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Doshi PK, Baldia M, Mulroy E, Krauss JK, Bhatia K. Outcomes of Unilateral Pallidotomy in Focal and Hemidystonia Cases: A Single-Blind Cohort Study. Mov Disord Clin Pract 2024; 11:30-37. [PMID: 38291847 PMCID: PMC10828613 DOI: 10.1002/mdc3.13912] [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: 05/19/2023] [Revised: 10/08/2023] [Accepted: 10/10/2023] [Indexed: 02/01/2024] Open
Abstract
BACKGROUND The role of deep brain stimulation in the treatment of dystonia has been widely documented. However, there is limited literature on the outcome of lesioning surgery in unilateral dystonia. OBJECTIVE We restrospectively reviewed our cases of focal and hemidystonia undergoing unilateral Pallidotomy at our institute to evaluate the short-term and long-term outcome. METHODS Patients who underwent radiofrequency lesioning of GPi for unilateral dystonia between 1999 and 2019 were retrospectively reviewed. All patients were evaluated using the Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS) and Dystonia Disability Scale (DDS) preoperatively at the short term follow-up (<1 year) and at long-term follow-up (2-7.5 years). Video recordings performed at these time points were independently reviewed by a blinded movement disorders specialist. RESULTS Eleven patients were included for analysis. The preoperative, short-term, and long-term follow-up motor BFMDRS and DDS scores were 15.5 (IQR [interquartile range]: 10.5, 23.75) and 10.5 (IQR: 6.0, 14.5); 3.0 (IQR: 1.0, 6.0, P = 0.02) and 3.0 (IQR: 3.0, 8.0, P = 0.016); and 14.25 (IQR: 4.0, 20.0, P = 0.20) and 10.5 (IQR: 2.0, 15.0, P = 0.71) respectively. For observers B, the BFMDRS scores at the same time points were 19 (IQR: 12.5, 27.0), 7.5 (IQR: 6.0, 15.0, P = 0.002), and 21 (IQR: 7.0, 22.0, P = 0.65) respectively. The improvement was statistically significant for all observations at short-term follow-up but not at long-term follow-up. CONCLUSION Pallidotomy is effective for hemidystonia or focal dystonia in the short term. Continued benefit was seen in the longer term in some patients, whereas others worsened. Larger studies may be able to explain this in future.
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Affiliation(s)
- Paresh K. Doshi
- Department of Stereotactic and Functional NeurosurgeryJaslok Hospital and Research CentreMumbaiIndia
| | - Manish Baldia
- Department of Stereotactic and Functional NeurosurgeryJaslok Hospital and Research CentreMumbaiIndia
| | - Eoin Mulroy
- Department of Clinical and Movement NeurosciencesUCL Queen Square Institute of NeurologyLondonUnited Kingdom
| | - Joachim K. Krauss
- Department of Neurosurgery, MHHHannover Medical SchoolHanoverGermany
| | - Kailash Bhatia
- Department of Clinical and Movement NeurosciencesUCL Queen Square Institute of NeurologyLondonUnited Kingdom
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2
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Abdulbaki A, Jijakli A, Krauss JK. Deep brain stimulation for hemidystonia: A meta-analysis with individual patient data. Parkinsonism Relat Disord 2023; 108:105317. [PMID: 36813584 DOI: 10.1016/j.parkreldis.2023.105317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 01/27/2023] [Accepted: 02/05/2023] [Indexed: 02/17/2023]
Abstract
BACKGROUND Deep brain stimulation (DBS) is now well established for the treatment of dystonic movement disorders. There is limited data, however, on the efficacy of DBS in hemidystonia. This meta-analysis aims to summarize the published reports on DBS for hemidystonia of different etiologies, to compare different stimulation targets, and to evaluate clinical outcome. METHODS A systematic literature review was performed on PubMed, Embase and Web of Science to identify appropriate reports. The primary outcome variables were the improvement in the Burke-Fahn-Marsden Dystonia Rating Scale movement (BFMDRS-M) and disability (BFMDRS-D) scores for dystonia. RESULTS Twenty-two reports (39 patients; 22 with pallidal stimulation, 4 with subthalamic stimulation, 3 with thalamic stimulation, and 10 with combined target stimulation) were included. Mean age at surgery was 26.8 years. Mean follow-up time was 31.72 months. An overall mean improvement of 40% in the BFMDRS-M score was achieved (range 0%-94%), which was paralleled by a mean improvement of 41% in the BFMDRS-D score. When considering a 20% cut-off for improvement, 23/39 patients (59%) would qualify as responders. Hemidystonia due to anoxia did not significantly improve with DBS. Several limitations of the results must be considered, most importantly the low level of evidence and the small number of reported cases. CONCLUSION Based on the results of the current analysis, DBS can be considered as a treatment option for hemidystonia. The posteroventral lateral GPi is the target used most often. More research is needed to understand the variability in outcome and to identify prognostic factors.
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Affiliation(s)
- Arif Abdulbaki
- Department of Neurosurgery, Hannover Medical School, Hannover, Germany.
| | - Amr Jijakli
- Department of Neurology, Tufts Medical Center, Boston, MA, USA
| | - Joachim K Krauss
- Department of Neurosurgery, Hannover Medical School, Hannover, Germany
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Wolff Fernandes F, Saryyeva A, Ertl P, Krauss JK. Hemidystonia secondary to pediatric thalamic glioblastoma: a case report. Childs Nerv Syst 2023; 39:557-559. [PMID: 36220936 PMCID: PMC10006018 DOI: 10.1007/s00381-022-05698-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 09/28/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Thalamic tumors are rare and uncommonly manifest as movement disorders, including hemidystonia. Despite this association, little is known about the evolution of hemidystonia. CASE DESCRIPTION We report on a 11-year-old boy who complained of hypaesthesia and fine motor problems in the left hand. A magnetic resonance imaging showed a large mass in the right thalamus. Stereotactic biopsy revealed a WHO grade 4 astrocytoma, and the patient underwent normofractioned radiochemotherapy with proton-beam radiation and temozolomide. Three months later, a spastic hemiparesis developed on the left side, which progressed over months. Over the following months, the hemiparesis slowly improved, but hemidystonia in the same side developed. This was accompanied with radiological evidence of tumor regression, showing a persistent lesion in the ventral posterolateral and the intralaminar thalamus. CONCLUSION This case illustrates the unusual and complex temporal course of appearance and disappearance of hemidystonia along with the regression and growth in glioblastoma involving the thalamus.
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Affiliation(s)
- Filipe Wolff Fernandes
- Department of Neurosurgery, Hannover Medical School, Carl-Neuberg Strasse 1, 30625, Hannover, Germany.
| | - Assel Saryyeva
- Department of Neurosurgery, Hannover Medical School, Carl-Neuberg Strasse 1, 30625, Hannover, Germany
| | - Philipp Ertl
- Department of Neurosurgery, Hannover Medical School, Carl-Neuberg Strasse 1, 30625, Hannover, Germany
| | - Joachim Kurt Krauss
- Department of Neurosurgery, Hannover Medical School, Carl-Neuberg Strasse 1, 30625, Hannover, Germany
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Pentony M, Featherstone M, Sheikh Y, Stroiescu A, Bruell H, Gill I, Gorman KM. Dystonia in children with acquired brain injury. Eur J Paediatr Neurol 2022; 41:41-47. [PMID: 36209658 DOI: 10.1016/j.ejpn.2022.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 07/25/2022] [Accepted: 09/22/2022] [Indexed: 01/11/2023]
Abstract
AIM To quantify the proportion of children who develop dystonia after acquired brain injury (ABI) admitted to a tertiary paediatric intensive care unit (PICU) and analyse the trajectory of dystonia over a 6 month period. METHODS Children's Health Ireland at Temple Street PICU electronic database was searched for key terms related to ABI from January 1, 2016 to March 14, 2021. Individuals meeting inclusion criteria were analysed, and clinical data pertinent to ABI, dystonia, treatment and outcomes were reviewed. RESULTS Six-hundred and forty-three PICU episodes (580 patients) met search criteria for ABI, with 379 included in the final analysis. Twelve patients developed dystonia following ABI, giving an incidence of 3.2%. The incidence was higher in the hypoxia/anoxia and TBI cohort at 8.3% and 6.2%, respectively. All patients developed dystonia within the first month following ABI (50% by a week). Patients who developed dystonia compared to non-dystonia cohort had a median lower GCS on admission (4.5 versus 7.0, p value 0.032), longer median length of PICU stay (14.0 versus 3.0 days, p value < 0.001) and were older (median age 9.08 versus 4.68 years, p value 0.06). Dystonia persisted in the majority at 6 months (10/11), requiring on-going medical therapies. CONCLUSION In our retrospective study, the estimated incidence of dystonia following ABI admitted to the PICU was 3.2%, highest in the hypoxia/anoxia (8.3%) and TBI (6.2%) cohorts. Dystonia emerged early and persisted at 6 months in the majority. This is the first review of dystonia, clinical trajectory and outcomes conducted post-PICU admission for ABI. Future prospective studies are required to determine the true prevalence and burden of disease in the PICU setting.
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Affiliation(s)
- M Pentony
- Department of Neurology and Clinical Neurophysiology, Children's Health Ireland at Temple Street, Ireland
| | - M Featherstone
- School of Medicine and Medical Science, University College Dublin, Dublin, Ireland
| | - Y Sheikh
- Department of Paediatric Radiology, Children's Health Ireland at Temple Street, Ireland
| | - A Stroiescu
- Department of Paediatric Radiology, Children's Health Ireland at Temple Street, Ireland
| | - H Bruell
- Department of Paediatric Intensive Care, Children's Health Ireland at Temple Street, Ireland
| | - I Gill
- School of Medicine and Medical Science, University College Dublin, Dublin, Ireland; Department of Neurodisability, Children's Health Ireland at Temple Street, Ireland; Department of Paediatric Rehabilitation, National Rehabilitation Hospital, Dublin, Ireland
| | - K M Gorman
- Department of Neurology and Clinical Neurophysiology, Children's Health Ireland at Temple Street, Ireland; School of Medicine and Medical Science, University College Dublin, Dublin, Ireland.
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Cunha de Azevedo AR, Contreras López WO, Navarro PA, Gouveia FV, Germann J, Elias GJB, Ruiz Martinez RC, Lopes Alho EJ, Fonoff ET. Unilateral Campotomy of Forel for Acquired Hemidystonia: An Open-Label Clinical Trial. Neurosurgery 2022; 91:139-145. [PMID: 35550448 DOI: 10.1227/neu.0000000000001963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 01/24/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Hemidystonia (HD) is characterized by unilateral involuntary torsion movements and fixed postures of the limbs and face. It often develops after deleterious neuroplastic changes secondary to injuries to the brain. This condition usually responds poorly to medical treatment, and deep brain stimulation often yields unsatisfactory results. We propose this study based on encouraging results from case reports of patients with HD treated by ablative procedures in the subthalamic region. OBJECTIVE To compare the efficacy of stereotactic-guided radiofrequency lesioning of the subthalamic area vs available medical treatment in patients suffering from acquired HD. METHODS This is an open-label study in patients with secondary HD allocated according to their treatment choice, either surgical or medical treatment; both groups were followed for one year. Patients assigned in the surgical group underwent unilateral campotomy of Forel. The efficacy was assessed using the Unified Dystonia Rating Scale, Fahn-Marsden Dystonia Scale, Arm Dystonia Disability Scale, and SF-36 questionnaire scores. RESULTS Patients in the surgical group experienced significant improvement in the Unified Dystonia Rating Scale, Fahn-Marsden Dystonia Scale, and Arm Dystonia Disability Scale (39%, 35%, and 15%, respectively) 1 year after the surgery, with positive reflex in quality-of-life measures, such as bodily pain and role-emotional process. Patients kept on medical treatment did not experience significant changes during the follow-up. No infections were recorded, and no neurological adverse events were associated with either intervention. CONCLUSION The unilateral stereotaxy-guided ablation of Forel H1 and H2 fields significantly improved in patients with HD compared with optimized clinical treatment.
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Affiliation(s)
| | - William Omar Contreras López
- Department of Functional Neurosurgery, NEMOD Research Group, Universidad Autónoma de Bucaramanga, Division of Functional Neurosurgery, FOSCAL Hospital, Bucaramanga, Colombia
| | | | - Flavia Venetucci Gouveia
- Neurosciences and Mental Health, The Hospital for Sick Children Research Institute, Toronto, Canada
| | | | | | - Raquel Chacon Ruiz Martinez
- LIM/23, Institute of Psychiatry, University of Sao Paulo School of Medicine, Sao Paulo, Brazil
- Division of Neuroscience, Hospital Sirio-Libanes, Sao Paulo, Brazil
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Moon D. Disorders of Movement due to Acquired and Traumatic Brain Injury. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2022; 10:311-323. [PMID: 36164499 PMCID: PMC9493170 DOI: 10.1007/s40141-022-00368-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/28/2022] [Indexed: 12/14/2022]
Abstract
Purpose of Review Both traumatic and acquired brain injury can result in diffuse multifocal injury affecting both the pyramidal and extrapyramidal tracts. Thus, these patients may exhibit signs of both upper motor neuron syndrome and movement disorder simultaneously which can further complicate diagnosis and management. We will be discussing movement disorders following acquired and traumatic brain injury. Recent Findings Multiple functions including speech, swallowing, posture, mobility, and activities of daily living can all be affected. Medical treatment and rehabilitation-based therapy can be especially challenging due to accompanying cognitive deficits and severity of the disorder which can involve multiple limbs in addition to muscles of the face and axial skeleton. Tremor and dystonia are the most reported movement disorders following traumatic brain injury. Dystonia and myoclonus are well documented following hypoxic ischemic brain injuries. Electrophysiological studies such as dynamic surface poly-electromyography can assist with identifying phenomenology, especially differentiating between jerk-like phenomenon and help guide further work up and management. Management with medications remains challenging due to potential adverse effects. Surgical interventions including stereotactic surgery, deep brain stimulation, and intrathecal baclofen pumps have been reported, but most of the evidence supporting them has been limited to primarily case reports except for post-traumatic tremor. Summary Brain injury can lead to motor disorders, movement disorders, visual (processing) deficits, and vestibular deficits which often coexist with cognitive deficits making it challenging to treat and rehabilitate these patients. Unfortunately, the evidence regarding the medical management and rehabilitation of brain injury patients with movement disorders is sparse and leaves much to be desired.
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Affiliation(s)
- Daniel Moon
- grid.421874.c0000 0001 0016 6543Moss Rehabilitation Hospital, Elkins Park, PA USA
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Li J, Levin DS, Kim AJ, Pappas SS, Dauer WT. TorsinA restoration in a mouse model identifies a critical therapeutic window for DYT1 dystonia. J Clin Invest 2021; 131:139606. [PMID: 33529159 DOI: 10.1172/jci139606] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 01/27/2021] [Indexed: 12/18/2022] Open
Abstract
In inherited neurodevelopmental diseases, pathogenic processes unique to critical periods during early brain development may preclude the effectiveness of gene modification therapies applied later in life. We explored this question in a mouse model of DYT1 dystonia, a neurodevelopmental disease caused by a loss-of-function mutation in the TOR1A gene encoding torsinA. To define the temporal requirements for torsinA in normal motor function and gene replacement therapy, we developed a mouse line enabling spatiotemporal control of the endogenous torsinA allele. Suppressing torsinA during embryogenesis caused dystonia-mimicking behavioral and neuropathological phenotypes. Suppressing torsinA during adulthood, however, elicited no discernible abnormalities, establishing an essential requirement for torsinA during a developmental critical period. The developing CNS exhibited a parallel "therapeutic critical period" for torsinA repletion. Although restoring torsinA in juvenile DYT1 mice rescued motor phenotypes, there was no benefit from adult torsinA repletion. These data establish a unique requirement for torsinA in the developing nervous system and demonstrate that the critical period genetic insult provokes permanent pathophysiology mechanistically delinked from torsinA function. These findings imply that to be effective, torsinA-based therapeutic strategies must be employed early in the course of DYT1 dystonia.
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Affiliation(s)
- Jay Li
- Medical Scientist Training Program.,Cellular and Molecular Biology Graduate Program
| | - Daniel S Levin
- Department of Neurology, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Samuel S Pappas
- Peter O'Donnell Jr. Brain Institute.,Department of Neurology
| | - William T Dauer
- Peter O'Donnell Jr. Brain Institute.,Department of Neurology.,Department of Neuroscience, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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8
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Tambirajoo K, Furlanetti L, Samuel M, Ashkan K. Subthalamic Nucleus Deep Brain Stimulation in Post-Infarct Dystonia. Stereotact Funct Neurosurg 2020; 98:386-398. [DOI: 10.1159/000509317] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 06/10/2020] [Indexed: 11/19/2022]
Abstract
Dystonia secondary to cerebral infarcts presents months to years after the initial insult, is usually unilateral and causes significant morbidity. Deep brain stimulation (DBS) of the globus pallidus internus (GPi) is established as the most frequent target in the management of the dystonic symptoms. We report our experience with subthalamic nucleus (STN) DBS in 3 patients with post-infarct dystonia, in whom GPi DBS was not confidently possible due to the presence of striatal infarcts. Two patients had unilateral STN DBS implantation, whereas the third patient had bilateral STN DBS implantation for bilateral dystonic symptoms. Prospectively collected preoperative and postoperative functional assessment data including imaging, medication and neuropsychology evaluations were analyzed with regard to symptom improvement. Median follow-up period was 38.3 months (range 26–43 months). All patients had clinically valuable improvements in dystonic symptoms and pain control despite variable improvements in the Burke-Fahn-Marsden dystonia rating scores. In our series, we have demonstrated that STN DBS could be an alternative in the management of post-infarct dystonia in patients with abnormal striatal anatomy which precludes GPi DBS. A multidisciplinary team-based approach is essential for patient selection and management.
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9
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Li HX, He L, Zhang CC, Eisinger R, Pan YX, Wang T, Sun BM, Wu YW, Li DY. Deep brain stimulation in post-traumatic dystonia: A case series study. CNS Neurosci Ther 2019; 25:1262-1269. [PMID: 31033189 PMCID: PMC6834919 DOI: 10.1111/cns.13145] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 03/27/2019] [Accepted: 04/14/2019] [Indexed: 11/29/2022] Open
Abstract
Aims Deep brain stimulation (DBS) has been proposed as an effective treatment for drug‐intolerant isolated dystonia, but whether it is also efficacious for posttraumatic dystonia (PTD) is unknown. Reports are few in number and have reached controversial conclusions regarding the efficacy of DBS for PTD treatment. Here, we report a case series of five PTD patients with improved clinical benefit following DBS treatment. Methods Five patients with disabling PTD underwent DBS therapy. The clinical outcomes were assessed with the Burke–Fahn–Marsden dystonia rating scale (BFMDRS) at baseline and the last follow‐up visit (at more than 12 months). Results Patients 1 and 3 received unilateral globus pallidus internus (GPi) DBS for contralateral dystonia. The subthalamic nucleus (STN) was chosen as target for patients 2 and 4, due to a lesion located in the globus pallidus. Patient 5 had an electrode in the ventral intermediate nucleus (VIM) for treating predominant tremor of left upper extremity, with unexpected improvement of focal hand dystonia. The scores of BFMDRS movement exhibited favorable improvement in all five patients at the last follow‐up, ranging from 52.4% to 78.6%. Conclusions Deep brain stimulation may be an effective and safe treatment for medically refractory PTD, but this needs to be confirmed by further studies.
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Affiliation(s)
- Hong-Xia Li
- Department of Neurology & Institute of Neurology, Ruijin Hospital, Affiliated with Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lu He
- Department of Neurology & Institute of Neurology, Ruijin Hospital, Affiliated with Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chen-Cheng Zhang
- Department of Functional Neurosurgery, Ruijin Hospital, Affiliated with Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Robert Eisinger
- Department of Neuroscience, University of Florida, Gainesville, Florida
| | - Yi-Xin Pan
- Department of Functional Neurosurgery, Ruijin Hospital, Affiliated with Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tao Wang
- Department of Functional Neurosurgery, Ruijin Hospital, Affiliated with Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bo-Min Sun
- Department of Functional Neurosurgery, Ruijin Hospital, Affiliated with Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yi-Wen Wu
- Department of Neurology & Institute of Neurology, Ruijin Hospital, Affiliated with Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Laboratory of Neurodegenerative Diseases & Key Laboratory of Stem Cell Biology, Institute of Health Science, Shanghai Institutes for Biological Sciences (SIBS), Chinese Academy of Sciences (CAS) & Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Dian-You Li
- Department of Functional Neurosurgery, Ruijin Hospital, Affiliated with Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Ogawa T, Shojima Y, Kuroki T, Eguchi H, Hattori N, Miwa H. Cervico-shoulder dystonia following lateral medullary infarction: a case report and review of the literature. J Med Case Rep 2018; 12:34. [PMID: 29426369 PMCID: PMC5807857 DOI: 10.1186/s13256-018-1561-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 12/31/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Secondary cervical dystonia is induced by organic brain lesions involving the basal ganglia, thalamus, cerebellum, and brain stem. It is extremely rare to see cervical dystonia induced by a medullary lesion. CASE PRESENTATION We report a case of an 86-year-old Japanese woman who developed cervical dystonia following lateral medullary infarction. She developed sudden-onset left upper and lower extremity weakness, right-side numbness, and dysarthria. Brain magnetic resonance imaging revealed an acute ischemic lesion involving the left lateral and dorsal medullae. A few days after her stroke, she complained of a taut sensation in her left neck and body, and cervico-shoulder dystonia toward the contralateral side subsequently appeared. Within a few weeks, it disappeared spontaneously, but her hemiplegia remained residual. CONCLUSIONS To date, to the best of our knowledge, there has been only one reported case of cervical dystonia associated with a single medullary lesion. It is interesting to note the similarities in the clinical characteristics of the previously reported case and our patient: the involvement of the dorsal and caudal parts of the medullary and associated ipsilateral hemiplegia. The present case may support the speculation that the lateral and caudal regions of the medulla may be the anatomical sites responsible for inducing cervical dystonia.
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Affiliation(s)
- Takashi Ogawa
- Department of Neurology, Juntendo University Nerima Hospital, 3-1-10 Takanodai, Nerima, Tokyo, 177-8521, Japan
| | - Yuri Shojima
- Department of Neurology, Juntendo University Nerima Hospital, 3-1-10 Takanodai, Nerima, Tokyo, 177-8521, Japan
| | - Takuma Kuroki
- Department of Neurology, Juntendo University Nerima Hospital, 3-1-10 Takanodai, Nerima, Tokyo, 177-8521, Japan
| | - Hiroto Eguchi
- Department of Neurology, Juntendo University Nerima Hospital, 3-1-10 Takanodai, Nerima, Tokyo, 177-8521, Japan
| | - Nobutaka Hattori
- Department of Neurology, Juntendo University School of Medicine, 1-21-1 Hongo, Bunkyo, Tokyo, 113-0033, Japan
| | - Hideto Miwa
- Department of Neurology, Juntendo University Nerima Hospital, 3-1-10 Takanodai, Nerima, Tokyo, 177-8521, Japan.
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11
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Frei K. Posttraumatic dystonia. J Neurol Sci 2017; 379:183-191. [DOI: 10.1016/j.jns.2017.05.040] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 05/17/2017] [Accepted: 05/21/2017] [Indexed: 11/29/2022]
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12
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Liuzzi D, Gigante AF, Leo A, Defazio G. The anatomical basis of upper limb dystonia: lesson from secondary cases. Neurol Sci 2016; 37:1393-8. [PMID: 27173653 DOI: 10.1007/s10072-016-2598-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 04/28/2016] [Indexed: 10/21/2022]
Abstract
Upper limb dystonia is a focal dystonia that may affect muscles in the arm, forearm and hand. The neuroanatomical substrates involved in upper limb dystonia are not fully understood. Traditionally, dysfunction of the basal ganglia is presumed to be the main cause of dystonia but a growing body of evidence suggests that a network of additional cortical and subcortical structures may be involved. To identify the brain regions that are affected in secondary upper limb dystonia may help to better understand the neuroanatomical basis of the condition. We considered only patients with focal upper limb dystonia associated with a single localized brain lesion. To identify these patients, we conducted a systematic review of the published literature as well as the medical records of 350 patients with adult-onset dystonia seen over past 15 years at our movement disorder clinic. The literature review revealed 36 articles describing 72 cases of focal upper limb dystonia associated with focal lesions. Among patients at our clinic, four had focal lesions on imaging studies. Lesions were found in multiple regions including thalamus (n = 39), basal ganglia (n = 17), cortex (n = 4), brainstem (n = 4), cerebellum (n = 1), and cervical spine (n = 7). Dystonic tremor was not associated with any particular site of lesion, whereas there was a trend for an inverse association between task specificity and thalamic involvement. These data in combination with functional imaging studies of idiopathic upper limb dystonia support a model in which a network of different regions plays a role in pathogenesis.
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Affiliation(s)
- Daniele Liuzzi
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, "Aldo Moro" University of Bari, 70124, Bari, Italy
| | - Angelo Fabio Gigante
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, "Aldo Moro" University of Bari, 70124, Bari, Italy
| | - Antonio Leo
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, "Aldo Moro" University of Bari, 70124, Bari, Italy
| | - Giovanni Defazio
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, "Aldo Moro" University of Bari, 70124, Bari, Italy. .,Department of Neuroscience and Sense Organs, "Aldo Moro" University of Bari, Policlinico di Bari, piazza Giulio Cesare, 11-70124, Bari, Italy.
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13
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Slotty PJ, Poologaindran A, Honey CR. A prospective, randomized, blinded assessment of multitarget thalamic and pallidal deep brain stimulation in a case of hemidystonia. Clin Neurol Neurosurg 2015; 138:16-9. [DOI: 10.1016/j.clineuro.2015.07.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Revised: 07/13/2015] [Accepted: 07/14/2015] [Indexed: 10/23/2022]
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Polemikos M, Lütjens G, Krauss JK. Dystonic Hand Associated with Spontaneous Migration of a Retained Bullet. Mov Disord Clin Pract 2015; 3:98-99. [PMID: 30363478 DOI: 10.1002/mdc3.12223] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Revised: 06/18/2015] [Accepted: 06/30/2015] [Indexed: 11/06/2022] Open
Affiliation(s)
| | - Götz Lütjens
- Department of Neurosurgery Hannover Medical School Hannover Germany
| | - Joachim K Krauss
- Department of Neurosurgery Hannover Medical School Hannover Germany
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Abstract
Over the past few decades it has been recognized that traumatic brain injury may result in various movement disorders. In survivors of severe head injury, post-traumatic movement disorders were reported in about 20%, and they persisted in about 10% of patients. The most frequent persisting movement disorder in this population is kinetic cerebellar outflow tremor in about 9%, followed by dystonia in about 4%. While tremor is associated most frequently with cerebellar or mesencephalic lesions, patients with dystonia frequently have basal ganglia or thalamic lesions. Moderate or mild traumatic brain injury only rarely causes persistent post-traumatic movement disorders. It appears that the frequency of post-traumatic movement disorders overall has been declining which most likely is secondary to improved treatment of brain injury. In patients with disabling post-traumatic movement disorders which are refractory to medical treatment, stereotactic neurosurgery can provide long-lasting benefit. While in the past the primary option for severe kinetic tremor was thalamotomy and for dystonia thalamotomy or pallidotomy, today deep brain stimulation has become the preferred treatment. Parkinsonism is a rare consequence of single head injury, but repeated head injury such as seen in boxing can result in chronic encephalopathy with parkinsonian features. While there is still controversy whether or not head injury is a risk factor for the development of Parkinson's disease, recent studies indicate that genetic susceptibility might be relevant.
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Affiliation(s)
- Joachim K Krauss
- Department of Neurosurgery, Medical School Hannover, Hannover, Germany.
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Komarova IB, Zykov VP, Shuleshko OV, Mamedova LS, Netesova EV, Voronenko OA. Arterial ischemic stroke in children with mild head trauma. Zh Nevrol Psikhiatr Im S S Korsakova 2015; 115:28-34. [DOI: 10.17116/jnevro20151155228-34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Abstract
Traumatic brain injury (TBI) remains a significant public health problem and is a leading cause of death and disability in many countries. Durable treatments for neurological function deficits following TBI have been elusive, as there are currently no FDA-approved therapeutic modalities for mitigating the consequences of TBI. Neurostimulation strategies using various forms of electrical stimulation have recently been applied to treat functional deficits in animal models and clinical stroke trials. The results from these studies suggest that neurostimulation may augment improvements in both motor and cognitive deficits after brain injury. Several studies have taken this approach in animal models of TBI, showing both behavioral enhancement and biological evidence of recovery. There have been only a few studies using deep brain stimulation (DBS) in human TBI patients, and future studies are warranted to validate the feasibility of this technique in the clinical treatment of TBI. In this review, the authors summarize insights from studies employing neurostimulation techniques in the setting of brain injury. Moreover, they relate these findings to the future prospect of using DBS to ameliorate motor and cognitive deficits following TBI.
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Affiliation(s)
- Samuel S Shin
- Department of Neurological Surgery, University of Pittsburgh, Pennsylvania
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DiFrancesco MF, Halpern CH, Hurtig HH, Baltuch GH, Heuer GG. Pediatric indications for deep brain stimulation. Childs Nerv Syst 2012; 28:1701-14. [PMID: 22828866 DOI: 10.1007/s00381-012-1861-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2012] [Accepted: 07/10/2012] [Indexed: 12/16/2022]
Abstract
PURPOSE Based on the success of deep brain stimulation (DBS) in the treatment of adult disorders, it is reasonable to assume that the application of DBS in the pediatric population is an emerging area worthy of study. The purpose of this paper is to outline the current movement disorder indications for DBS in the pediatric population, and to describe areas of investigation, including possible medically refractory psychiatric indications. METHODS We performed a structured review of the English language literature from 1990 to 2011 related to studies of DBS in pediatrics using Medline and PubMed search results. RESULTS Twenty-four reports of DBS in the pediatric population were found. Based on published data on the use of DBS for pediatric indications, there is a spectrum of clinical evidence for the use of DBS to treat different disorders. Dystonia, a disease associated with a low rate of remission and significant disability, is routinely treated with DBS and is currently the most promising pediatric application of DBS. We caution the application of DBS to conditions associated with a high remission rate later in adulthood, like obsessive-compulsive disorder and Tourette's syndrome. Moreover, epilepsy and obesity are currently being investigated as indications for DBS in the adult population; however, both are associated with significant morbidity in pediatrics. CONCLUSION While currently dystonia is the most promising application of DBS in the pediatric population, multiple conditions currently being investigated in adults also afflict children and adolescents, and thus warrant further research.
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Affiliation(s)
- Matthew F DiFrancesco
- Center for Functional and Restorative Neurosurgery, Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA 19104-4399, USA
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Kemp S, Kim S, Cordato D, Fung V. Delayed-onset focal dystonia of the leg secondary to traumatic brain injury. J Clin Neurosci 2012; 19:916-7. [DOI: 10.1016/j.jocn.2011.08.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2011] [Accepted: 08/28/2011] [Indexed: 10/14/2022]
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The long-term surgical outcomes of secondary hemidystonia associated with post-traumatic brain injury. Acta Neurochir (Wien) 2012; 154:823-30. [PMID: 22367408 DOI: 10.1007/s00701-012-1306-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2011] [Accepted: 02/07/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND The aim was to assess the effect of deep brain stimulation for secondary hemidystonias associated with focal post-traumatic brain injuries. METHODS Four patients underwent deep brain stimulation for the treatment of medically refractory secondary hemidystonia associated with post-traumatic brain injury. Clinical outcome assessments were based on Burke-Fahn-Marsden Dystonia Rating Scale movement and disability scores. Health-related quality of life was assessed using a 36-item short-form general health survey questionnaire administered preoperatively and at the last follow-up visit. RESULTS Burke-Fahn-Marsden Dystonia Rating Scale movement scores had improved by 73.2% (range, 38.1-94.1) and disability scores had improved by 75% (range, 60-100) at the 2-year follow-up visit. The health-related quality of life assessment revealed satisfactory results at follow-up, such that body pain, general health, vitality, social functioning, as well as emotional and mental health improved significantly. CONCLUSIONS Globus pallidus internus deep brain stimulation can be used to modulate and ameliorate secondary hemidystonia associated with focal post-traumatic brain injury.
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Trompetto C, Avanzino L, Marinelli L, Mori L, Pelosin E, Roccatagliata L, Abbruzzese G. Corticospinal excitability in patients with secondary dystonia due to focal lesions of the basal ganglia and thalamus. Clin Neurophysiol 2012; 123:808-14. [DOI: 10.1016/j.clinph.2011.06.033] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2010] [Revised: 05/20/2011] [Accepted: 06/26/2011] [Indexed: 11/16/2022]
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22
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Pérez Errazquin F, Gomez Heredia M. Levodopa-responsive parkinsonism-dystonia due to a traumatic injury of the substantia nigra. NEUROLOGÍA (ENGLISH EDITION) 2012. [DOI: 10.1016/j.nrleng.2012.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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23
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Kim YW, Kim JY, Koh DJ. Movement Disorders after Traumatic Brain Injury. BRAIN & NEUROREHABILITATION 2012. [DOI: 10.12786/bn.2012.5.2.47] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Yong Wook Kim
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Korea
| | - June Yop Kim
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Korea
| | - Dong Jin Koh
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Korea
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Treatment of secondary dystonia with a combined stereotactic procedure: long-term surgical outcomes. Acta Neurochir (Wien) 2011; 153:2319-27; discussion 2328. [PMID: 21909834 DOI: 10.1007/s00701-011-1147-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2011] [Accepted: 08/24/2011] [Indexed: 12/18/2022]
Abstract
OBJECTIVE There is some debate about the effects of pallidal deep brain stimulation (DBS) or lesioning on secondary dystonia. We applied a multimodal method to maximize the treatment effects of deep brain stimulation in patients with secondary dystonia. METHODS Between March 2003 and January 2009, four patients underwent bilateral globus pallidus internus (GPi) DBS and six patients underwent bilateral GPi DBS plus unilateral thalamotomy for treatment of cerebral palsy (CP). Among the patients with secondary dystonia without CP, five were also treated by DBS. We classified patients with generalized secondary dystonia with cerebral palsy into group I and patients with focal dystonia without CP into group II. Clinical outcome assessments were based on Burke-Fahn-Marsden Dystonia Rating Scale movement and disability scores. Heath-related quality of life was assessed with a 36-item short-form general health survey questionnaire preoperatively and at the last follow-up. RESULTS The movement and disability scores of group I-A had improved by 32.0% (P = 0.285) and 14.3% (P = 0.593), respectively, at the last follow-up compared with baseline. The movement and disability scores of group I-B had improved by 31.5% and 0.18% at the last follow-up compared with baseline, respectively. In comparison with patients in group I-A, patients in group I-B showed a significant improvement in movement scores for the contralateral arm (P = 0.042). Group II patients showed a marked improvement in movement and disability scores of 77.7% (P = 0.039) and 80.0% (P = 0.041), respectively. CONCLUSIONS We demonstrated that DBS plus unilateral ventralis oralis thalamotomy for CP patients with fixed states in the upper extremities is useful not only to treat secondary dystonic movement but also to improve quality of life. In group II patients with post-traumatic dystonia and tardive dyskinesia, we achieved excellent clinical outcomes using a stereotactic procedure.
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Pérez Errazquin F, Gomez Heredia MJ. [Levodopa-responsive parkinsonism-dystonia due to a traumatic injury of the substantia nigra]. Neurologia 2011; 27:181-3. [PMID: 21570743 DOI: 10.1016/j.nrl.2011.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2011] [Accepted: 03/06/2011] [Indexed: 11/24/2022] Open
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Abstract
The relationship between peripheral trauma and dystonia has been debated for more than a century but the issue still remains controversial. There are passionate supporters and detractors of the association and both the groups have their own arguments. This review aims to critically evaluate those arguments and presents current understanding of this association. In the process, the relevant case series and scientific papers exploring this subject have been discussed. Upon careful review of available literature coupled with their own experience, the authors believe that peripheral trauma can predispose to abnormal posturing of a body part after variable intervals. To call this posturing a "post-traumatic dystonia" might be premature and the term "post-traumatic syndrome" can be used instead. More work is needed to unravel the pathophysiology of this post-traumatic syndrome.
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Abstract
Secondary dystonia is well known subsequent to lesions of the basal ganglia or the thalamus. There is evidence that brainstem lesions may also be associated with dystonia, but little is known about pathoanatomical correlations. Here, we report on a series of four patients with acquired dystonia following brainstem lesions. There were no basal ganglia or thalamic lesions. Three patients suffered tegmental pontomesencephalic hemorrhage and one patient diffuse axonal injury secondary to severe craniocerebral trauma. Dystonia developed with a delay of 1 to 14 months, at a mean delay of 6 months. The patients' mean age at onset was 33 years (range 4-56 years). All patients presented with hemidystonia combined with cervical dystonia, and two patients had craniofacial dystonia in addition. Three patients had postural or kinetic tremors. Dystonia was persistent in three patients, and improved gradually in one. There was little response to medical treatment. One patient with hemidystonia combined with cervical dystonia improved after thalamotomy. Overall, the phenomenology of secondary dystonia due to pontomesencephalic lesions is similar to that caused by basal ganglia or thalamic lesions. Structures involved include the pontomesencephalic tegmentum and the superior cerebellar peduncles. Such lesions are often associated with fatal outcome. While delayed occurrence of severe brainstem dystonia appears to be rare, it is possible that mild manifestations of dystonia might be ignored or not be emphasized in the presence of other disabling deficits.
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Abstract
Cervical dystonia, the most common focal dystonia, frequently results in cervical pain and disability as well as impairments affecting postural control. The predominant treatment for cervical dystonia is provided by physicians, and treatment can vary from pharmacological to surgical. Little literature examining more conservative approaches, such as physical therapy, exists. This article reviews the etiology and pathophysiology of the disease as well as medical and physical therapist management for people with cervical dystonia.
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Affiliation(s)
- Beth E Crowner
- Program in Physical Therapy, Washington University School of Medicine, 4444 Forest Park Blvd, Campus Box 8502, St Louis, MO 63108, USA.
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Nabika S, Kiya K, Satoh H, Mizoue T, Oshita J, Kondo H. Ischemia of the internal capsule due to mild head injury in a child. Pediatr Neurosurg 2007; 43:312-5. [PMID: 17627149 DOI: 10.1159/000103313] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2005] [Accepted: 05/23/2006] [Indexed: 11/19/2022]
Abstract
We encountered an instructive case of repetitive reversible severe neurological deficit due to ischemia of the internal capsule after mild head injury. A 1-year-old boy fell and hit his head on the floor without losing consciousness. Intermittent episodes of left hemiparesis lasting from 30 s to 30 min developed 4 h later. Magnetic resonance (MR) imaging revealed acute infarction in the left internal capsule and corona radiata on diffusion-weighted imaging, and no microbleeding on susceptibility-weighted imaging. MR angiography of the intracranial and cervical vessels showed no obstruction of the large cerebral arteries. Motor impairment began to improve the next day with conservative therapy. Neurological deficit gradually resolved over the course of 1 month. This tiny lesion of the internal capsule and corona radiata may have represented a small infarction caused by mechanical vasospasm of the perforating vessels branching from the middle cerebral artery after minor injury. Even mild head injuries may cause infarction of the internal capsule, although minor head injuries are common accidents in childhood and usually do not result in severe complications.
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Affiliation(s)
- S Nabika
- Department of Neurosurgery, Hiroshima Prefectural Hospital, Hiroshima, Japan.
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30
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Imer M, Murat I, Ozeren B, Bekir O, Karadereler S, Selhan K, Yapici Z, Zuhal Y, Omay B, Bülent O, Hanağasi H, Hanğasi H, Haşmet H, Eraksoy M, Mefkure E. Destructive stereotactic surgery for treatment of dystonia. ACTA ACUST UNITED AC 2005; 64 Suppl 2:S89-94; discussion S94-5. [PMID: 16256851 DOI: 10.1016/j.surneu.2005.07.036] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND This study is a retrospective review of the results of stereotactic destructive surgery in selected cases of drug-resistant dystonia. METHODS Fifty-eight patients with drug-resistant dystonia were treated with stereotactic surgery between 1991 and 1999 in our institution. These patients' charts were retrospectively analyzed. The timing of the conducted evaluations was as follows: preoperatively, postoperatively, in the postoperative 1st week, 6th month, 12th month, and also thereafter every year. RESULTS Symptoms of dystonia occurred before the age of 10 years in 30 patients (51.8%) and after the age of 10 years in 28 patients (48.2%). Generalized dystonia was detected in 41 patients, whereas 11 patients had hemidystonia, 5 patients had focal dystonia, and 1 patient had segmental dystonia. The most common etiologic factor was CP (n = 34). A total of 103 ablative lesions were created in 86 surgical sessions. Thalamotomy, pallidotomy, subthalamotomy, and the region of Forel lesions were performed either separately or in combination. In this series, the mean follow-up time was 102.2 months. Except for 2 cases of temporary hemiparesis, no other complications were observed. Minor improvement was obtained in 17 patients (19.7%), improvement of a medium degree was obtained in 17 patients (19.7%), high-degree improvement was obtained in 11 (12.8%), and very high degree improvement was obtained in 16 (18.6%) patients. A final evaluation revealed permanent improvement in 32 patients (55.2%). CONCLUSION Production of stereotactic destructive lesions in certain specified targets is a safe method that improves quality of life and aids ambulation in patients with dystonia resistant to medical therapy.
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Affiliation(s)
- Murat Imer
- Department of Neurosurgery, Istanbul Faculty of Medicine, University of Istanbul, Capa-Istanbul 34390, Turkey
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Frei KP, Pathak M, Jenkins S, Truong DD. Natural history of posttraumatic cervical dystonia. Mov Disord 2005; 19:1492-8. [PMID: 15390063 DOI: 10.1002/mds.20239] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
We studied a case series of 9 patients with posttraumatic cervical dystonia, in whom involuntary muscle spasms and abnormal head postures occurred within 7 days after cervical injury. Patients were examined, treated with botulinum toxin as necessary, and were followed up to 5 years. Based on our observations of these cases, we propose that complex regional pain syndrome (CRPS) could represent a variant of posttraumatic cervical dystonia that may develop over time after the initiation of dystonia.
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Affiliation(s)
- Karen P Frei
- The Parkinson's and Movement Disorder Institute, Fountain Valley, California 92708, USA
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32
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Bogey RA, Elovic EP, Bryant PR, Geis CC, Moroz A, O'Neill BJ. Rehabilitation of movement disorders11A commercial party with a direct financial interest in the results of the research supporting this article has conferred or will confer a financial benefit upon the author or one or more of the authors. Elovic is on the advisory board and speaker’s bureau of Allergan. Arch Phys Med Rehabil 2004; 85:S41-5. [PMID: 15034854 DOI: 10.1053/j.apmr.2003.11.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
UNLABELLED This self-directed learning module highlights several movement disorders. These include dystonia, chorea, tremors, and myoclonus. A description of the clinical presentation and associated disease processes is presented. Although the discussion on treatment focuses on pharmacologic intervention, surgical options are presented when appropriate. Other movement disorders (ie, parkinsonism) are discussed elsewhere in the Study Guide. OVERALL ARTICLE OBJECTIVES (a) To define the various symptoms and etiologies of dystonia; (b) to define chorea and its treatment; (c) to define tremors, including associated neurologic disorders, plus pharmacologic and potential surgical interventions; and (d) to describe the symptoms, classification, and treatment of primary and secondary myoclonus.
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Affiliation(s)
- Ross A Bogey
- Department of Physical Medicine and Rehabilitation, Rehabilitation Institute of Chicago, IL 60611, USA.
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33
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Abstract
Head injury can cause extrapyramidal movement disorders such as tremors, parkinsonism, dystonia, chorea, myoclonus, and tics. Pure adventitious movements are rare, but combinations with paresis, spasticity, apraxia, or ataxia occur in approximately 20% of cases of severe head injury, in many cases appearing or evolving in the months following the injury. Tremors may improve in time but many of the other syndromes tend to persist. Reversible causes such as medications or metabolic derangements are occasionally identifiable. Some of these adventitious movements can be improved using neuroactive drugs, botulinum toxin injections, or stereotactic brain surgery.
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Affiliation(s)
- Padraig O'Suilleabhain
- Department of Neurology, University of Texas Southwestern Medical School, Dallas, 75390, USA.
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Duprey E, Dehail P, Cuny E, Arné P, Fernandez B, Joseph PA, Mazaux JM, Barat M. [Botulinum toxin and traumatic brain injury]. ANNALES DE READAPTATION ET DE MEDECINE PHYSIQUE : REVUE SCIENTIFIQUE DE LA SOCIETE FRANCAISE DE REEDUCATION FONCTIONNELLE DE READAPTATION ET DE MEDECINE PHYSIQUE 2003; 46:303-6. [PMID: 12928134 DOI: 10.1016/s0168-6054(03)00108-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Botulinum toxin is a successful focal spasticity therapy. The aim of this article is to study the data of the literature concerning its utilisation in traumatic brain injured patients, whom motor and tonus disturbances are polymorphic, in their clinical presentation as well as in their evolution. Although there are few studies concerning its utilisation in such patients, none of them being controlled, its use seems interesting in focal spasticity treatment. It can contribute to improve functional abilities and comfort for these patients.
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Affiliation(s)
- E Duprey
- Clinique Napoléon, lac de Christus, 40990 Saint-Paul-Lès-Dax, France.
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Sabbahi M, Etnyre B, Al-Jawayed I, Jankovic J. Soleus H-reflex measures in patients with focal and generalized dystonia. Clin Neurophysiol 2003; 114:288-94. [PMID: 12559236 DOI: 10.1016/s1388-2457(02)00375-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The purpose of this study was to examine neurophysiological characteristics of dystonia patients using electromyographic soleus H-reflex methods. METHODS Thirty normal healthy individuals were compared to 27 patients with focal (cervical) or generalized dystonia. Three H-reflex assessment methods were included: the ratio of maximum H-reflex to direct muscle potential (H/M ratio); vibration inhibition (H(v)/H(c) ratio); and H-reflex recovery curves (HRRC). RESULTS Average H/M ratios between groups were not statistically significant. The average H(v)/H(c) ratio for the generalized dystonia group was significantly greater than the focal dystonia and normal groups. Average values of the HRRC showed the generalized dystonia group had significantly greater disinhibition than the focal dystonia and control groups during the early inhibition phase. The HRRC for the focal dystonia group was greater than normal and more similar to the generalized dystonia group during the late phases of the recovery curve. The average value of the localized late facilitation phase for the focal dystonia group was significantly greater than the control group and less than the generalized dystonia group. No differences were observed between groups for the average localized late inhibition phase of the recovery curve. CONCLUSIONS Soleus H-reflex measures identified neurophysiologic differences between generalized dystonia, cervical dystonia and normal conditions. SIGNIFICANCE This methodology enables analysis of the underlying characteristics of dystonic pathologies using soleus H-reflex methods rather than upper extremity H-reflex techniques.
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Krauss JK, Jankovic J. Head injury and posttraumatic movement disorders. Neurosurgery 2002; 50:927-39; discussion 939-40. [PMID: 11950395 DOI: 10.1097/00006123-200205000-00003] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2001] [Accepted: 10/17/2001] [Indexed: 11/26/2022] Open
Abstract
WE REVIEW THE phenomenology, pathophysiology, pathological anatomy, and therapy of posttraumatic movement disorders with special emphasis on neurosurgical treatment options. We also explore possible links between craniocerebral trauma and parkinsonism. The cause-effect relationship between head injury and subsequent movement disorder is not fully appreciated. This may be related partially to the delayed appearance of the movement disorder. Movement disorders after severe head injury have been reported in 13 to 66% of patients. Although movement disorders after mild or moderate head injury are frequently transient and, in general, do not result in additional disability, kinetic tremors and dystonia may be a source of marked disability in survivors of severe head injury. Functional stereotactic surgery provides long-term symptomatic and functional benefits in the majority of patients. Thalamic radiofrequency lesioning, although beneficial in some patients, frequently is associated with side effects such as increased dysarthria or gait disturbance, particularly in patients with kinetic tremor secondary to diffuse axonal injury. Deep brain stimulation is used increasingly as an option in such patients. It remains unclear whether pallidal or thalamic targets are more beneficial for treatment of posttraumatic dystonia. Trauma to the central nervous system is an important causative factor in a variety of movement disorders. The mediation of the effects of trauma and the pathophysiology of the development of posttraumatic movement disorders require further study. Functional stereotactic surgery should be considered in patients with disabling movement disorders refractory to medical treatment.
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Affiliation(s)
- Joachim K Krauss
- Departments of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA.
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Chuang C, Fahn S, Frucht SJ. The natural history and treatment of acquired hemidystonia: report of 33 cases and review of the literature. J Neurol Neurosurg Psychiatry 2002; 72:59-67. [PMID: 11784827 PMCID: PMC1737703 DOI: 10.1136/jnnp.72.1.59] [Citation(s) in RCA: 83] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To evaluate the natural history and response to treatment in hemidystonia. METHODS 190 Cases of hemidystonia were identified; 33 patients in this series and 157 from the world literature. Data was collected on aetiology, age of onset, latency, lesion location, and response to treatment. RESULTS The most common aetiologies of hemidystonia were stroke, trauma, and perinatal injury. Mean age of onset was 20 years in this series and 25.7 years in the literature. The average latency from insult to dystonia was 4.1 years in this series and 2.8 years in the literature, with the longest latencies occurring after perinatal injury. Basal ganglia lesions were identified in 48% of cases in this series and 60% of the cases in the literature, most commonly involving the putamen. Patients experienced benefit from medical therapy in only 26% of medication trials in this series and in only 35% of trials in the literature. In the patients reported here, the benzodiazepines clonazepam and diazepam were the most effective medications with 50% of trials resulting in at least some benefit. In the literature, anticholinergic drugs were most effective with 41% of trials resulting in benefit. Surgery was successful in five of six cases in this series and in 22 of 23 cases in the literature. However, in 12 cases, results were transient. CONCLUSIONS The most common cause of hemidystonia is stroke, with the lesion most commonly involving the basal ganglia. Hemidystonia responds poorly to most medical therapies, but some patients may benefit from treatment with benzodiazepines or anticholinergic drugs. Surgical therapy may be successful but benefit is often transient.
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Affiliation(s)
- C Chuang
- The Neurological Institute, Columbia-Presbyterian Medical Center, 710 West 168th Street, New York, NY 10032, USA.
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Pezzini A, Zavarise P, Palvarini L, Viale P, Oladeji O, Padovani A. Holmes' tremor following midbrain Toxoplasma abscess: clinical features and treatment of a case. Parkinsonism Relat Disord 2002; 8:177-80. [PMID: 12039428 DOI: 10.1016/s1353-8020(01)00013-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
The label Holmes' tremor defines a rare symptomatic movement disorder frequently occurring with midbrain damage. It appears at rest and worsens adopting a posture and on attempting movements. We describe the case of a patient with Holmes' tremor due to a presumed Toxoplasma abscess of the midbrain. The positive response to a combined therapy with levodopa and isoniazid is also reported.
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Affiliation(s)
- A Pezzini
- Department of Neurology, University of Brescia, Brescia, Italy.
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Kirton CA, Riopelle RJ. Meige syndrome secondary to basal ganglia injury: a potential cause of acute respiratory distress. Can J Neurol Sci 2001; 28:167-73. [PMID: 11383945 DOI: 10.1017/s0317167100052896] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Meige syndrome is a movement disorder that includes blepharospasm and oromandibular dystonias. Its etiology may be idiopathic (primary) or it may arise secondary to focal brain injury. Acute respiratory distress as a feature of such dystonias occurs infrequently. A review of the literature on Meige syndrome and the relationship between dystonias and respiratory compromise is presented. METHODS A 60-year-old woman suffered a cerebral anoxic event secondary to manual strangulation. She developed progressive blepharospasm combined with oromandibular and cervical dystonias. Neuroimaging demonstrated bilateral damage localized to the globus pallidus. Years later, she presented to the emergency department in intermittent respiratory distress associated with facial and cervical muscle spasms. RESULTS Increasing frequency and severity of the disorder was noted over years. The acute onset of respiratory involvement required intubation and eventual tracheotomy. A partial therapeutic benefit of tetrabenazine was demonstrated. CONCLUSION This case highlights two interesting aspects of Meige's syndrome: (1) Focal bilateral basal ganglia lesions appear to be responsible for this patient's movement disorder which is consistent with relative overactivity of the direct pathway from striatum to globus pallidus internal and substantia nigra pars reticularis; (2) Respiratory involvement in a primarily craniofacial dystonia to the point of acute airway compromise.
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Affiliation(s)
- C A Kirton
- Division of Neurology, Queen's University, Kingston, ON, Canada
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Affiliation(s)
- W J Weiner
- Department of Neurology, University of Maryland School of Medicine, Baltimore 21201, USA
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Bhatt M, Desai J, Mankodi A, Elias M, Wadia N. Posttraumatic akinetic-rigid syndrome resembling Parkinson's disease: a report on three patients. Mov Disord 2000; 15:313-7. [PMID: 10752583 DOI: 10.1002/1531-8257(200003)15:2<313::aid-mds1017>3.0.co;2-p] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
We describe three patients who developed a rapidly evolving posttraumatic akinetic-rigid syndrome (ARS), the clinical manifestations of which were similar to Parkinson's disease, including response to levodopa. Despite initial imaging studies showing traumatic damage to the substantia nigra, the ARS appeared after a delay of 1-5 months after the injury. We stress the importance of magnetic resonance imaging to illustrate nigral damage in all patients in whom head trauma precedes an ARS.
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Affiliation(s)
- M Bhatt
- Movement Disorders Clinic, Department of Neurology, Jaslok Hospital & Research Centre, Mumbai, India
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Loher TJ, Hasdemir MG, Burgunder JM, Krauss JK. Long-term follow-up study of chronic globus pallidus internus stimulation for posttraumatic hemidystonia. J Neurosurg 2000; 92:457-60. [PMID: 10701534 DOI: 10.3171/jns.2000.92.3.0457] [Citation(s) in RCA: 80] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The authors report the first case of chronic globus pallidus internus (GPi) stimulation for treatment of medically intractable hemidystonia for which long-term follow-up data are available. The patient had developed left-sided low-frequency tremor and hemidystonia after a severe head trauma sustained at 15 years of age. He experienced relief of the tremor but not of the hemidystonia after a thalamotomy was performed in the right hemisphere 3 years postinjury. When the patient was 24 years old, the authors performed a magnetic resonance-guided stereotactic implantation of a monopolar electrode in the right-sided posteroventral GPi. Chronic deep brain stimulation resulted in remarkable improvement of dystonia-associated pain, phasic dystonic movements, and dystonic posture, which was accompanied by functional gain. Postoperative improvement was sustained after 4 years of follow up. Chronic GPi stimulation appears to be a valuable treatment option for posttraumatic dystonia.
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Affiliation(s)
- T J Loher
- Department of Neurosurgery, Inselspital, University of Berne, Switzerland
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Samii A, Pal PK, Schulzer M, Mak E, Tsui JK. Post-traumatic cervical dystonia: a distinct entity? Can J Neurol Sci 2000; 27:55-9. [PMID: 10676589 DOI: 10.1017/s0317167100051982] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND/OBJECTIVE The incidence of head/neck trauma preceding cervical dystonia (CD) has been reported to be 5-21%. There are few reports comparing the clinical characteristics of patients with and without a history of injury. Our aim was to compare the clinical characteristics of idiopathic CD (CD-I) to those with onset precipitated by trauma (CD-T). METHODS We evaluated 114 consecutive patients with CD over a 9-month period. All patients were interviewed using a detailed questionnaire and had a neurological examination. Their clinical charts were also reviewed. RESULTS Fourteen patients (12%) had mild head/neck injury within a year preceding the onset of CD. Between the two groups (CD-I and CD-T), the gender distribution (F:M of 3:2), family history of movement disorders (32% vs. 29%), the prevalence of gestes antagonistes (65% vs. 64%), and response to botulinum toxin were similar. There were non-specific trends, including an earlier age of onset (mean ages 43.3 vs. 37.6), higher prevalence of neck pain (86% vs. 100%), head tremor (67% vs. 79%), and dystonia in other body parts (23% vs. 36%) in CD-T. CONCLUSIONS CD-I and CD-T are clinically similar. Trauma may be a triggering factor in CD but this was only supported by non-significant trends in its earlier age of onset.
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Affiliation(s)
- A Samii
- Neurodegenerative Disorders Centre, Vancouver Hospital and Health Sciences Centre, British Columbia, Canada
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Abstract
Three patients with Sjogren's syndrome are presented in whom frequent tonic/dystonic spasms of the limbs developed during the course of the illness. These patients' clinical findings suggested spinal cord involvement, a localization that was confirmed by magnetic resonance imaging in two patients. In one patient the painful movements responded to treatment with phenytoin and in one other to baclofen. Sjogren's syndrome should be considered in the differential diagnosis of conditions that produce tonic/dystonic limb spasms.
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Affiliation(s)
- B Jabbari
- Department of Neurology, Uniformed Services University of the Health Sciences, Bethesda, Maryland 20814, USA
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Fernandez HH, Friedman JH, Centofanti JV. Benedikt's syndrome with delayed-onset rubral tremor and hemidystonia: a complication of tic douloureux surgery. Mov Disord 1999; 14:695-7. [PMID: 10435512 DOI: 10.1002/1531-8257(199907)14:4<695::aid-mds1024>3.0.co;2-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- H H Fernandez
- Department of Neurology, Brown University School of Medicine, Memorial Hospital of Rhode Island, Pawtucket, USA
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Krauss JK, Kiriyanthan GD, Borremans JJ. Cerebral arteriovenous malformations and movement disorders. Clin Neurol Neurosurg 1999; 101:92-9. [PMID: 10467903 DOI: 10.1016/s0303-8467(99)00020-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
A series of six patients with movement disorders associated with cerebral arteriovenous malformations (AVM) is reported. The AVMs were classified according to the Spetzler-Martin classification as grade V (one patient), grade IV (four patients), and as grade III (one patient). One patient had action-induced hemidystonia caused by a contralateral frontoparietal AVM which compressed the putamen and was supplied partially by enlarged lenticulostriate arteries. Two patients presented with unilateral cortical tremor associated with contralateral high-frontal cortical/subcortical AVMs sparing the basal ganglia. Another patient developed hemidystonia and hemichorea-hemiballism after bleeding of a contralateral temporooccipital AVM and subsequent ischemia. Two patients had focal dystonia after thalamic and basal ganglia hemorrhage from AVMs. Five patients were operated on. The movement disorder was abolished in one patient postoperatively. Different mechanisms were identified that are relevant for the development of AVM-related movement disorders: mass effect, diaschisis, local parenchymal altered cerebral blood flow, and hemorrhagic or ischemic structural lesions.
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Affiliation(s)
- J K Krauss
- Department of Neurosurgery, Inselspital, University of Berne, Switzerland.
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Krauss JK, Borremans JJ, Pohle T, Godoy N. Movement disorders following nonfunctional neurosurgery. J Neurosurg 1999; 90:883-90. [PMID: 10223455 DOI: 10.3171/jns.1999.90.5.0883] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Knowledge is scarce about movement disorders that follow neurosurgical operations other than functional stereotactic surgery. The cases of 14 patients who suffered from movement disorders secondary to craniocerebral or spinal surgery are analyzed. None of these patients was initially treated by any of the authors. METHODS Twelve patients underwent surgery for cerebral diseases. Nine of these patients harbored tumors and three patients had neurovascular disorders. Two patients underwent spinal surgery for cervicothoracic ependymoma or for multiple cervical disc herniations. Twelve of the 14 patients had immediate postoperative side effects such as hemiparesis, ataxia, and somnolence. In all but two patients, movement disorders became manifest only after a delay. Dystonic movement disorders developed in eight patients, unilateral tremors in three patients, unilateral facial myokymia in one patient, and hemichorea-hemiballism in two patients. The mean delay of onset for tremor was 5 weeks and that for dystonic movement disorders was 5.5 months. Movement disorders were transient in three patients; however, they were persistent in 11 patients at a mean follow-up period of 5 years. These movement disorders caused marked persistent disability in four patients. Lesions of the contralateral striatum were identified in patients with dystonic syndromes and lesions of the dentatothalamic outflow in patients with tremors. In three patients who had postoperative basal ganglia lesions after partial removal of astrocytomas, tumor regrowth was later documented. Medical treatment in patients with persistent movement disorders rendered only limited benefit. Two patients improved with botulin injections. In one patient postoperative hemidystonia was alleviated by contralateral thalamotomy. CONCLUSIONS Dystonic syndromes and tremors are the most common movement disorders that occur after craniocerebral and spinal surgery. Postoperative movement disorders can lead to various degrees of functional disability. The pathoanatomical correlations are similar to those described in other patients with secondary movement disorders.
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Affiliation(s)
- J K Krauss
- Department of Neurosurgery, Inselspital, University of Berne, Switzerland.
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Wichmann T, DeLong MR. Models of Basal Ganglia Function and Pathophysiology of Movement Disorders. Neurosurg Clin N Am 1998. [DOI: 10.1016/s1042-3680(18)30261-4] [Citation(s) in RCA: 48] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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