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Risk factors for idiopathic dystonia in Queensland, Australia. J Clin Neurosci 2014; 21:2145-9. [DOI: 10.1016/j.jocn.2014.03.032] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Revised: 03/22/2014] [Accepted: 03/25/2014] [Indexed: 11/18/2022]
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Craig-McQuaide A, Akram H, Zrinzo L, Tripoliti E. A review of brain circuitries involved in stuttering. Front Hum Neurosci 2014; 8:884. [PMID: 25452719 PMCID: PMC4233907 DOI: 10.3389/fnhum.2014.00884] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Accepted: 10/14/2014] [Indexed: 11/13/2022] Open
Abstract
Stuttering has been the subject of much research, nevertheless its etiology remains incompletely understood. This article presents a critical review of the literature on stuttering, with particular reference to the role of the basal ganglia (BG). Neuroimaging and lesion studies of developmental and acquired stuttering, as well as pharmacological and genetic studies are discussed. Evidence of structural and functional changes in the BG in those who stutter indicates that this motor speech disorder is due, at least in part, to abnormal BG cues for the initiation and termination of articulatory movements. Studies discussed provide evidence of a dysfunctional hyperdopaminergic state of the thalamocortical pathways underlying speech motor control in stuttering. Evidence that stuttering can improve, worsen or recur following deep brain stimulation for other indications is presented in order to emphasize the role of BG in stuttering. Further research is needed to fully elucidate the pathophysiology of this speech disorder, which is associated with significant social isolation.
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Affiliation(s)
| | - Harith Akram
- Unit of Functional Neurosurgery, Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, University College London London, UK ; Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery London, UK
| | - Ludvic Zrinzo
- Unit of Functional Neurosurgery, Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, University College London London, UK ; Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery London, UK
| | - Elina Tripoliti
- Unit of Functional Neurosurgery, Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, University College London London, UK ; Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery London, UK
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Defazio G, Gigante AF. The environmental epidemiology of primary dystonia. TREMOR AND OTHER HYPERKINETIC MOVEMENTS (NEW YORK, N.Y.) 2013; 3. [PMID: 23724359 PMCID: PMC3628345 DOI: 10.7916/d8qn65gq] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/13/2012] [Accepted: 12/26/2012] [Indexed: 12/01/2022]
Abstract
BACKGROUND Dystonia is a movement disorder characterized by involuntary muscle contractions that cause twisting movements and abnormal postures. Primary dystonia is the most common form and is thought to be a multifactorial condition in which one or more genes combine with environmental factors to reach disease. METHODS We reviewed controlled studies on possible environmental risk factors for primary early- and late-onset dystonia. RESULTS Environmental factors associated with primary early-onset dystonia are poorly understood. Early childhood illnesses have been reported to be more frequent in patients with DYT1 dystonia than in subjects carrying the DYT1 mutation that did not manifest dystonia, thus raising the possibility that such exposures precipitate dystonia among DYT1 carriers. Conversely, several environmental factors have been associated with primary adult-onset focal dystonias compared to control subjects. Namely, eye diseases, sore throat, idiopathic scoliosis, and repetitive upper limb motor action seem to be associated with blepharospasm (BSP), laryngeal dystonia (LD), cervical dystonia (CD), and upper limb dystonia, respectively. In addition, an inverse association between coffee drinking and BSP has been observed in both case-unrelated control and family-based case-control studies. Additional evidence supporting a causal link with different forms of primary late-onset dystonia is only available for diseases of the anterior segment of the eye, writing activity, and coffee intake. CONCLUSION There is reasonable epidemiological evidence that some environmental factors are risk-modifying factors for specific forms of primary adult-onset focal dystonia.
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Affiliation(s)
- Giovanni Defazio
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, "Aldo Moro" University of Bari, Bari, Italy
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4
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Abstract
In 1984, dystonia was defined by an ad hoc committee of the Dystonia Medical Research Foundation as a syndrome of involuntary, sustained muscle contractions affecting one or more sites of the body, frequently causing twisting and repetitive movements, or abnormal postures. In 2011, dystonia remains a purely clinical diagnosis. Primary dystonia includes syndromes in which dystonia is the sole phenotypic manifestation with the exception that tremor can be present as well. Primary dystonias are typically mobile and may show task specificity. Fixed dystonias are often psychogenic or associated with complex regional pain syndrome. Fixed dystonia may also be the terminal consequence of long-standing, inadequately-treated, severe appendicular or cervical dystonia. The vast majority of primary dystonias have their onset in adults. Late-onset, primary, focal dystonia, particularly blepharospasm, may spread to affect other anatomical segments. Patients with focal dystonia may also exhibit spontaneous remissions that last for years. Although sensory tricks are commonly reported by patients with primary dystonia, they have also been described in subjects with secondary dystonia. Another important sensory aspect of dystonia is pain which is relatively common in cervical dystonia but also reported by many patients with masticatory dystonia, hand-forearm dystonia and blepharospasm. In conclusion, "dystonia" can be used to delimit a clinical sign or loosely define a neuropsychiatric sensorimotor syndrome.
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Affiliation(s)
- Mark S LeDoux
- Department of Neurology, University of Tennessee Health Science Center, Memphis, TN 38163, USA.
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5
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Abstract
Task-specific tremor is a form of action tremor that occurs only or mainly when a person is performing a specific skilled task. The most frequently encountered form of task-specific tremor is primary writing tremor (PWT). Currently, there is debate about whether PWT is a variant of essential tremor, writer's cramp (dystonia), a separate entity, or in some cases related to essential tremor and in others to dystonia. PWT typically occurs at a frequency of 5-7Hz and has been subdivided into to two types: Type A, task-induced tremor, and type B, positionally sensitive tremor. Temporary suppression of the tremor by alcohol is seen in about one-third of cases. There are no randomized controlled therapeutic studies involving patients with PWT, although anecdotal reports of beneficial responses to propranolol, primidone, anticholinergics, botulinum toxin treatment, and stereotactic surgery have been reported. Reciprocal inhibition of the H-reflex and intracortical excitability are normal in PWT, unlike writer's cramp. Hyperactivity in the cerebellar hemispheres has been demonstrated with positron emission tomography in PWT. Other task-specific tremors have been described but have not been studied in detail.
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Affiliation(s)
- Peter G Bain
- Department of Medicine, Imperial College School of Medicine, Charing Cross Hospital Campus, London, UK.
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6
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Abstract
Dystonia is defined as involuntary sustained muscle contractions producing twisting or squeezing movements and abnormal postures. The movements can be stereotyped and repetitive and they may vary in speed from rapid to slow; sustained contractions can result in fixed postures. Dystonic disorders are classified into primary and secondary forms. Several types of adult-onset primary dystonia have been identified but all share the characteristic that dystonia (including tremor) is the sole neurologic feature. The forms most commonly seen in neurological practice include cranial dystonia (blepharospasm, oromandibular and lingual dystonia and spasmodic dysphonia), cervical dystonia (also known as spasmodic torticollis) and writer's cramp. These are the disorders that benefit most from botulinum toxin injections. A general characteristic of dystonia is that the movements or postures may occur in relation to specific voluntary actions by the involved muscle groups (such as in writer's cramp). Dystonic contractions may occur in one body segment with movement of another (overflow dystonia). With progression, dystonia often becomes present at rest. Dystonic movements typically worsen with anxiety, heightened emotions, and fatigue, decrease with relaxation, and disappear during sleep. There may be diurnal fluctuations in the dystonia, which manifest as little or no involuntary movement in the morning followed by severe disabling dystonia in the afternoon and evening. Morning improvement (or honeymoon) is seen with several types of dystonia. Patients often discover maneuvers that reduce the dystonia and which involve sensory stimuli such as touching the chin lightly in cervical dystonia. These maneuvers are known as sensory tricks, or gestes antagonistes. This chapter focuses on adult-onset focal dystonias including cranial dystonia, cervical dystonia, and writer's cramp. The chapter begins with a review of the epidemiology of focal dystonias, followed by discussions of each major type of focal dystonia, covering clinical phenomenology, differential genetics, and diagnosis. The chapter concludes with discussions of the pathophysiology, the few pathological cases published of adult-onset focal dystonia and management options, and a a brief look at the future.
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Affiliation(s)
- Marian L Evatt
- Department of Neurology, Emory University School of Medicine, Atlanta, GA 30322, USA
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7
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Ludlow CL, Adler CH, Berke GS, Bielamowicz SA, Blitzer A, Bressman SB, Hallett M, Jinnah HA, Juergens U, Martin SB, Perlmutter JS, Sapienza C, Singleton A, Tanner CM, Woodson GE. Research priorities in spasmodic dysphonia. Otolaryngol Head Neck Surg 2008; 139:495-505. [PMID: 18922334 DOI: 10.1016/j.otohns.2008.05.624] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2007] [Revised: 05/02/2008] [Accepted: 05/28/2008] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To identify research priorities to increase understanding of the pathogenesis, diagnosis, and improved treatment of spasmodic dysphonia. STUDY DESIGN AND SETTING A multidisciplinary working group was formed that included both scientists and clinicians from multiple disciplines (otolaryngology, neurology, speech pathology, genetics, and neuroscience) to review currently available information on spasmodic dysphonia and to identify research priorities. RESULTS Operational definitions for spasmodic dysphonia at different levels of certainty were recommended for diagnosis and recommendations made for a multicenter multidisciplinary validation study. CONCLUSIONS The highest priority is to characterize the disorder and identify risk factors that may contribute to its onset. Future research should compare and contrast spasmodic dysphonia with other forms of focal dystonia. Development of animal models is recommended to explore hypotheses related to pathogenesis. Improved understanding of the pathophysiology of spasmodic dysphonia should provide the basis for developing new treatment options and exploratory clinical trials. SIGNIFICANCE This document should foster future research to improve the care of patients with this chronic debilitating voice and speech disorder by otolaryngology, neurology, and speech pathology.
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Affiliation(s)
- Christy L Ludlow
- Laryngeal and Speech Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, 10 Center Drive, Bethesda, MD 20892, USA
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Movsessian P. Neuropharmacology of theophylline induced stuttering: the role of dopamine, adenosine and GABA. Med Hypotheses 2005; 64:290-7. [PMID: 15607558 DOI: 10.1016/j.mehy.2004.07.026] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2004] [Accepted: 07/19/2004] [Indexed: 11/24/2022]
Abstract
Developmental stuttering is a poorly understood speech disorder that starts out in childhood and some individuals continue to stutter throughout their lives. Stuttering is a disruption in smooth and fluent speech. Some stuttering primarily involves vocal blocks, which are spasms of the laryngeal musculature while prolongations, and repetitions of sound occur in other cases. Acquired stuttering, on the other hand, can occur at all ages and can be caused by brain injury and by pharmacological agents. Theophylline-induced stuttering is form of acquired stuttering. It is a rare side effect of theophylline therapy, but it provides interesting clues to the pharmacological mechanisms involved in stuttering. Theophylline-induced stuttering may involve the disrupt the optimal balance between excitatory and inhibitory neurotransmission throughout the brain by inhibiting GABA receptors. The disruption of the optimal balance between excitatory and inhibitory neurotransmission can also cause dysfunction in white matter fiber tracts such as those that connect the Broca's area to the motor cortex. This leads to a hyperexitation of the motor cortex which may mimic the motor cortex hyperexitability that exists in developmental stuttering. Theophylline also enhances dopaminergic neurotransmission through the inhibition of adenosine receptors and this may mimic the hyperdopaminergic state that exists in the brain of developmental stutterers. Theophylline causes the greatest release of dopamine in the basal ganglia through the inhibition of adenosine and GABA receptors. This may also cause dysfunction in the basal ganglia similar in some ways to the dysfunction that exits in developmental stuttering. Pharmacological enhancement of dopaminergic neurotransmission by other drugs been reported to cause stuttering in fluent individuals and to aggrevate dysfluency in stutterers.
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Abstract
Psychogenic movement disorders (PMDs) are best defined as hyper- or hypo-kinetic movement disorders, often associated with gait disorders, that cannot be directly attributed to a lesion or dysfunction of the nervous system and which are derived in most cases from psychological or psychiatric causes. There are a variety of PMDs including tremor, dystonia, parkinsonism, gait disorders and, even, unusual forms including paroxysmal dyskinesias. As has been recognised in the recent literature, PMDs cannot be strictly classified into clearly defined psychiatric disorders such as somatoform, dissociative or conversion disorders. In this review, we discuss the diagnosis of various PMDs (including hyper- and hypo-kinetic disorders; and current evidence for underlying comorbid disorders) and the current therapeutic approach to them. The therapy of PMDs is not well established, is very challenging to the clinician, and a better outcome can be achieved in the setting of a team approach involving movement disorders specialists, psychiatrists and therapists who specialise in cognitive-behavioural techniques. Current pharmacological and non-pharmacological approaches to treatment focus on therapy of underlying comorbid psychiatric and psychological issues, although compliance is a major concern.
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Affiliation(s)
- Madhavi Thomas
- Department of Neurology, Parkinson's Disease Center and Movement Disorders Clinic, Baylor College of Medicine, Houston, Texas, USA
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10
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McAuley J, Rothwell J. Identification of psychogenic, dystonic, and other organic tremors by a coherence entrainment test. Mov Disord 2004; 19:253-67. [PMID: 15022179 DOI: 10.1002/mds.10707] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
The differentiation of psychogenic from organic tremors, particularly those of a dystonic nature, can be difficult on clinical grounds. Entrainment of tremulous movements of different body parts into a single rhythm has been used clinically as a means of distinguishing these tremor forms, based on the inability of a patient with hysterical tremor to generate voluntary tapping oscillations independent of their ongoing tremor oscillation. The coherence entrainment test is a quantified electrophysiological entrainment test performed on accelerometer or surface EMG tremor signals. This test was carried out on 25 patients referred with suspected psychogenic tremor or dystonic tremor and on 10 normal subjects attempting to tap two independent voluntary oscillations. Using established and new clinical diagnostic criteria, patients were assigned the following final clinical diagnoses: 6 cases of clinically definite dystonic tremor, 5 cases of probable dystonic tremor, 2 cases of classic essential tremor, 5 cases of clinically definite psychogenic tremor, 3 cases of probable psychogenic tremor and 4 uncertain cases. On comparing these clinical diagnoses with those reached by a coherence entrainment test subsequently carried out on each patient, there was 100% concordance in both clinically definite and clinically probable patients. In uncertain cases, when later clinical information came to light, this also corroborated with the coherence entrainment diagnosis. No normal subjects were able to "mimic" organic tremor. The coherence entrainment test appears to be a sensitive and specific means of distinguishing psychogenic tremor from dystonic and other organic tremors.
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Affiliation(s)
- John McAuley
- Queen Mary Medical College, Royal London Hospital, London, United Kingdom.
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Alm PA. Stuttering and the basal ganglia circuits: a critical review of possible relations. JOURNAL OF COMMUNICATION DISORDERS 2004; 37:325-69. [PMID: 15159193 DOI: 10.1016/j.jcomdis.2004.03.001] [Citation(s) in RCA: 319] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2003] [Revised: 02/12/2004] [Accepted: 03/16/2004] [Indexed: 05/23/2023]
Abstract
UNLABELLED The possible relation between stuttering and the basal ganglia is discussed. Important clues to the pathophysiology of stuttering are given by conditions known to alleviate dysfluency, like the rhythm effect, chorus speech, and singing. Information regarding pharmacologic trials, lesion studies, brain imaging, genetics, and developmental changes of the nervous system is reviewed. The symptoms of stuttering are compared with basal ganglia motor disorders like Parkinson's disease and dystonia. It is proposed that the basal ganglia-thalamocortical motor circuits through the putamen are likely to play a key role in stuttering. The core dysfunction in stuttering is suggested to be impaired ability of the basal ganglia to produce timing cues for the initiation of the next motor segment in speech. Similarities between stuttering and dystonia are indicated, and possible relations to the dopamine system are discussed, as well as the interaction between the cerebral cortex and the basal ganglia. Behavioral and pharmacologic information suggests the existence of subtypes of stuttering. LEARNING OUTCOMES As a result of this activity, the reader will (1) become familiar with the research regarding the basal ganglia system relating to speech motor control; (2) become familiar with the research on stuttering with indications of basal ganglia involvement; and (3) be able to discuss basal ganglia mechanisms with relevance for theory of stuttering.
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Affiliation(s)
- Per A Alm
- Department of Clinical Neuroscience, Lund University, Lund, Sweden.
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12
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Abstract
The development of abnormal posturing of the neck or shoulder after local injury has been termed posttraumatic cervical dystonia (PTCD). Certain features seem to distinguish a unique subgroup of patients with this disorder from those with features more akin to typical idiopathic cervical dystonia, such as onset and maximum disability that occurs very quickly after injury, severe pain and a fixed abnormal posture. In an attempt to clarify the nature of this syndrome further, we evaluated 16 such patients (8 men, 8 women). Motor vehicle accident and work-related injuries were common precipitants, with posturing usually developing shortly after trauma, and little progression occurring after the first week. A characteristic, painful, fixed head tilt and shoulder elevation were present in all but one patient, who had a painless elevated shoulder and painful contralateral shoulder depression, as well as nondermatomal sensory loss in 14 patients. Additional abnormalities included dystonic posturing in a limb (2 patients) or jaw (1 patient), limb tremor (3 patients) and "give-way" limb weakness (8 patients). The tremor and the jaw dystonia demonstrated features suggestive of a psychogenic movement disorder, most commonly distractibility. Litigation or compensation was present in all 16 patients. Intravenous sodium amytal improved the posture, pain or both in 13 of 13 patients; in 7 of 13 the sensory deficit either markedly improved or normalized. General anesthesia demonstrated full range of motion in all 5 patients assessed. Psychological evaluations suggested that psychological conflict, stress, or both were being expressed via somatic channels in 11 of 12 tested patients. Our results suggest an important role of psychological factors in the etiology or maintenance of abnormal posture, pain and associated disability of these patients. The role of central factors triggered in psychologically vulnerable individuals after physical trauma is discussed. We propose that the disorder be referred to as "posttraumatic painful torticollis" rather than characterize it as a form of dystonia until further information on its pathogenesis is forthcoming.
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Affiliation(s)
- Daniel S Sa
- Movement Disorders Unit, Toronto Western Hospital, University of Toronto, Ontario, Canada
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13
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Abstract
Movement disorders, a common problem in children with neurologic impairment, are receiving increasing clinical attention. The differences in movement disorders between adults and children are striking; presentation is frequently insidious and may be characterized by mild hypotonia. The clinical manifestations of extrapyramidal disorders are profoundly influenced by the age of onset. The conditions reviewed in this article are expressed clinically by the occurrence of abnormalities of movement and posture, often in association with disturbances of muscle tone. This article reviews empiric drug use and recommendations for childhood movement disorders.
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Affiliation(s)
- Terence S Edgar
- Department of Pediatric Neurology, Medical University of South Carolina, Charleston, SC 29425, USA.
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14
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Abstract
BACKGROUND Developmental stuttering affects 1% of the population but its cause remains unclear. Recent PET studies of metabolism in the central nervous system suggest that it may be related to dysfunction in the basal ganglia or its connections with regions of the cortex associated with speech and motor control. OBJECTIVE To determine the presence and characteristics of involuntary movements (IMs) in people who stutter and to investigate the hypothesis that these movements may be of a very similar nature to the IMs seen in patients with movement disorders due to basal ganglia dysfunction. METHODS Sixteen adults with developmental stuttering and 16 controls matched for sex and age were audio-videotaped while freely speaking 300 words in conversation and reading aloud 300 words. The audio data was inspected for dysfluencies and the video data was scrutinised for the presence and characteristics of IMs. RESULTS Subjects who stuttered produced more IMs than controls during free speech (354 vs 187, p<0.05) and reading (297 vs 47, p<0.001). Most of the IMs in both groups were tics, with a greater number of both simple and complex motor tics (CMTs) in subjects who stuttered. CMTs were more frequent than simple motor tics in those who stuttered, but not in controls. The combination of repetitive eye blink followed by prolonged eye closure was found exclusively in the stuttering group, as were simple tics consisting of eyebrow raise or jaw movement. Dystonia in the form of blepharospasm was identified in a small number of subjects who stuttered. Choreic movements were not associated with stuttering. CONCLUSIONS Developmental stuttering is associated with the presence of IMs that are predominantly simple and CMTs. This association suggests that tics and stuttering may share a common pathophysiology and supports the view that, in common with tics, stuttering may reflect dysfunction in the basal ganglia or its immediate connections.
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Abstract
Psychogenic movement disorders (PMD) are challenging to diagnose and to treat. Since the nineteenth century, PMDs were recognized and described in painstaking detail. In the modern neurology clinic, PMDs may comprise 2-25% of the patient population. Recognition of the various types of PMDs, differentiation from organic illness and an approach to PMDs are described in this article.
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Affiliation(s)
- Janis M Miyasaki
- Morton and Gloria Shulman Movement Disorders Centre, Toronto Western Hospital, Department of Medicine (Neurology), University of Toronto, ON, Canada
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16
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Mulligan HF, Anderson TJ, Jones RD, Williams MJ, Donaldson IM. Dysfluency and involuntary movements: a new look at developmental stuttering. Int J Neurosci 2001; 109:23-46. [PMID: 11699339 DOI: 10.3109/00207450108986523] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Studies using modern imaging techniques suggest that, in developmental stuttering, there is dysfunction within the cortical and subcortical areas of the motor control system wider than that pertaining to speech motor control alone. If this is the case, one might expect motor deficits extending beyond and unrelated to the production of speech in people who stutter. This study explored this proposal by investigating the presence and characteristics of involuntary movements accompanying stuttering. Sixteen adults with developmental stuttering and 16 controls matched for age and sex were audio-videotaped during 5 minutes of conversational speech and reading a passage of 350 words. Audio-data were examined for dysfluencies. Movements of the face, head and upper body considered involuntary and not part of normal facial expression or gesture and not part of the mechanics of speech were identified and described from muted video-data. Subjects who stuttered had a higher proportion of classic (within-word) dysfluencies accompanied by involuntary movements (IMs) than controls during speech (24.4% vs. 4.5%, p = .054) and reading (28.6% vs. 4.9%, p = .033). There was no difference in proportion of classic dysfluencies accompanied by IMs between speech and reading for either group. IMs were also seen in both groups during fluent speech, with a similar incidence during free speech (3.9% vs. 3.0%, NS) but a greater incidence in the subjects who stuttered during reading (2.4% vs. 0.8%, p = .03). In contrast, there was no difference between the two groups for IMs accompanying normal (between-word) dysfluencies. This suggests that classic and normal dysfluency and their accompanying IMs have different etiologies. The notion that stuttering and IMs are due to altered function in a motor control system wider than that of speech motor control alone is supported by a higher incidence of IMs in people who stutter during both classic dysfluencies and fluent speech.
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Affiliation(s)
- H F Mulligan
- Christchurch Centre, School of Physiotherapy, University of Otago, PO Box 4345, Christchurch, New Zealand.
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Carluer L, Marié RM, Lambert J, Defer GL, Coskun O, Rossa Y. Acquired and persistent stuttering as the main symptom of striatal infarction. Mov Disord 2000; 15:343-6. [PMID: 10752592 DOI: 10.1002/1531-8257(200003)15:2<343::aid-mds1026>3.0.co;2-i] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- L Carluer
- Service de Neurologie Dejerine, CHU de la Côte de Nacre, Caen, France
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18
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Abstract
Essential tremor (ET) is one of the most common movement disorders. However, the etiology and pathogenesis are as yet unknown. Continued research will give us clues to understanding the impact on society, identifying genetic and environmental contributors to the disease, understanding the significance of a sporadic case, the phenotypic spectrum and timing of presentation, and the relationship with other neurologic disorders. Because the condition is both clinically and genetically heterogeneous and there is overlap with these other disorders, such as dystonia, parkinsonism, peripheral neuropathy, and migraine, the definition of phenotype plagues research in this area. Advances in understanding the genetic and molecular underpinnings of tremor should provide additional tools to unravel the clinical phenotype (including physiology), genotype-phenotype relationships, and the epidemiology of tremor.
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Affiliation(s)
- M F Brin
- Mount Sinai Medical Center, Department of Neurology, New York, NY 10029, USA
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19
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Abstract
Many different disorders have dystonia as the only or primary sign. The list of causes for dystonia increases yearly and now includes three mapped loci for primary torsion dystonia, although other susceptibility genes are suspected. Study of one of these primary torsion dystonia loci (DYT1) has culminated in the cloning of a gene which codes for a novel protein, torsin A. Physiological and positron emission tomography analyses suggest that dystonia results from impaired inhibition at cortical and subcortical levels; these physiological changes may in turn be due to striatal dysfunction and a mismatch or imbalance between the direct and indirect pathways. Future study of normal and mutant torsin A, as well as the identification of other primary torsion dystonia genes, should help elucidate the mechanisms underlying dystonia.
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Affiliation(s)
- S B Bressman
- Albert Einstein College of Medicine and Beth Israel Medical Center, New York, USA
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20
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Deuschl G, Heinen F, Guschlbauer B, Schneider S, Glocker FX, Lücking CH. Hand tremor in patients with spasmodic torticollis. Mov Disord 1997; 12:547-52. [PMID: 9251073 DOI: 10.1002/mds.870120411] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
The occurrence of hand tremors in patients with spasmodic torticollis (ST) was investigated in 55 patients by clinical and quantitative measurements. Ten patients had first-order or second-order relatives affected with postural tremor. Although 40% of the patients had a medical history and clinical findings for mild postural and action tremor of the hands, only four had moderate tremor amplitudes. One patient had a severe tremor, including resting tremor, and two had mild voice tremor. A positive correlation was found between hand and head tremor. Patients with hand tremor were younger at the onset of ST than were those without. The mean amplitudes of postural tremor were only slightly higher than for the controls and much smaller than those found in classic essential tremor. The tremor caused only mild disabilities. The tremor frequencies were indistinguishable from physiologic tremor. Further analysis of the tremor records showed evidence for physiologic tremor mechanisms only. We conclude that slightly enhanced postural hand tremors are common in ST but have a low amplitude and are only rarely clinically relevant for ST patients. Although the present data support the notion of an enhanced risk of postural tremor in families of patients affected with ST, none of the criteria allowed the separation of the hand tremor of ST from other postural/action tremors and especially from enhanced physiologic tremor. Thus, the present data do not support the classification of hand tremor in ST as either "dystonic" or essential tremor.
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Affiliation(s)
- G Deuschl
- Department of Neurology, Christian Albrechts University, Kiel, Germany
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21
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Abstract
We observed abnormal involuntary movements, involving principally the facial and neck muscles, in 23 patients with stuttering. These movements were similar to involuntary movements seen in distinct dystonic syndromes. There was a history of stuttering in the first degree relatives of six patients. The association of stuttering with degenerative neurologic disorders and focal brain lesions, cerebral blood flow changes in patients with developmental stuttering, its occurrence as a side effect of centrally acting drugs, induction and alleviation of stuttering by mechanical perturbation, or by electrical stimulation of the thalamus, a strong genetic predisposition with male preponderance, and the statistically significant occurrence of stuttering in the family history of patients with idiopathic torsion dystonia suggest an organic basis for developmental stuttering. These findings and the reported similarities between the involuntary movements associated with stuttering and dystonic involuntary movements support the hypothesis that stuttering is a form of segmental or focal action dystonia.
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Affiliation(s)
- G Kiziltan
- Department of Neurology, Cerrahpasa Medical Faculty, Istanbul University, Turkey
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22
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Abstract
OBJECTIVE To review the clinical characteristics and associated features found in patients with psychogenic dystonia. METHODS A 10 year retrospective chart review of all patients diagnosed by the author as having psychogenic dystonia. RESULTS Eighteen patients fulfilled diagnostic criteria for "Documented" or "Clinically Established" psychogenic dystonia. Clinical characteristics of the dystonia were inconsistent or incongruous with established forms of organic dystonia. Fourteen of the 18 patients had a known precipitant. In most, the onset was abrupt and progression occurred rapidly, often to fixed dystonic postures. In contrast to idiopathic dystonia, involvement of the legs was common (12 patients), despite onset in adult life. Although cases of isolated paroxysmal dystonia were excluded in the review, 10 patients had paroxysmal worsening of dystonia or other abnormal movements. Pain was a prominent feature in 14 of 16 patients with the complaint and 1 patient with documented psychogenic dystonia also had well established reflex sympathetic dystrophy (RSD). Other psychogenic movement disorders, psychogenic neurological signs and multiple somatizations were common. Long-term follow up was available for less than one-half of the patients. Outcome varied considerably; some patients had complete resolution of symptoms (including 1 who had undergone 2 previous thalamotomies) and others remained disabled by persistent dystonia. CONCLUSIONS Dystonia is uncommonly due to primary psychological factors. At times this is an extremely difficult diagnosis to make and even when the diagnosis is confirmed, management remains very challenging. Future studies are required in hopes of providing more efficient means of distinguishing psychogenic dystonia from other dystonic syndromes especially those which rarely follow peripheral injury or accompany RSD/causalgia syndromes.
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Affiliation(s)
- A E Lang
- Department of Medicine, Toronto Hospital, Ontario, Canada
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23
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Bressman SB, Hunt AL, Heiman GA, Brin MF, Burke RE, Fahn S, Trugman JM, de Leon D, Kramer PL, Wilhelmsen KC. Exclusion of the DYT1 locus in a non-Jewish family with early-onset dystonia. Mov Disord 1994; 9:626-32. [PMID: 7845403 DOI: 10.1002/mds.870090608] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
The DYT1 gene on chromosome 9q34 underlies idiopathic torsion dystonia (ITD) in Jewish and non-Jewish families with childhood and adolescent-onset dystonia that usually starts in a limb, spreads to other limbs, and uncommonly involves cranial muscles. We examined 39 members of a Mennonite family of German ancestry in which seven were affected with ITD. Age at onset was 14.7 years (range 5-34 years) and symptoms began in a limb in four. The remaining three had onset in the neck, face, and larynx. Dystonia progressed to involve at least one arm and one leg in all seven and there was cranial involvement in six. Five of these six had moderate or severe speech impairment. Linkage analysis with 9q34 markers excluded the region containing the DYT1 locus in this family. This study suggests that a gene other than DYT1 underlies some cases of early limb-onset ITD. The clinical features of prominent cranial involvement and impaired speech distinguish this "non-DYT1" early-onset ITD family from the typical DYT1 phenotype.
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Affiliation(s)
- S B Bressman
- Department of Neurology, Columbia-Presbyterian Medical Center, New York, New York 10032
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24
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Bain P. A combined clinical and neurophysiological approach to the study of patients with tremor. J Neurol Neurosurg Psychiatry 1993; 56:839-44. [PMID: 8350097 PMCID: PMC1015135 DOI: 10.1136/jnnp.56.8.839] [Citation(s) in RCA: 51] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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25
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Bertrand CM. Selective peripheral denervation for spasmodic torticollis: surgical technique, results, and observations in 260 cases. SURGICAL NEUROLOGY 1993; 40:96-103. [PMID: 8362358 DOI: 10.1016/0090-3019(93)90118-k] [Citation(s) in RCA: 103] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
A total of 260 cases of spasmodic torticollis or of the cervical component of diffuse dystonias have been surgically treated with selective peripheral denervation of the involved muscles sparing their antagonists, after verification with electromyography and, if necessary, nerve blocks. Total or marked relief of symptoms with preservation of normal or nearly normal movements has been obtained in 88% of the patients with surgery followed by early physiotherapy. There are minimal sequelae with this approach. Selective denervation may be recommended if, after 2 years, conservative treatment, including botulinum injections, does not offer satisfactory relief of symptoms.
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Affiliation(s)
- C M Bertrand
- Department of Neurosurgery, Hôpital Notre-Dame, Montréal, Canada
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26
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Sveinbjornsdottir S, Pakkenberg H, Werdelin L. Developmental stuttering followed by intermittent jaw opening dystonia. Mov Disord 1993; 8:396-7. [PMID: 8341312 DOI: 10.1002/mds.870080330] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
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27
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Conway D, Bain PG, Warner TT, Davis MB, Findley LJ, Thompson PD, Marsden CD, Harding AE. Linkage analysis with chromosome 9 markers in hereditary essential tremor. Mov Disord 1993; 8:374-6. [PMID: 8341306 DOI: 10.1002/mds.870080324] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Hereditary essential tremor (ET) is an autosomal dominant disorder with variable expression and reduced penetrance. A tremor indistinguishable from ET may be observed in patients with autosomal dominant idiopathic torsion dystonia (ITD), in which the disease locus has been mapped to 9q32-34 in some kindreds, tightly linked to the argininosuccinate synthetase (ASS) locus. We performed linkage analysis in 15 families with ET containing 60 definitely affected individuals, using dinucleotide repeat polymorphisms at the ASS locus and the Abelson locus (ABL). Cumulative lod scores were -19.5 for ASS and -10.8 for ABL at a recombination fraction of 0.01, and tight linkage to ASS was excluded individually in 11 of the families. These data indicate that the ET gene is not allelic to that causing ITD.
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Affiliation(s)
- D Conway
- University Department of Clinical Neurology, (Neurogenetics Section and MRC Human Movement and Balance Unit), Institute of Neurology, London, England
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28
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Affiliation(s)
- M Stacy
- Department of Neurology, University of Missouri, Columbia
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29
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Abstract
Dystonia is a term used to describe a specific set of abnormal movements that can occur as a symptom of a variety of neurologic disorders, but also as a disease entity in its own right. This review focuses on the primary dystonias and delineates the genetic contribution to these disorders. Included is a description of the well recognized forms of primary dystonias which manifest autosomal dominant inheritance, especially the "classic" type of early onset, generalized torsion dystonia, but also other clinically distinct forms such as myoclonic dystonia, paroxysmal dystonia, and DOPA-responsive dystonia. Also, a summary of the molecular genetic studies pertinent to these disorders and a discussion of the implications of recent genetic research for delineating the wide spectrum of this phenotypically and genetically heterogeneous group of diseases are forthcoming.
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Affiliation(s)
- T Gasser
- Department of Neurology, Massachusetts General Hospital, Charlestown 02129
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