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Yu K, Zhou H, Chen Z, Lei Y, Wu J, Yuan Q, He J. Mechanism of cognitive impairment and white matter damage in the MK-801 mice model of schizophrenia treated with quetiapine. Behav Brain Res 2024; 461:114838. [PMID: 38157989 DOI: 10.1016/j.bbr.2023.114838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 12/11/2023] [Accepted: 12/23/2023] [Indexed: 01/03/2024]
Abstract
Schizophrenia has been linked to cognitive impairment and white matter damage in a growing number of studies this year. In this study, we used the MK-801-induced schizophrenia-like mice model to investigate the effects of quetiapine on behavioral changes and myelin loss in the model mice. The subjects selected for this study were C57B6/J male mice, MK-801 (1 mg/kg/d intraperitoneal injection) modeling for 1 week and quetiapine (10 mg/kg/d intraperitoneal injection) treatment for 2 weeks. Behavioral tests were then performed using the three-chamber paradigm test and the Y maze test. Moreover, western blot, immunohistochemistry, and immunofluorescence were conducted to investigate the changes in oligodendrocyte spectrum markers. In addition, we performed some mechanism-related proteins by western blot. Quetiapine ameliorated cognitive impairment and cerebral white matter damage in MK-801 model mice, and the mechanism may be related to the PI3K/AKT pathways. The present study suggests that quetiapine has a possible mechanism for treating cognitive impairment and white matter damage caused by schizophrenia.
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Affiliation(s)
- Kai Yu
- School of Mental Health and the Affiliated Kangning Hospital, Wenzhou Key Laboratory for Basic and Translational Research in Mental Health, Zhejiang Provincial Clinical Research Center for Mental Disorders, Institute of Aging, Key Laboratory of Alzheimer's Disease of Zhejiang Province, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Han Zhou
- School of Mental Health and the Affiliated Kangning Hospital, Wenzhou Key Laboratory for Basic and Translational Research in Mental Health, Zhejiang Provincial Clinical Research Center for Mental Disorders, Institute of Aging, Key Laboratory of Alzheimer's Disease of Zhejiang Province, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Zhuo Chen
- School of Mental Health and the Affiliated Kangning Hospital, Wenzhou Key Laboratory for Basic and Translational Research in Mental Health, Zhejiang Provincial Clinical Research Center for Mental Disorders, Institute of Aging, Key Laboratory of Alzheimer's Disease of Zhejiang Province, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Yuying Lei
- School of Mental Health and the Affiliated Kangning Hospital, Wenzhou Key Laboratory for Basic and Translational Research in Mental Health, Zhejiang Provincial Clinical Research Center for Mental Disorders, Institute of Aging, Key Laboratory of Alzheimer's Disease of Zhejiang Province, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Junnan Wu
- School of Mental Health and the Affiliated Kangning Hospital, Wenzhou Key Laboratory for Basic and Translational Research in Mental Health, Zhejiang Provincial Clinical Research Center for Mental Disorders, Institute of Aging, Key Laboratory of Alzheimer's Disease of Zhejiang Province, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Qianfa Yuan
- Xiamen Xian Yue Hospital, Xiamen, Fujian, China
| | - Jue He
- School of Mental Health and the Affiliated Kangning Hospital, Wenzhou Key Laboratory for Basic and Translational Research in Mental Health, Zhejiang Provincial Clinical Research Center for Mental Disorders, Institute of Aging, Key Laboratory of Alzheimer's Disease of Zhejiang Province, Wenzhou Medical University, Wenzhou, Zhejiang, China; Institute of Neurological Disease, First Affiliated Hospital, Henan University, Kaifeng, Henan, China.
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Arecco A, Ottaviani S, Boschetti M, Renzetti P, Marinelli L. Diabetic striatopathy: an updated overview of current knowledge and future perspectives. J Endocrinol Invest 2024; 47:1-15. [PMID: 37578646 PMCID: PMC10776723 DOI: 10.1007/s40618-023-02166-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 07/24/2023] [Indexed: 08/15/2023]
Abstract
PURPOSE Diabetic striatopathy (DS) is a rare complication of poorly controlled diabetes mellitus (DM), characterized by hyperglycemia associated with chorea/ballism and characteristic reversible basal ganglia abnormalities on computed tomography (CT) and/or magnetic resonance imaging (MRI). We propose a narrative review of the literature on this topic, currently unknown to most, and about which physicians should be aware. We intend to summarize, critically review, and take to mean the evidence on this disorder, describing its typical features. METHODS We searched Pubmed for English-language sources using the following keywords in the title and the abstract: diabetic striatopathy, hyperglycemic non-ketotic hemichorea/hemiballism, chorea/hemichorea associated with non-ketotic hyperglycemia, diabetic hemiballism/hemichorea, chorea, hyperglycemia, and basal ganglia syndrome. We collected scientific articles, including case reports, reviews, systematic reviews, and meta-analyses from the years 1975 to 2023. We eliminated duplicate, non-English language or non-related articles. RESULTS Older Asian women are more frequently affected. Suddenly or insidiously hemichorea/hemiballism, mainly in the limbs, and high blood glucose with elevated HbA1c in the absence of ketone bodies have been observed. Furthermore, CT striatal hyperdensity and T1-weighted MRI hyperintensity have been observed. DS is often a treatable disease following proper hydration and insulin administration. Histopathological findings are variable, and no comprehensive hypothesis explains the atypical cases reported. CONCLUSION DS is a rare neurological manifestation of DM. If adequately treated, although treatment guidelines are lacking, the prognosis is good and life-threatening complications may occur occasionally. During chorea/hemiballism, we recommend blood glucose and HbA1c evaluation. Further studies are needed to understand the pathogenesis.
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Affiliation(s)
- A Arecco
- Endocrinology Unit, Department of Internal Medicine and Medical Specialties, School of Medical and Pharmaceutical Sciences, University of Genova, 16132, Genoa, Italy
| | - S Ottaviani
- Section of Geriatrics, Department of Internal Medicine and Medical Specialties, University of Genova, 16132, Genoa, Italy
| | - M Boschetti
- Endocrinology Unit, Department of Internal Medicine and Medical Specialties, School of Medical and Pharmaceutical Sciences, University of Genova, 16132, Genoa, Italy.
- IRCCS Ospedale Policlinico San Martino, 16132, Genoa, Italy.
| | - P Renzetti
- IRCCS Ospedale Policlinico San Martino, 16132, Genoa, Italy
| | - L Marinelli
- IRCCS Ospedale Policlinico San Martino, 16132, Genoa, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, 16132, Genoa, Italy
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Tavares WC, Seuánez HN. Disease-associated mitochondrial mutations and the evolution of primate mitogenomes. PLoS One 2017; 12:e0177403. [PMID: 28510580 PMCID: PMC5433710 DOI: 10.1371/journal.pone.0177403] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 04/26/2017] [Indexed: 01/09/2023] Open
Abstract
Several human diseases have been associated with mutations in mitochondrial genes comprising a set of confirmed and reported mutations according to the MITOMAP database. An analysis of complete mitogenomes across 139 primate species showed that most confirmed disease-associated mutations occurred in aligned codon positions and gene regions under strong purifying selection resulting in a strong evolutionary conservation. Only two confirmed variants (7.1%), coding for the same amino acids accounting for severe human diseases, were identified without apparent pathogenicity in non-human primates, like the closely related Bornean orangutan. Conversely, reported disease-associated mutations were not especially concentrated in conserved codon positions, and a large fraction of them occurred in highly variable ones. Additionally, 88 (45.8%) of reported mutations showed similar variants in several non-human primates and some of them have been present in extinct species of the genus Homo. Considering that recurrent mutations leading to persistent variants throughout the evolutionary diversification of primates are less likely to be severely damaging to fitness, we suggest that these 88 mutations are less likely to be pathogenic. Conversely, 69 (35.9%) of reported disease-associated mutations occurred in extremely conserved aligned codon positions which makes them more likely to damage the primate mitochondrial physiology.
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Affiliation(s)
- William Corrêa Tavares
- Programa de Genética, Instituto Nacional de Câncer, Rio de Janeiro, Rio de Janeiro, Brazil
- Departamento de Genética, Instituto de Biologia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
- Departamento de Zoologia, Instituto de Biologia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Héctor N. Seuánez
- Programa de Genética, Instituto Nacional de Câncer, Rio de Janeiro, Rio de Janeiro, Brazil
- Departamento de Genética, Instituto de Biologia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
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Onder H. Hemichorea-hemiballismus in the setting of posterolateral putaminal lesion and treatment with topiramate. J Neurol Sci 2017; 375:388-389. [DOI: 10.1016/j.jns.2017.02.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 01/20/2017] [Accepted: 02/13/2017] [Indexed: 11/25/2022]
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Koprich JB, Fox SH, Johnston TH, Goodman A, Le Bourdonnec B, Dolle RE, DeHaven RN, DeHaven-Hudkins DL, Little PJ, Brotchie JM. The selective mu-opioid receptor antagonist adl5510 reduces levodopa-induced dyskinesia without affecting antiparkinsonian action in mptp-lesioned macaque model of Parkinson's disease. Mov Disord 2011; 26:1225-33. [DOI: 10.1002/mds.23631] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2010] [Revised: 12/06/2010] [Accepted: 12/16/2010] [Indexed: 11/05/2022] Open
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Abstract
Hemiballism is a relatively rare hyperkinetic movement disorder characterized by involuntary, violent, coarse and wide-amplitude movements involving ipsilateral arm and leg. Although classically related to lesions in the subthalamic nucleus, in clinical-radiological series of hemiballism most patients had lesions outside this nucleus, involving mainly other basal ganglia structures. It has been suggested that abnormal neuronal firing patterns in the internal segment of the globus pallidus may be related to the pathogenesis of hemiballism. Stroke is the most common cause, but in recent years an increasing number of patients with hemiballism associated with nonketotic hyperglycemia or with complications of human immunodeficiency virus (HIV) infection have been reported. Contrarily to what was stated in older literature, hemiballism has, in general, a relatively good prognosis. Depending on the underlying causes, many patients may experience spontaneous improvements or remissions. Treatment should be directed to the cause of hemiballism. Symptomatic treatment includes the use of drugs, particularly blockers of striatal D2 dopamine receptors and tetrabenazine. Surgical treatment, especially pallidotomy, is a therapeutic option for the minority of patients with severe persistent disabling hemiballism.
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Affiliation(s)
- Francisco Grandas
- Department of Neurology, Hospital Universitario Gregorio Marañón and Parkinson's Disease and Movement Disorders Unit, Hospital Beata Maria Ana, Madrid, Spain.
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Abstract
Chorea may occur as part of the symptomatology of acute stroke; it occasionally also may be delayed or progressive. Patients with vascular-related chorea typically present with an acute or subacute onset of chorea of one side of the body (hemichorea), contralateral to the lesion. Cerebrovascular disease is the most common cause of sporadic chorea. Lesions are most frequently found in the thalamus and lentiform nucleus, and less often in subthalamic nucleus. The differential diagnosis of choreic syndromes relies not so much on differences in the phenomenology of the hyperkinesia but the age at onset, mode of onset, time course, family history, drug use, distribution of chorea in the body, and presence of accompanying neurological findings. Magnetic resonance imaging is preferred to demonstrate the presence of strategic small lesions in regions that are difficult to image with computed tomography, such as the globus pallidus, thalamus, and subthalamic nucleus. Although the prognosis of hemichorea can be benign, the long-term prognosis is not specifically determined by the hemichorea but by the long-term prognosis of stroke patients. Symptomatic treatment with antichoreic drugs may be necessary in the acute phase. Surgery is rarely indicated to treat vascular chorea.
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Goto T, Hashimoto T, Hirayama S, Kitazawa K. Pallidal neuronal activity in diabetic hemichorea-hemiballism. Mov Disord 2010; 25:1295-7. [PMID: 20629129 DOI: 10.1002/mds.23058] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Yamada K, Harada M, Inoue N, Yoshida S, Morioka M, Kuratsu JI. Concurrent hemichorea and migrainous aura--a perfusion study on the basal ganglia using xenon-computed tomography. Mov Disord 2008; 23:425-9. [PMID: 18067174 DOI: 10.1002/mds.21804] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
A variety of etiologies underlie the neurophysiological imbalance resulting in chorea. We report a 57-year-old woman with a long-history of migraine who suddenly experienced concurrent scintillating scotoma and rapid involuntary movement of her neck and right extremities. Diffusion-weighted magnetic resonance imaging (MRI) failed to detect any fresh ischemic and/or hemorrhagic lesions. Xenon-computed tomography (CT) disclosed gross reduction in the cerebral blood flow (CBF) of the left occipital area. With precise mapping to the brain atlas, extreme hyperperfusion in the motor thalamus was found on the left side. Asymmetrical CBF reduction of the left subthalamic nucleus was also noted. Her symptoms gradually improved and completely disappeared within 15 days. Repeated xenon-CT 1 month post-onset demonstrated normalized CBF in the affected areas. Our study suggests that vascular event underlies the migrainous aura in this case and secondarily provokes a loss of inhibitory control of the motor thalamus resulting in the manifestation of hemichorea.
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Affiliation(s)
- Kazumichi Yamada
- Department of Neurosurgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
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Affiliation(s)
- F Durif
- Service de Neurologie, CHU de Clermont-Ferrand.
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Shimojima Y, Hashimoto T, Kaneko K, Yazaki M, Yoshida K, Goto T, Yamada R, Hongo K, Ikeda SI. Thalamic Stimulation for Disabling Tremor in a Patient with Spinocerebellar Degeneration. Stereotact Funct Neurosurg 2005; 83:131-4. [PMID: 16155369 DOI: 10.1159/000088159] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Thalamic stimulation alleviated coarse action tremor in a patient with spinocerebellar degeneration (SCD) and led to substantial improvement in daily functioning, though disability from ataxia remained. Intraoperative microrecording revealed a significant correlation between neuronal activity of the ventral intermediate nucleus (Vim) and tremor electromyograms. The tremor-correlated activities of Vim neurons and abolition of the tremor by Vim stimulation suggest that Vim may be related to the generation of action tremor in SCD. Thalamic stimulation can be a useful treatment option for SCD patients with disabling tremor.
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Affiliation(s)
- Yasuhiro Shimojima
- Third Department of Medicine (Neurology), Shinshu University School of Medicine, Matsumoto, Japan
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Zesiewicz TA, Sullivan KL, Hauser RA. Vascular hemichorea/hemiballismus and topiramate. Mov Disord 2005; 21:581; author reply 582. [PMID: 16342173 DOI: 10.1002/mds.20745] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Yamada K, Goto S, Kaji R, Kuratsu JI. Modulation of torsinA expression in the globus pallidus internus is associated with levodopa-induced dyskinesia in hemiparkinsonian rats. Neurosci Lett 2005; 396:62-6. [PMID: 16325337 DOI: 10.1016/j.neulet.2005.11.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2005] [Revised: 10/14/2005] [Accepted: 11/04/2005] [Indexed: 11/28/2022]
Abstract
TorsinA is the causative protein of DYT1 dystonia, a major representative of hyperkinetic movement disorders. In this study, the distribution of torsinA was investigated in the basal ganglia of hemiparkinsonian rats with or without levodopa-induced dyskinesia (LID). Two months after 6-hydroxydopamine (OHDA) treatment, Wistar-albino rats were subjected to intermittent intraperitoneal injection of levodopa/benserazid (LID-group, n=5) or vehicle (control, n=5) for 21 days. Immunohistochemical analysis disclosed that in the caudal portion of the entopeduncular nucleus (EP), homologous to the globus pallidus internus (GPi) in primates, on the parkinsonian side, there was a significant decrease of torsinA-immunopositive neurons in rats with LID, but not in those without LID. However, Nissl-staining showed no loss of GPi neurons in rats with LID. In both groups, there was no significant difference between ipsi- and contralateral sides with respect to the density of torsinA-positive neuronal cells in the striatum, globus pallidus externus, and subthalamic nucleus. Ours are the first data to demonstrate the specific modulation of torsinA expression in the basal ganglia of the hyperkinesia model, suggesting that GPi neurons containing torsinA possess pathologic plasticity for LID.
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Affiliation(s)
- Kazumichi Yamada
- Department of Neurosurgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto 860-8556, Japan
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Papapetropoulos S, Singer C. Improvement of cervico-trunco-brachial segmental dystonia with topiramate. J Neurol 2005; 253:535-6. [PMID: 16328112 DOI: 10.1007/s00415-005-0029-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2005] [Revised: 08/18/2005] [Accepted: 08/29/2005] [Indexed: 11/29/2022]
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Gatto EM, Uribe Roca C, Raina G, Gorja M, Folgar S, Micheli FE. Vascular hemichorea/hemiballism and topiramate. Mov Disord 2004; 19:836-838. [PMID: 15254947 DOI: 10.1002/mds.20086] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Although vascular hemichorea/hemiballism (HC/HB) has been reported to be self-limited, in some cases, it can be irreversible and severely disabling. The standard treatment includes typical and atypical neuroleptics and GABA-mimetic drugs. Topiramate is a new antiepileptic drug possessing a complex mechanism of action, including the enhancement of GABA-mediated inhibition. We describe a 71-year-old patient with HC/HB who markedly improved after topiramate treatment.
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Affiliation(s)
- Emilia Mabel Gatto
- Parkinson's Disease and Movement Disorders Program, Department of Neurosciences, Hospital de Clínicas, University of Buenos Aires, Buenos Aires, Argentina
| | - Claudia Uribe Roca
- Parkinson's Disease and Movement Disorders Program, Department of Neurosciences, Hospital de Clínicas, University of Buenos Aires, Buenos Aires, Argentina
| | - Gabriela Raina
- Parkinson's Disease and Movement Disorders Program, Department of Neurosciences, Hospital de Clínicas, University of Buenos Aires, Buenos Aires, Argentina
| | - Marcelo Gorja
- Parkinson's Disease and Movement Disorders Program, Department of Neurosciences, Hospital de Clínicas, University of Buenos Aires, Buenos Aires, Argentina
| | - Silvia Folgar
- Parkinson's Disease and Movement Disorders Program, Department of Neurosciences, Hospital de Clínicas, University of Buenos Aires, Buenos Aires, Argentina
| | - Federico E Micheli
- Parkinson's Disease and Movement Disorders Program, Department of Neurosciences, Hospital de Clínicas, University of Buenos Aires, Buenos Aires, Argentina
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Yamada K, Harada M, Goto S. Response of postapoplectic hemichorea/ballism to gpi pallidotomy: Progressive improvement resulting in complete relief. Mov Disord 2004; 19:1111-4. [PMID: 15372609 DOI: 10.1002/mds.20143] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
We report on a 66-year-old woman in whom GPi pallidotomy produced progressive and eventually complete relief of hemichorea/ballism (HCB) after a subthalamic hemorrhage. Although choreoballistic movements were unchanged during and immediately after the surgery, the symptoms were gradually improved and consequently abolished by 5 days postoperatively. HCB has never recurred up to the present (9 months follow-up period). This note is the first report describing detailed postsurgical process in HCB relief after pallidotomy.
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Affiliation(s)
- Kazumichi Yamada
- Department of Neurosurgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
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Abstract
Hemiballism is a rare movement disorder that presents with unilateral flinging movements of the limbs. In traditional teaching, it has been characterised as almost pathognomonic of a lesion in the subthalamic nucleus (STN). The prognosis was described as grave, with severe disability and death in many cases. However, review of more recent reports shows that the STN is directly involved in only a minority of cases. The prognosis is benign in most cases, with almost all patients responding well to treatment and many having spontaneous remission, although long-term prognosis of cerebrovascular disease may not be so good. There have also been recent insights into the pathophysiology of hemiballism, which have emphasised the importance of altered firing patterns in basal-ganglia structures. Recent studies have pointed to previously unrecognised causes, particularly non-ketotic hyperosmolar hyperglycaemia and complications of HIV infection, that may account for a substantial proportion of cases of hemiballism.
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Affiliation(s)
- Ronald B Postuma
- Morton and Gloria Shulman Movement Disorders Center, Toronto Western Hospital, Ontario, Toronto, Canada
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Watarai M, Hashimoto T, Yamamoto K, Matsumoto Y, Tada T, Ikeda S. Pallidotomy for severe generalized chorea of juvenile-onset dentatorubral-pallidoluysian atrophy. Neurology 2003; 61:1452-4. [PMID: 14638982 DOI: 10.1212/01.wnl.0000094202.26313.73] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- M Watarai
- Third Department of Medicine (Neurology), Shinshu University School of Medicine, Matsumoto, Japan
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Choi SJ, Lee SW, Kim MC, Kwon JY, Park CK, Sung JH, Hong JT, Woo HK. Posteroventral pallidotomy in medically intractable postapoplectic monochorea: case report. SURGICAL NEUROLOGY 2003; 59:486-90; discussion 490. [PMID: 12826351 DOI: 10.1016/s0090-3019(03)00085-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Posteroventral pallidotomy is a widely accepted surgical procedure for treating medically intractable Parkinson's disease and Levo-dopa induced dyskinesia. In the surgical treatment of hyperkinetic movement disorders, generalized dystonia has recently become a favorable indication of posteroventral pallidotomy. However, a commonly recognized surgical procedure for treating choreiform movement disorders has not yet been established. Here we present an unusual experience of a posteroventral pallidotomy performed to treat a medically intractable monochorea caused by a vascular insult on the basal ganglia. METHODS A 63-year-old female presented with choreiform movement of the left upper limb that she had suffered for 5 months. She was found to have a hemorrhagic infarction in the right putaminal area. No other abnormal lesions were shown by magnetic resonance imaging except for a widening of the right cerebellopontine cistern because of an acoustic neurinoma removed 5 years previously. Despite medication with a dopamine antagonist, choreiform movement of the left limb had not improved, and the patient complained of rigidity and slowness of ambulation owing to the side effects of the medicine. A right posteroventral pallidotomy was performed with macrostimulation for a physiologic confirmation of the globus pallidus internus (GPi), which is the conventional target for Parkinson's disease. After coagulating the GPi target, the choreiform movement of the contralateral upper limb was completely abolished. RESULTS The postoperative course was uneventful and no recurrence of chorea was observed over a follow-up period of 6 months. CONCLUSIONS Stereotactic surgery for hyperkinetic movement disorders is not as common a procedure as that used for treating Parkinson's disease. Furthermore, there have been few reports of pallidal surgery for treating the chorea caused by an ischemic insult. However, on the basis of the current concept that varying types of hyperkinetic disorders may have a common pathophysiological mechanism, a posteroventral pallidotomy may be an alternative surgical procedure for treating medically intractable postapoplectic chorea like in an occasion of dystonia.
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Affiliation(s)
- Seung-Jin Choi
- Department of Neurosurgery, St. Vincent Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
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