of taste), which were prominent early symptoms of acute COVID-19, have also been observed to persist in some individuals, sometimes lasting for many months. ^4,5

The pathophysiology underlying these neurologic sequelae is multifactorial. It involves direct viral invasion of the nervous system, immune-mediated damage, systemic inflammation, microvascular injury, and a possible reactivation of latent neurotropic viruses. Additionally, prolonged ICU stays, mechanical ventilation, and sedative use in severely ill patients may contribute to post-intensive care syndrome (PICS), which includes cognitive and psychiatric symptoms.^3-5

Mental health implications are also part of the broader neurologic picture. Anxiety, depression, post-traumatic stress disorder (PTSD), and sleep disturbances are frequently reported in COVID-19 survivors, often overlapping with organic neurologic symptoms and further complicating recovery.^7,8

In the study by Akase and colleagues, which leveraged on the evolving role of digital tools in epidemiologic surveillance, data was captured from a diverse cross-section of Nigerians, many of whom may not otherwise present to formal healthcare settings. The study revealed that about a quarter of respondents with PCR-confirmed COVID-19 experienced post-acute neurologic complications, most commonly fatigue, generalized weakness, and memory impairment. What is perhaps more striking, and deeply concerning, is the low rate of healthcare engagement for these lingering symptoms. Only just over half of those with post-COVID symptoms sought care, with a minority resorting to informal providers such as patent medicine vendors or community pharmacies. This highlights persistent cultural, perceptual, and systemic barriers to healthcare access in Nigeria. Compounding this challenge is the low PCR testing rate (18.1%), which limits accurate diagnosis and epidemiologic tracking. Together, these findings underscore the need for improved testing, greater public awareness, and strengthened neurological care services.

While this study provides essential preliminary data, more rigorous, prospective research is needed to define the natural history, risk factors, and therapeutic options for post-COVID neurologic sequelae in African populations. Policymakers, clinicians, and researchers must collaborate to ensure that survivors of COVID-19 are not left to silently navigate a new, often disabling, spectrum of disease. We must not allow this silent strain to go unaddressed. The neurologic complications of COVID-19 are diverse and potentially long-lasting. They can affect individuals of all ages and health backgrounds, regardless of initial disease severity. As the global health community shifts focus from acute management to long-term care, understanding, recognizing, and addressing these neurologic consequences is essential for comprehensive patient recovery and rehabilitation. Continued research is critical to unravel the underlying mechanisms and develop effective treatment strategies for those living with post-COVID neurologic sequelae.

This edition of the journal reaffirms the value of contextually relevant research in informing clinical practice and public health policy. The studies featured not only highlight the ingenuity and resilience of researchers in the region but also underscore the pressing need for continued investment in health systems research, innovation, and capacity building. As we reflect on the findings presented, we encourage our readers to translate this knowledge into action through improved patient care, informed decision-making, and sustained advocacy. We thank our contributors, reviewers, and readers for their ongoing support and commitment to advancing health across the subregion.

Prof. G. E. Erhabor

Editor-in-chief

References

Pezzini A, Padovani A. Lifting the mask on neurological manifestations of COVID-19. Nature Reviews Neurology. 2020;16(11):636-44.
Yang J, Markus K, Andersen KM, Rudolph AE, McGrath LJ, Nguyen JL, Kyaw MH, Whittle I, Blazos V, Heron L, Spinardi JR. Definition and measurement of post-COVID-19 conditions in real-world practice: a global systematic literature review. BMJ open. 2024;14(1):e077886.
Tana C, Bentivegna E, Cho SJ, Harriott AM, García-Azorín D, Labastida-Ramirez A, Ornello R, Raffaelli B, Beltrán ER, Ruscheweyh R, Martelletti P. Long COVID headache. The journal of headache and pain. 2022;23(1):93.
Ahmad SJ, Feigen CM, Vazquez JP, Kobets AJ, Altschul DJ. Neurological sequelae of COVID-19. Journal of integrative neuroscience. 2022;21(3):77.
Brola W, Wilski M. Neurological consequences of COVID-19. Pharmacological Reports. 2022;74(6):1208-22.
Tran DH, Basra D, Bilgrami Z, Challa SR, Kwon C, Marciniak E, Verceles AC. Guillain‐Barre syndrome secondary to COVID‐19 infection: a case report. Clinical Case Reports. 2023;11(4):e7104.
Kubota T, Kuroda N, Sone D. Neuropsychiatric aspects of long COVID: a comprehensive review. Psychiatry and Clinical Neurosciences. 2023;77(2):84-93.
Schou TM, Joca S, Wegener G, Bay-Richter C. Psychiatric and neuropsychiatric sequelae of COVID-19–A systematic review. Brain, behavior, and immunity. 2021;97:328-48.

Pulmonary Aspergillosis Complicated by Recurrent Pneumothorax in a Healthy Nigerian Adolescent at Cedar Crest Hospital, Abuja: A Diagnostic Conundrum (Case Report)

O A Oyedeji — 2025-09-20

Pulmonary Aspergillosis and recurrent pneumothorax are rare paediatrics conditions posing a diagnostic difficulty when presenting together in a patient. We report the case of a male Nigerian adolescent presenting with features of community acquired pneumonia (CAP) and recurrent pneumothoraces. He had several courses of empirical antibiotics indicated for CAP with partial evidence of improvement and underwater seal drainage chest tube, for the pneumothorax severally. The pneumothorax resolved after each course of antibiotics but re-occurred after removal of closed tube thoracotomy drainage (CTTD). A galactomannan antigen test done, after six weeks of admission was positive for Aspergillus. Administration of Voriconazole, was associated with resolution of the lung opacities and recurrent pneumothorax. The diagnostic conundrum is discussed with a view to increase disease awareness among physicians working in similar resource limited setting and improve similar case management.

ORIGINAL Quality of Life Assessment Among Patients with Papulosquamous Disorders in Southern Nigeria

E A Sokunbi — 2025-09-20

Background: Papulosquamous disorders (PSDs) are a broad group of relatively common dermatoses that run a chronic course; usually with unsatisfactory outcomes which impacts on the Quality of Life (QOL) of subjects. Few studies have attempted to quantify their burden on QOL in this environment. This study aims to assess the disease impact on QOL of affected subjects.

Methods: This was a descriptive cross-sectional study conducted at the University of Benin Teaching Hospital, Benin City among two hundred subjects with PSDs. Consecutive patients with PSDs were recruited for this study after obtaining ethical approval. The Dermatology Life Quality index (DLQI) questionnaire was used to estimate the impact of these dermatoses on the QOL of subjects. Data was analysed using IBM SPSS version 21.

Result: PSDs affected all age groups with a mean age of 40.9 ± 16.4 years. Male: female ratio was 1: 1.30. The mean DLQI score was 9.5 ±5.9. Pityriasis rubra pilaris subject recorded the highest burden with DLQI score of 14.0 ±5.0, followed by psoriasis; 11.7 ± 6.3. Over half (57%) of participants had severe impact on their QOL; 34.0% had "extremely large" impact. QOL were similar among gender; but worse in extremes of age. The most commonly affected domains using the DLQI questionnaire were the "symptoms" and "feelings" domains; with 34% and 21% affected respectively.

Conclusion: Most subjects had severe impact on their QOL from these dermatoses; which mostly affected the symptoms and feelings of participants. Efforts to improve treatment outcome through interdisciplinary care alongside psychological assessment should be escalated.

ORIGINAL Kaolin-Induced Hydrocephalus in the Developing Rat Brain: Deficits of Visual Perception and Structural Changes in the Visual Cortex

M T Shokunbi — 2025-09-20

Background and objectives: Cortical visual deficits occur in hydrocephalus but the morphological changes in the visual cortex are not fully understood. This study assessed the population and cytoarchitecture of neurons in the cortex of neonatal and juvenile rats, in relation to the findings on assessment of visual perception.

Methods: Hydrocephalus was induced by injecting sterile kaolin (150 mg/l) into the cisterna magna of neonatal (7 days old) and juvenile (4 weeks old) rats. Vision was assessed using a dark chamber preference test prior to sacrifice at two and four weeks for the neonatal rats, and four and eight weeks for the juvenile rats following kaolin injection, at which time significant ventriculomegaly and cortical thinning were apparent in the parieto-occipital region. Tissue samples from the visual cortex were processed for modified Golgi, haematoxylin and eosin, and Nissl stains.

Results: The hydrocephalic rats failed the dark chamber tests of transition, peeping and preference and lacked a distinct horizontal layering of the visual cortex. There was neuronal degeneration as evidenced by increased pyknosis, and increased cytoplasmic eosinophilia. The size and dendritic branching of pyramidal neurons in layer 5 were reduced. This was especially notable in the juvenile group after four weeks of hydrocephalus. The density of layer 5 pyramidal neurons was reduced in both neonatal and juvenile hydrocephalic rats at the two time points of assessment.

Conclusions: The results showed that hydrocephalus altered the morphology of the pyramidal neurons of the visual cortex, and suggest that these changes were associated with deficits in visual perception.

ORIGINAL Symptoms and Physiological Parameters of Obstructive Sleep Apnoea Patients Diagnosed with a Portable Sleep Monitor: Implications and Challenges

N I Nwosu — 2025-09-20

Background: Obstructive sleep apnoea is a chronic, debilitating condition that if left undiagnosed and untreated is associated with adverse clinical events. The WatchPAT® is a portable wrist-worn sleep study device that uses peripheral arterial tonometry with pulse oximetry and actigraphy to assess respiratory disturbances. Unlike other level 111 sleep monitors, it measures actual sleep time, distinguishes between REM and Non-REM sleep stages, and thus generates actual apnoea-hypopnoea index.

Objectives: The study was done to assess symptoms of obstructive sleep apnoea, evaluate physiological parameters recorded by the sleep monitor and highlight changes encountered in deploying the monitor for diagnosis of sleep apnoeas.

Methods: It was a cross-sectional study. A structured Questionnaire was administered to all patients to obtain data regarding their symptoms, co-morbidities and socio demographics. Sleep study was conducted using a Watch-PAT® portable monitor. Data were entered first on Microsoft excel sheet and analysed using SPSS version 25.

Results: Thirty-eight participants, mean age 49±14 years (17 to76 years) were studied (females, 73.7%). Thirty-four (89.5%) of them were diagnosed with OSA. Sixteen (47.0%), 9 (26.5%) and 9 (26.5%) had severe, moderate and mild OSA respectively. Commonest symptoms were snoring (85.7%), abrupt awakening accompanied by gasping/choking at night (65.8%) and non-refreshing sleep (60.5%). Memory loss occurred significantly among those with severe OSA compared with mild and moderate OSA (X2=9.920, p=0.007). Seventeen participants (44%) had excessive daytime somnolence (EPSS > 10). Those with severe OSA recorded the lowest minimum pulse (median 42.5, IQR 39.3-51.8), highest maximum pulse (median 130bpm, IQR 114-138), and lowest minimum SPO2 (median 70%, IQR 64.3-80.3). Severe OSA was associated with reduced mean percentage of REM sleep (14.6%) compared to moderate (25.1%) and mild (16.1%) OSA.

Conclusion: Diagnosing OSA objectively using a portable sleep monitor such as WatchPAT® is feasible. Snoring (85.7%) was the commonest symptom among those diagnosed with OSA. Physiological parameters obtained from the monitor provide the clinician the requisite information with which to persuade patients of a need for intervention. However, cost of CPAP machine and mandibular advancement device delayed immediate intervention.

ORIGINAL A Social Media Survey on the Prevalence of Post-COVID Neurologic Complications Among Nigerians

I E Akase — 2025-09-20

Background and objective: Cultural barriers and perceptual factors that are peculiar among Africans are known to limit the number of people seeking medical care for post-COVID conditions. The aim of this social media survey was to ascertain the burden of post-COVID neurologic complications in Nigeria in individuals with confirmed COVID-19.

Methods: We performed a cross-sectional web-based survey of persons with PCR-confirmed or suspected SARS-CoV-2 infection in Nigeria with incident infection between March 2020 and April 2022. Our survey utilized Kobo Toolbox® and was disseminated via several online platforms (including WhatsApp ®, Facebook®, and Twitter (X)®). Participant demographics, COVID-19 symptom profile, SARS-CoV-2 test results, and the occurrence of persistent neurological symptoms were documented.

Results: We analyzed the data of 963 participants with confirmed or suspected COVID-19 infection. The mean age was 36.9 ± 9.9 years, and 555/963 (57.6%) were female. Only 174/963 individuals (18.1%) had SARS-CoV-2 PCR confirmation at any point during the pandemic, of which 133 (76.4%) had accompanying symptoms consistent with the case definition. A total of 47/174 (27.0%) of the PCR-positive participants reported post-acute COVID symptoms, and 46/174 (26.4%) had post-COVID neurologic complaints. The most commonly reported symptoms were fatigue (25; 14.4%), generalized body weakness (22; 12.6%), and difficulty remembering things (15; 8.6%). Slightly over half of those with post-COVID symptoms (25/47; 53.2%) sought care, with 21/25 (84%) presenting to a medical facility. Others presented either to a community pharmacy (1/25) or a patent medicine store (3/25) for care.

Conclusion: Despite low testing rates in Nigeria, the prevalence of post-COVID neurologic complications is approximately 1 in 4 individuals. Further studies on the prognosis and management of post-COVID neurologic sequelae in Nigeria are warranted.

ORIGINAL The Interplay Between Fibroblast Growth Factor-23 (Fgf-23) and Traditional Biomarkers of Chronic Kidney Disease – Mineral and Bone Disorder

R S Ezeugonwa — 2025-09-20

Introduction: Chronic kidney disease (CKD) is a global health challenge affecting 11-13% of the world's population. Chronic kidney disease - mineral and bone disorder (CKD-MBD) has been recognized as an important complication of CKD. There has been an increasing interest in fibroblast growth factor 23 (FGF-23), regarding its roles in the pathophysiology, diagnosis, and management of CKD-MBD but its relationship with other biomarkers of CKD-MBD has not been well investigated in sub-Saharan Africa, especially in Nigeria.

Method: This study aimed to assess the levels of FGF-23 in patients with kidney disease: Improving Global Outcome (KDIGO) CKD stages 3a to 5 and its relationship with traditional biomarkers of CKD-MBD. One hundred and thirty-eight (138) participants, 103 patients and 35 controls, completed the study. Serum intact parathyroid hormone (iPTH), FGF-23, and calcium among others were measured and a structured, interviewer-administered questionnaire was used to collect data. Data collected were analyzed using the Statistical Package for Social Sciences version 20 (SPSS 20).

Results: The mean serum levels of FGF-23 were different between patients (241.05 ± 3.40pg/ml) and the controls (133.66 ± 2.35pg/ml; p=0.009), and the same applied to the mean serum levels of iPTH for patients and controls (56.15 ± 43.48pg/ml vs 20.11 ± 5.57pg/ml, p = 0.009). The FGF-23 levels increased from stages 3 to 5; however, in stage 5 CKD, those on dialysis had lower iPTH and FGF-23 compared to those who were yet to commence dialysis. In the CKD arm, the calcium-phosphate product had a positive correlation with both FGF-23 and iPTH (r = 0.212; p = 0.01, and r = 0.195; p = 0.022, respectively). The prevalence of CKD-MBD increased as CKD progressed through stages 3 to 5 (72%, 90% and 100% respectively).

Conclusion: The prevalence of CKD-MBD was very high in this study, the rate progressively increased as GFR declined. FGF-23 showed a weak correlation with Ca x P product but did not correlate with calcium, phosphate, or iPTH.

ORIGINAL Population Survey on Contributing Factors to Sustained Prevalence of Sickle Cell Disease in Enugu, Nigeria

A O Ugwu — 2025-09-20

Background: According to the World Health Organization, about 5% of the world's population has the abnormal haemoglobin gene with Nigeria having the highest burden of sickle cell disease (SCD). Concerted efforts should target the reduction of SCD prevalence.

Objective: This study aimed to determine the various factors that contribute to the non-dwindling prevalence of SCD in Nigeria.

Methods: A community-based cross-sectional survey was carried out on 883 respondents aged 18 years and above between February 2021 and March 2023 in Enugu State, Nigeria. Interviewer-administered questionnaires were used to obtain relevant socio-demographic data, family history of SCD, knowledge of their haemoglobin phenotype, and information on any previous misdiagnosis of their haemoglobin phenotype. Statistical Package for the Social Sciences (SPSS) software program, version 26.0 (Chicago, Illinois) was used for data analysis. A value of P < 0.05 was considered statistically significant.

Results: Median age was 43 years with a range of 18-88 years. Seven hundred and forty-three (743/883, 81.1%) have done the test to ascertain their haemoglobin phenotype. On the other hand, 140 respondents (15.9%) have never done the test due to: lack of awareness (35/140, 25%); financial difficulties (53/140, 37.8%); religious reasons (35/140, 25%); discordant results (301/743, 40.5%) and not knowing where to go for the test (17/140, 12.1%). The distributions of the haemoglobin phenotypes were: HbAA (519/743, 69.9%); HbAS (196/743, 26.4%) and HbSS (28/743, 3.8%).

Conclusions: Over one-tenth (15.9%) of the study population do not know their haemoglobin phenotype status and their reasons for non-testing are varied. The population prevalence of SCD (3.8%) is higher than the previously reported national prevalence range of 1 - 3%. Addressing the identified barriers to non-testing might help in checking the increasing prevalence of SCD in Nigeria.

ORIGINAL Diagnostic Performance of Xpert MTB/RIF Assay in Adults with Presumed Pulmonary Tuberculosis at Uyo, Nigeria

S B Udoette — 2025-09-20

Background: Tuberculosis (TB) is a disease of immense public health importance in sub-Saharan Africa. Xpert MTB/RIF assay, a relatively recent, rapid molecular testing modality offers potential solutions to most of the challenges associated with TB diagnosis.

Objective: This study determined the diagnostic performance of Xpert MTB/RIF assay in adults with presumed pulmonary tuberculosis (PTB).

Methods: This was a descriptive cross-sectional study involving consenting adults with presumed PTB at the University of Uyo Teaching Hospital, Uyo, southern Nigeria. A structured questionnaire was used to collect participants' data. All participants submitted 2 sputum samples (spot and early morning). Sputum smear microscopy, Xpert MTB/RIF assay and mycobacterial culture were done. They also had chest radiography.

Results: They were 230 participants in the study. Seventy-nine (34.3%) patients were living with HIV. Xpert MTB/RIF assay detected MTB in 65 (28.3%) patients with 2 (3.1%) of them having rifampicin resistance. M. tuberculosis was isolated from sputum culture in 69 participants while the result was negative in 151 participants. The culture results of these 220 patients were used as the reference standard for the determination of the sensitivity and specificity of Xpert MTB/RIF assay. The overall sensitivity and specificity of the assay were 88.4% and 98.7% respectively. Younger age, longer duration of cough, weight loss, low body mass index (BMI) and positive smear status were independent factors associated with MTB detection using the assay.

Conclusion: Xpert MTB/RIF assay is a highly sensitive and specific modality for pulmonary TB diagnosis when compared with mycobacterial culture, which is the gold standard.

ORIGINAL Assessing the Efficacy of Peko-D Forte as Add-on Therapy for Parkinson's Disease: A Proof of Concept, Double-Blind, Placebo-Controlled Study

O V Olalusi — 2025-09-20

Background: Hypoestes rosea, an endemic shrub in Nigeria and Cameroon with documented anti-inflammatory properties, has been shown to modify disease progression in transgenic mouse models with Parkinson's Disease PD. We investigated the efficacy and side effect profile of Hypoestes rosea (Peko-D forte) in improving motor performance of PD patients.

Methods: This double-blind, randomized, placebo-controlled, proof-of-concept (phase I) study involved 19 patients with mild to moderate PD. Routine dopaminergic therapy was maintained. Following randomization, half of the patients received 4 capsules each of 350 mg Peko-D forte tablets, and the other half, 4 capsules of matching placebo (USP-grade starch) for 8 weeks. After a wash-out period of 4 weeks, patients were switched over (cross-over design). The effects of the medication on motor activity were analyzed using the Unified Parkinson's Disease Rating Scale (UPDRS).

Results: Overall, 14 patients completed the study, comprising 93% males with a mean age of 72 (13.2) years. Their median (IQR) UPDRS score at baseline of 18 (13-20) improved significantly with both Peko-D forte 12 (6 - 16) and placebo 12.5 (9- 15) (p<0.001). Compared to baseline, Peko-D forte improved bradykinesis, rest tremor amplitude and frequency, and rigidity. There was no significant difference between the median UPDRS score with the use of Peko-D forte compared to placebo. The test drug had 93% tolerability with a good side effect profile.

Conclusion: Peko-D forte improved motor functions in PD, and it is safe and tolerable. Its efficacy is unclear due to the lack of significant difference between the test drug and placebo. Larger studies will be needed to confirm its efficacy. Clinical Trials.org (NCT04858074).