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Freezing of gait: overview on etiology, treatment, and future directions. Neurol Sci 2022; 43:1627-1639. [DOI: 10.1007/s10072-021-05796-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Accepted: 11/28/2021] [Indexed: 10/19/2022]
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Automated Assessment of Brain CT After Cardiac Arrest-An Observational Derivation/Validation Cohort Study. Crit Care Med 2021; 49:e1212-e1222. [PMID: 34374503 DOI: 10.1097/ccm.0000000000005198] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Objectives Prognostication of outcome is an essential step in defining therapeutic goals after cardiac arrest. Gray-white-matter ratio obtained from brain CT can predict poor outcome. However, manual placement of regions of interest is a potential source of error and interrater variability. Our objective was to assess the performance of poor outcome prediction by automated quantification of changes in brain CTs after cardiac arrest. Design Observational, derivation/validation cohort study design. Outcome was determined using the Cerebral Performance Category upon hospital discharge. Poor outcome was defined as death or unresponsive wakefulness syndrome/coma. CTs were automatically decomposed using coregistration with a brain atlas. Setting ICUs at a large, academic hospital with circulatory arrest center. Patients We identified 433 cardiac arrest patients from a large previously established database with brain CTs within 10 days after cardiac arrest. Interventions None. Measurements and Main Results Five hundred sixteen brain CTs were evaluated (derivation cohort n = 309, validation cohort n = 207). Patients with poor outcome had significantly lower radiodensities in gray matter regions. Automated GWR_si (putamen/posterior limb of internal capsule) was performed with an area under the curve of 0.86 (95%-CI: 0.80-0.93) for CTs taken later than 24 hours after cardiac arrest (similar performance in the validation cohort). Poor outcome (Cerebral Performance Category 4-5) was predicted with a specificity of 100% (95% CI, 87-100%, derivation; 88-100%, validation) at a threshold of less than 1.10 and a sensitivity of 49% (95% CI, 36-58%, derivation) and 38% (95% CI, 27-50%, validation) for CTs later than 24 hours after cardiac arrest. Sensitivity and area under the curve were lower for CTs performed within 24 hours after cardiac arrest. Conclusions Automated gray-white-matter ratio from brain CT is a promising tool for prediction of poor neurologic outcome after cardiac arrest with high specificity and low-to-moderate sensitivity. Prediction by gray-white-matter ratio at the basal ganglia level performed best. Sensitivity increased considerably for CTs performed later than 24 hours after cardiac arrest.
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Miranda-Domínguez Ó, Ragothaman A, Hermosillo R, Feczko E, Morris R, Carlson-Kuhta P, Nutt JG, Mancini M, Fair D, Horak FB. Lateralized Connectivity between Globus Pallidus and Motor Cortex is Associated with Freezing of Gait in Parkinson's Disease. Neuroscience 2020; 443:44-58. [PMID: 32629155 PMCID: PMC7503210 DOI: 10.1016/j.neuroscience.2020.06.036] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Revised: 06/24/2020] [Accepted: 06/25/2020] [Indexed: 01/26/2023]
Abstract
Freezing of gait (FoG) is a brief, episodic absence or marked reduction of forward progression of the feet, despite the intention to walk, that is common in people with Parkinson's disease (PD). We hypothesized that not only motor, but higher level cognitive and attention areas may be impaired in freezers. In this study, we aimed to characterize differences in cortical and subcortical functional connectivity specific to FoG. We examined resting state neuroimaging and objective measures of FoG severity and gait from 103 individuals (28 PD + FoG, 36 PD - FoG and 39 healthy controls). Inertial sensors were used to quantify freezing severity and gait. Groups with and without FoG were matched on age, disease severity, cognitive status, and levodopa medication. MRI data was processed using surface-based registration. High-quality imaging data were used to characterize differences in connectivity specific to FoG using a pre-defined set of Regions of Interest (ROIs) and validated using whole-brain connectivity analysis. Associations between functional connectivity and objective measures of FoG were determined via predictive modeling using hold-out cross validation. We found that connectivity between the left globus pallidus (GP) and left somatosensory cortex and between two brain areas in the default and insular/vestibular networks exhibited significant differences specific to FoG and were also strong and significant predictors of FoG severity. Our findings suggest that the interplay among motor, default and vestibular areas of the left cortex are critical in the pathology of FoG.
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Affiliation(s)
- Óscar Miranda-Domínguez
- Department of Behavioral Neuroscience, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, United States
| | - Anjanibhargavi Ragothaman
- Department of Biomedical Engineering, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, United States
| | - Robert Hermosillo
- Department of Behavioral Neuroscience, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, United States
| | - Eric Feczko
- Department of Behavioral Neuroscience, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, United States; Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, United States
| | - Rosie Morris
- Department of Neurology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, United States
| | - Patricia Carlson-Kuhta
- Department of Neurology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, United States
| | - John G Nutt
- Department of Neurology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, United States
| | - Martina Mancini
- Department of Biomedical Engineering, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, United States; Department of Neurology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, United States
| | - Damien Fair
- Department of Behavioral Neuroscience, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, United States; Department of Psychiatry, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, United States; Advanced Imaging Research Center, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, United States
| | - Fay B Horak
- Department of Behavioral Neuroscience, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, United States; Department of Biomedical Engineering, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, United States; Department of Neurology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, United States.
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Yoon SY, Lee SC, An YS, Kim YW. Neural correlates and gait characteristics for hypoxic-ischemic brain injury induced freezing of gait. Clin Neurophysiol 2019; 131:46-53. [PMID: 31751839 DOI: 10.1016/j.clinph.2019.09.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Revised: 09/04/2019] [Accepted: 09/29/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To investigate gait characteristics in patients with freezing of gait (FOG) after hypoxic-ischemic brain injury (HIBI) and to elucidate neural correlates for FOG using F-18 fluoro-2-deoxy-d-glucose positron emission tomography. METHODS We enrolled 12 patients with FOG after HIBI and 17 patients without FOG after HIBI. We performed three-dimensional gait analyses and compared each parameter and gait variability. Brain metabolism was measured, and we compared regional brain metabolism using a voxel-by-voxel-based statistical mapping analysis. RESULTS The FOG group revealed a significantly decreased joint range of motion (ROM), particularly in the sagittal plane for three-joint summated ROM (p < 0.0025). Spatiotemporal results demonstrated that stride length and step length were decreased in the with FOG group (p < 0.005). FOG severity was negatively correlated with brain metabolism in the left thalamus, and three-joint summated ROM in the sagittal plane was positively associated with brain metabolism in the left thalamus and midbrain (p < 0.05). CONCLUSIONS Central organizational level amplitude disorder may play an important role in the pathophysiology, and disturbance in the cholinergic pathway might contribute to the development of FOG in patients with HIBI. SIGNIFICANCE These findings contribute to understanding FOG in HIBI.
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Affiliation(s)
- Seo Yeon Yoon
- Department of Rehabilitation Medicine, Bundang Jesaeng General Hospital, Gyeonggi-do, Republic of Korea
| | - Sang Chul Lee
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Young-Sil An
- Department of Nuclear Medicine and Molecular Imaging, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Yong Wook Kim
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
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Paramanandam V, Lizarraga KJ, Soh D, Algarni M, Rohani M, Fasano A. Unusual gait disorders: a phenomenological approach and classification. Expert Rev Neurother 2018; 19:119-132. [DOI: 10.1080/14737175.2019.1562337] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Vijayashankar Paramanandam
- Edmond J. Safra Program in Parkinson’s Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital and Division of Neurology, UHN, Division of Neurology, University of Toronto, Toronto, ON, Canada
| | - Karlo J. Lizarraga
- Edmond J. Safra Program in Parkinson’s Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital and Division of Neurology, UHN, Division of Neurology, University of Toronto, Toronto, ON, Canada
| | - Derrick Soh
- Edmond J. Safra Program in Parkinson’s Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital and Division of Neurology, UHN, Division of Neurology, University of Toronto, Toronto, ON, Canada
| | - Musleh Algarni
- Edmond J. Safra Program in Parkinson’s Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital and Division of Neurology, UHN, Division of Neurology, University of Toronto, Toronto, ON, Canada
| | - Mohammad Rohani
- Department of Neurology, Hazrat Rasool Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Alfonso Fasano
- Edmond J. Safra Program in Parkinson’s Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital and Division of Neurology, UHN, Division of Neurology, University of Toronto, Toronto, ON, Canada
- Krembil Brain Institute, Toronto, ON, Canada
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Criscuolo C, D'Amico A, Peluso S, Popolizio T, Pellecchia MT. Adult-onset pure tic disorder after post-traumatic hypoxic lesions of the globus pallidus. Parkinsonism Relat Disord 2016; 34:75-76. [PMID: 27887894 DOI: 10.1016/j.parkreldis.2016.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 11/01/2016] [Accepted: 11/17/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Chiara Criscuolo
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University, Via Pansini 5, 80131, Naples, Italy.
| | - Alessandra D'Amico
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Silvio Peluso
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University, Via Pansini 5, 80131, Naples, Italy
| | - Teresa Popolizio
- USO Neuroradiologia, Dipartimento di Diagnostica per Immagini, Ospedale IRCCS Casa Sollievo della Sofferenza, viale Cappuccini, San Giovanni Rotondo, FG, Italy
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Selikhova M, Tripoliti E, Fedoryshyn L, Matvienko Y, Stanetska H, Boychuk M, Komnatska I, Lees A, Sanotsky Y. Analysis of a distinct speech disorder seen in chronic manganese toxicity following Ephedrone abuse. Clin Neurol Neurosurg 2016; 147:71-7. [DOI: 10.1016/j.clineuro.2016.05.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Revised: 03/11/2016] [Accepted: 05/29/2016] [Indexed: 11/17/2022]
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Yoon SY, Lee SC, Kim YW. Spatiotemporal Characteristics of Freezing of Gait in Patients After Hypoxic-Ischemic Brain Injury: A Pilot Study. Medicine (Baltimore) 2016; 95:e3666. [PMID: 27175696 PMCID: PMC4902538 DOI: 10.1097/md.0000000000003666] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The objective of this study was to investigate spatiotemporal characteristics with gait variability in patients with freezing of gait (FOG) after hypoxic-ischemic brain injury (HIBI).Eleven patients showing FOG after HIBI and 15 normal controls were consecutively enrolled. We performed gait analysis using a computerized gait system (VICON MX-T10 Motion Analysis System) and compared spatiotemporal characteristics and gait variability in both groups. Additionally, we performed correlation analysis to identify the gait parameters associated with severity of freezing, which we measured based on unified Parkinson disease Rating Scale subscore.Spatiotemporal characteristic of FOG patients showed increased stance time and double support phase and decreased swing time, single support phase, stride length, step length, and gait velocity compared with normal controls (P < 0.05). Besides baseline spatiotemporal characteristics, step time asymmetry and step length asymmetry were significantly increased in HIBI patients with FOG (P < 0.05). The coefficient of variation, which reflects the variability of each parameter, demonstrated increased cadence, stride time, swing time, single support phase, stride length, step length, and gait velocity variability in HIBI patients with FOG compared with normal controls (P < 0.05). Correlation analysis between FOG severity and spatiotemporal parameters revealed gait velocity, step length, and single support phase to be spatiotemporal parameters related to FOG severity (P < 0.05).Our findings suggest that bilateral gait coordination deterioration plays a considerable role for pathophysiology of FOG in HIBI patients. Additional studies with a larger number of subjects are needed to further investigate the neural mechanism of FOG after HIBI.
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Affiliation(s)
- Seo Yeon Yoon
- From the Department of Rehabilitation Medicine, Bundang Jesaeng Hospital, Gyeonggi-do (SYY) and Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul (SCL, YWK), Republic of Korea
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Shu SL, Thompson PD, Kimber TE. Dystonia-Parkinsonism Due to Pallidal and Nigral Necrosis Following Heroin Overdose: Long-Term Evolution. Mov Disord Clin Pract 2015; 3:188-190. [PMID: 30713912 DOI: 10.1002/mdc3.12244] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2015] [Revised: 07/23/2015] [Accepted: 07/27/2015] [Indexed: 11/10/2022] Open
Affiliation(s)
- Siew Lee Shu
- Department of Neurology Royal Adelaide Hospital Adelaide Australia
| | - Philip D Thompson
- Department of Neurology Royal Adelaide Hospital Adelaide Australia.,University Department of Medicine University of Adelaide Adelaide Australia
| | - Thomas E Kimber
- Department of Neurology Royal Adelaide Hospital Adelaide Australia.,University Department of Medicine University of Adelaide Adelaide Australia
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Cohen-Oram AN, Stewart JT, Bero K, Hoffmann MW. Treatment of gait ignition failure with ropinirole. J Mov Disord 2014; 7:95-8. [PMID: 25360234 PMCID: PMC4213538 DOI: 10.14802/jmd.14014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Revised: 08/12/2014] [Accepted: 08/12/2014] [Indexed: 11/24/2022] Open
Abstract
Gait ignition failure (GIF) is a syndrome characterized by hesitation or inability to initiate gait from a static position. It may occur in a variety of conditions, including normal pressure hydrocephalus, subcortical vascular disease, parkinsonian syndromes and a variety of focal lesions. Previous information on the treatment of GIF has been primarily anecdotal, but there have been a few reports of response to dopamine agonists. We report a 63-year-old man with anoxic encephalopathy who developed GIF nine years after the initial anoxic insult. The patient's GIF responded robustly, albeit transiently, to ropinirole. MRI was unrevealing, but a positron emission tomography scan showed hypometabolism in the deep frontal ACA/MCA watershed area; this may have disconnected the basal ganglia from the motor cortex and/or interrupted dopaminergic mesocortical transmission. Our understanding of the pathophysiology and the treatment of GIF remains limited, but there may be at least a limited therapeutic role for dopamine agonists.
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Affiliation(s)
- Alexis N Cohen-Oram
- Department of Psychiatry, University of South Florida College of Medicine, Tampa, FL, USA
| | - Jonathan T Stewart
- Mental Health and Behavioral Science Service, James A Haley VA Hospital, Tampa, FL, USA; Departments of Psychiatry and Geriatric Medicine, University of South Florida College of Medicine, Tampa, FL, USA
| | - Kim Bero
- Kinesiotherapy Service, James A Haley VA Hospital, Tampa, FL, USA
| | - Michael W Hoffmann
- Stroke and Cognitive Programs, James A Haley VA Hospital, Tampa, FL, USA; Department of Neurology, University of Central Florida College of Medicine, Orlando, FL, USA
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Schrader C, Seehaus F, Capelle HH, Windhagen A, Windhagen H, Krauss JK. Effects of Pedunculopontine Area and Pallidal DBS on Gait Ignition in Parkinson's Disease. Brain Stimul 2013; 6:856-9. [DOI: 10.1016/j.brs.2013.05.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2013] [Revised: 04/17/2013] [Accepted: 05/15/2013] [Indexed: 10/26/2022] Open
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Abstract
BACKGROUND The prediction of neurologic outcome is a fundamental concern in the resuscitation of patients with severe brain injury. OBJECTIVE To provide an evidence-based update on neurologic prognosis following traumatic brain injury and hypoxic-ischemic encephalopathy after cardiac arrest. DATA SOURCE Search of the PubMed database and manual review of bibliographies from selected articles to identify original data relating to prognostic methods and outcome prediction models in patients with neurologic trauma or hypoxic-ischemic encephalopathy. DATA SYNTHESIS AND CONCLUSION Articles were scrutinized regarding study design, population evaluated, interventions, outcomes, and limitations. Outcome prediction in severe brain injury is reliant on features of the neurologic examination, anatomical and physiological changes identified with CT and MRI, abnormalities detected with electroencephalography and evoked potentials, and physiological and biochemical derangements at both the brain and systemic levels. Use of such information in univariable association studies generally lacks specificity in classifying neurologic outcome. Furthermore, the accuracy of established prognostic classifiers may be affected by the introduction of outcome-modifying interventions, such as therapeutic hypothermia following cardiac arrest. Although greater specificity may be achieved with scoring systems derived from multivariable models, they generally fail to predict outcome with sufficient accuracy to be meaningful at the single patient level. Discriminative models which integrate knowledge of genetic determinants and biologic processes governing both injury and repair and account for the effects of resuscitative and rehabilitative care are needed.
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Koo MW, Kim YK, Ku KM, Park WW, Minn YK. Exofocal anterograde transsynaptic neuronal death in the globus pallidus: two case reports. J Clin Neurol 2012; 8:308-10. [PMID: 23323141 PMCID: PMC3540292 DOI: 10.3988/jcn.2012.8.4.308] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2011] [Revised: 07/19/2011] [Accepted: 07/19/2011] [Indexed: 11/28/2022] Open
Abstract
Background Exofocal neuronal death in the substantia nigra (SN) is a well-known form of anterograde transsynaptic cell death. Exofocal neuronal death could theoretically also occur in the globus pallidus (GP) after striatal injury. Case Report Case 1. A 70-year-old woman visited the emergency room because of decreased mentality. On admission, blood-gas analysis indicated that her oxygen tension was 69.1 mm Hg. The caudate nucleus, putamen, and temporooccipital cortex on both sides of the brain exhibited high-intensity diffusion-weighted magnetic resonance imaging (MRI) signals. At 10 days after admission, new high-intensity signals had developed in the SN and GP on both sides. Case 2. A 48-year-old man visited the emergency room because of right-sided weakness. Lesions were noted in the left caudate nucleus and putamen. At 4 days after admission, newly developed high-intensity MRI signals were observed in the left SN and GP. Conclusions Exofocal neuronal death can occur in the GP as well as in the SN; these findings need to be clearly distinguished from those of recurrent ischemic injuries, such as recurrent stroke.
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Affiliation(s)
- Min Woo Koo
- Department of Neurology, Hallym University College of Medicine, Seoul, Korea
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Shahar T, Gadoth A, Nossek E, Giladi N, Ram Z, Maimon S. Reversible freezing of gait caused by dural arteriovenous fistula and congestion of the globus pallidus. Mov Disord 2012; 27:1690-3. [DOI: 10.1002/mds.25184] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2011] [Revised: 07/30/2012] [Accepted: 08/08/2012] [Indexed: 11/05/2022] Open
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Iron dysregulation in movement disorders. Neurobiol Dis 2012; 46:1-18. [DOI: 10.1016/j.nbd.2011.12.054] [Citation(s) in RCA: 127] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2011] [Revised: 12/22/2011] [Accepted: 12/31/2011] [Indexed: 01/04/2023] Open
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Fasano A, Baldari S, Di Giuda D, Paratore R, Piano C, Bentivoglio AR, Girlanda P, Morgante F. Nigro-striatal involvement in primary progressive freezing gait: insights into a heterogeneous pathogenesis. Parkinsonism Relat Disord 2012; 18:578-84. [PMID: 22459564 DOI: 10.1016/j.parkreldis.2012.03.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2011] [Revised: 02/10/2012] [Accepted: 03/03/2012] [Indexed: 12/11/2022]
Abstract
Primary progressive freezing gait (PPFG) is a clinical syndrome underlain by diverse neurodegenerative diseases and characterized by early occurrence of gait freezing. Either degeneration or integrity of the nigrostriatal terminals have been found by SPECT and PET studies. In this retrospective study, we evaluated (123)I-FP-CIT SPECT findings in a consecutive series of 13 PPFG patients with detailed clinical evaluation over time (mean follow-up duration: 3.1 ± 1.2 years). In all patients, (123)I-FP-CIT SPECT has been performed at the time of first clinical evaluation (1.7 ± 1.4 years after disease onset) and was compared with data from 23 age- and sex-matched healthy subjects. PPFG patients were categorized as having abnormal (n = 8) or normal (n = 5) SPECT. At disease onset, PPFG with abnormal SPECT had more frequent hypophonia, higher UPDRS-III scores and partial levodopa responsiveness. By contrast, PPFG with normal SPECT had more frequent bilateral plantar responses and no response to levodopa. At latest follow-up, initial diagnosis in the abnormal SPECT group was revised (n = 5) to progressive supranuclear palsy (n = 4) and pure akinesia with gait freezing (n = 1). Among the five patients with normal SPECT, follow-up evaluation disclosed corticobasal syndrome (n = 2) and primary lateral sclerosis (n = 1). Dopamine transporter imaging can capture the clinical heterogeneity of PPFG and might have a value to predict possible disease progression.
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Abstract
A 70-year-old woman developed marked akinesia after an anoxic event related to bronchiectasia. Magnetic resonance imaging studies revealed lesions in the bilateral globus pallidus and, to a lesser extent, in the putamen. Positron emission tomography studies with (18)F-6-fluoro-L-dopa and (11)C-N-methylspiperone showed a decreased pre- and post-synaptic uptake in the striatum. Consistent with previous reports, the present case demonstrated the basal ganglia, particularly the globus pallidus, to be selectively susceptible to anoxic insults. Furthermore, a PET study indicated a disrupted presynaptic integrity of the dopaminergic terminals and decreased dopamine D(2) receptor binding, which together appear to underlie the pathophysiology of post-anoxic akinesia, at least in the present case.
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Affiliation(s)
- Shunsuke Kobayashi
- Department of Neurology, School of Medicine, Fukushima Medical University, Japan.
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Abstract
Freezing of gait (FoG) is a unique and disabling clinical phenomenon characterised by brief episodes of inability to step or by extremely short steps that typically occur on initiating gait or on turning while walking. Patients with FoG, which is a feature of parkinsonian syndromes, show variability in gait metrics between FoG episodes and a substantial reduction in step length with frequent trembling of the legs during FoG episodes. Physiological, functional imaging, and clinical-pathological studies point to disturbances in frontal cortical regions, the basal ganglia, and the midbrain locomotor region as the probable origins of FoG. Medications, deep brain stimulation, and rehabilitation techniques can alleviate symptoms of FoG in some patients, but these treatments lack efficacy in patients with advanced FoG. A better understanding of the phenomenon is needed to aid the development of effective therapeutic strategies.
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Forebrain ischemia triggers GABAergic system degeneration in substantia nigra at chronic stages in rats. Cardiovasc Psychiatry Neurol 2010; 2010:506952. [PMID: 20981346 PMCID: PMC2957857 DOI: 10.1155/2010/506952] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2010] [Revised: 06/10/2010] [Accepted: 08/11/2010] [Indexed: 11/17/2022] Open
Abstract
The long-term consequences of forebrain ischemia include delayed Parkinson's syndrome. This study revealed delayed neurodegeneration in the substantia nigra 8 weeks after 12.5 minutes of global ischemia in rat brain. Following neuronal loss of 30-40% in central and dorsolateral striatum at day 3, neuronal damage in the substantia nigra (SN) was assessed at 4-8 weeks using immunohistochemistry for glutamate decarboxylase 67 (GAD67), vesicular GABA transporter (VGAT), and calretinin (CR). At day 56, the optical density of GAD67-, but not VGAT-, immunoreactivity in substantia nigra pars reticulata (SNR)-significantly decreased. CR-neurons concentrated in substantia nigra pars compacta (SNC) were reduced by 27% from day 3 (n = 5) to day 56 (n = 7, ANOVA, p < .01). Movement coordination was impaired at day 56, as evaluated using beam-walking test (time-to-traverse 5.6 ± 1.2 sec versus 11.8 ± 5.4 sec; sham versus ischemia, p < .05, n = 5, and 7, resp.). Our results demonstrate delayed impairment of the GABAergic system components in SN and associated with movement deficits after global ischemia.
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Boone M, Sini V, Dupuy D, Le Page L, Godefroy O, Krystkowiak P. Des troubles neurologiques persistants. Rev Med Interne 2010; 31:643-4. [DOI: 10.1016/j.revmed.2009.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2009] [Revised: 11/19/2009] [Accepted: 12/03/2009] [Indexed: 10/19/2022]
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Gutierrez LG, Rovira A, Portela LAP, Leite CDC, Lucato LT. CT and MR in non-neonatal hypoxic-ischemic encephalopathy: radiological findings with pathophysiological correlations. Neuroradiology 2010; 52:949-76. [PMID: 20585768 DOI: 10.1007/s00234-010-0728-z] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2010] [Accepted: 06/04/2010] [Indexed: 11/29/2022]
Abstract
Non-neonatal hypoxic-ischemic encephalopathy is a clinical condition often related to cardiopulmonary arrest that demands critical management and treatment decisions. Management depends mainly on the degree of neurological impairment and prognostic considerations. Computed tomography (CT) is often used to exclude associated or mimicking pathology. If any, only nonspecific signs such as cerebral edema, sulci effacement, and decreased gray matter (GM)/white matter (WM) differentiation are evident. Pseudosubarachnoid hemorrhage, a GM/WM attenuation ratio <1.18, and inverted GM attenuation are associated with a poor prognosis. Magnetic resonance (MR) imaging is more sensitive than CT in assessing brain damage in hypoxic-ischemic encephalopathy. Some MR findings have similarities to those seen pathologically, based on spatial distribution and time scale, such as lesions distributed in watershed regions and selective injury to GM structures. In the acute phase, lesions are better depicted using diffusion-weighted imaging (DWI) because of the presence of cytotoxic edema, which, on T2-weighted images, only become apparent later in the early subacute phase. In the late subacute phase, postanoxic leukoencephalopathy and contrast enhancement could be observed. In the chronic phase, atrophic changes predominate over tissue signal changes. MR can be useful for estimating prognosis when other tests are inconclusive. Some findings, such as the extent of lesions on DWI and presence of a lactate peak and depleted N-acetyl aspartate peak on MR spectroscopy, seem to have prognostic value.
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Affiliation(s)
- Leonardo Guilhermino Gutierrez
- Diagnostic Imaging Division, Hospital Alemão Oswaldo Cruz and Hospital do Coração, Praça Amadeu Amaral, 47-Conj. 112, São Paulo, 01327-904, Brazil,
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Lee MS, Lyoo CH, Choi YH. Primary progressive freezing gait in a patient with CO-induced parkinsonism. Mov Disord 2010; 25:1513-5. [DOI: 10.1002/mds.23124] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Welter ML, Westby G, Chastan N. Les troubles de la marche et de l’équilibre dans les syndromes parkinsoniens « plus ». Rev Neurol (Paris) 2010; 166:188-95. [DOI: 10.1016/j.neurol.2009.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2009] [Revised: 05/11/2009] [Accepted: 05/25/2009] [Indexed: 10/20/2022]
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Chang MH, Hung WL, Liao YC, Lee YC, Hsieh PF. Eye of the tiger-like MRI in parkinsonian variant of multiple system atrophy. J Neural Transm (Vienna) 2009; 116:861-6. [DOI: 10.1007/s00702-009-0234-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2008] [Accepted: 04/21/2009] [Indexed: 11/25/2022]
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25
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Factor SA. The clinical spectrum of freezing of gait in atypical parkinsonism. Mov Disord 2008; 23 Suppl 2:S431-8. [PMID: 18668624 DOI: 10.1002/mds.21849] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Freezing of gait (FOG), commonly seen in advanced Parkinson's disease (PD), has been classified as its fifth cardinal feature. However, its presence frequently leads to a misdiagnosis of PD. FOG is actually more common in atypical parkinsonism (AP): including vascular Parkinsonism (VP), progressive supranuclear palsy (PSP), multiple system atrophy (MSA), corticobasal degeneration (CBD), dementia with Lewy bodies (DLB), and higher level gait disorders (HLGDs). VP is the result of multiple small vessel infarcts (lacunar state or Binswanger's disease), particularly involving the frontal, parietal, and basal ganglia regions. Approximately 50% have FOG (often referred to as lower body parkinsonism). FOG is also common in neurodegenerative forms of AP, present in 45-57%. Of these, FOG is present in 53% of PSP, 54% MSA, 54% DLB, 25% CBD, and 40% HLGD. It is generally seen in the late stages. There are two syndromes closely associated with AP that are dominated by FOG; pure akinesia (PA) and primary progressive freezing gait (PPFG). PA is characterized by akinesia of gait (including FOG), writing, and speech. Tremor, rigidity, dementia, and response to levodopa are notably absent. PPFG is defined by early FOG (often the initial feature) that progresses to include postural instability. It is accompanied by bradykinesia, rigidity, postural tremor, dementia, and levodopa unresponsiveness. Both syndromes are heterogeneous but PSP seems to be the most common cause. CBD and DLB can also present as PPFG. FOG is a common feature of AP and although typically occurring late in disease may also be an early symptom.
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Affiliation(s)
- Stewart A Factor
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia 30329, USA.
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The basal ganglia. Clin Neuroradiol 2008. [DOI: 10.1017/cbo9780511551925.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Paola MD, Bozzali M, Fadda L, Musicco M, Sabatini U, Caltagirone C. Reduced oxygen due to high-altitude exposure relates to atrophy in motor-function brain areas. Eur J Neurol 2008; 15:1050-7. [DOI: 10.1111/j.1468-1331.2008.02243.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Lyoo CH, Prokisch H, Meitinger T, Lee SY, Kim DH, Lee MS. Anticholinergic-responsive gait freezing in a patient with pantothenate kinase-associated neurodegeneration. Mov Disord 2008; 23:283-4. [PMID: 17999425 DOI: 10.1002/mds.21799] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
A 43-year-old male patient suddenly developed freezing of gait (FOG) when making a first step, turning, or passing through a narrow path. Dystonic plantar flexion of his left foot always accompanied with FOG. He could walk without FOG when stepping on visual cues. Brain magnetic resonance imaging study showed typical "eye of the tiger" sign in the globus pallidus. He had heterozygous mutations in the exons 3 and 4 in the PANK2 gene. His FOG dramatically responded to the anticholinergic treatment. We report the first instance of a patient with genetically confirmed pantothenate kinase associated neurodegeneration showing typical FOG that responded to anticholinergic treatment.
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Affiliation(s)
- Chul Hyoung Lyoo
- Department of Neurology, Youngdong Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
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Matsumoto L, Yamamoto T, Higashihara M, Sugimoto I, Kowa H, Shibahara J, Nakamura K, Shimizu J, Ugawa Y, Goto J, Dalmau J, Tsuji S. Severe hypokinesis caused by paraneoplastic anti-Ma2 encephalitis associated with bilateral intratubular germ-cell neoplasm of the testes. Mov Disord 2007; 22:728-31. [PMID: 17269131 PMCID: PMC1909751 DOI: 10.1002/mds.21314] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
We report a 40-year-old man with severe hypokinesis as paraneoplastic manifestation of a microscopic "carcinoma in situ" of the testis. The young age of the patient, along with progressive neurologic deterioration, detection of anti-Ma2 antibodies, and ultrasound findings of bilateral microcalcifications, led to bilateral orchiectomy, revealing the tumor in both testes. After orchiectomy, neurological symptoms stabilized, but the patient eventually died of systemic complications caused by his severe neurological deficits. Anti-Ma2 paraneoplastic encephalitis should be considered in patients with severe hypokinesis, and intensive investigation and aggressive approach to treatment is encouraged to prevent progression of the neurological deficits.
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Vendrame M, Azizi SA. Pyramidal and extrapyramidal dysfunction as a sequela of hypoxic injury: case report. BMC Neurol 2007; 7:18. [PMID: 17597529 PMCID: PMC1925116 DOI: 10.1186/1471-2377-7-18] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2006] [Accepted: 06/27/2007] [Indexed: 11/19/2022] Open
Abstract
Background The clinical and radiological aspects of hypoxic brain injury without ischemia are not well characterized. A spectrum of clinical manifestations have been observed in patients that recover from hypoxic brain injury, including a subset that demonstrate persistent motor system disturbances. Early Magnetic Resonance Imaging (MRI) studies have shown abnormalities in basal ganglia, cerebral and cerebellar cortex. Case presentation A 23-year-old man was affected by acute respiratory failure after drug overdose. His clinical condition progressed from coma to partial recovery with persistent lack of control and stiffness in the lower extremities. MRI of the brain showed evolving lesions in the cerebellum, globus pallidus and motor cortex that correlated with neurological signs. Conclusion A careful analysis of this case and a review of the relevant literature indicate that the clinical residua after recovery from hypoxic injury to the brain is predominantly disorders of the motor system, and the MRI manifestations as well as the clinical presentation can evolve over time. Understanding more of the factors that affect hypoxic brain injury can be helpful in determining the clinical outcome and management of these patients.
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Affiliation(s)
- Martina Vendrame
- Department of Neurology, Temple University School of Medicine, Philadelphia, USA
| | - S Ausim Azizi
- Department of Neurology, Temple University School of Medicine, Philadelphia, USA
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Lyoo CH, Aalto S, Rinne JO, Lee KO, Oh SH, Chang JW, Lee MS. Different cerebral cortical areas influence the effect of subthalamic nucleus stimulation on parkinsonian motor deficits and freezing of gait. Mov Disord 2007; 22:2176-82. [PMID: 17712844 DOI: 10.1002/mds.21609] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Inconsistent response in freezing of gait (FOG) with levodopa treatment or STN DBS makes the pathogenesis difficult to understand. We studied brain areas associated with the expression of STN DBS effect on parkinsonian motor deficits and FOG. Ten Parkinson's disease patients with typical FOG were included. One month before STN DBS, we performed [(18)F]-deoxyglucose PET scans and measured the UPDRS motor and modified FOG (mFOG) scores during levodopa off and on periods. At two months after STN DBS, same rating scores were measured. The percentage improvement of mFOG and UPDRS motor scores by STN DBS during levodopa off period was calculated. We searched for brain areas in which glucose metabolism correlated with the improvement of mFOG and UPDRS motor scores by DBS. During levodopa off period, STN DBS improved the UPDRS motor scores by 32.3% and the mFOG scores by 56.6%. There was no correlation between the improvements of both scores. The improvement of UPDRS motor score by DBS correlated with the metabolic activities of rostral supplementary motor area (Brodmann's area 8; BA8), anterior cingulate cortex (BA32), and prefrontal cortex (BA9). On the other hand, there was a positive correlation between the improvement of mFOG score by DBS and the metabolic activity of the parietal, occipital, and temporal sensory association cortices. In conclusion, dysfunction of different cerebral cortical areas limits the beneficial effects of DBS on parkinsonian motor deficits and FOG.
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Affiliation(s)
- Chul Hyoung Lyoo
- Department of Neurology, Youngdong Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
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Abstract
It is difficult to predict precisely the final neurologic outcome from cardiac arrest and accompanying cerebral hypoxia. Although rare, several movement disorders may arise as a consequence of hypoxic injury, including myoclonus, dystonia, akinetic-rigid syndromes, tremor, and chorea. Dys-function of various portions of the central nervous system, including the basal ganglia, thalamus, midbrain, and cerebellum, is implicated in the pathogenesis of these posthypoxic movement disorders. The development of animal models of posthypoxic movement disorders and of newer imaging techniques applied to human patients who have movement disorders after hypoxic episodes has improved understanding of the pathophysiology of posthypoxic movement disorders and has suggested newer treatments. Many outstanding questions remain, however. What factors promote susceptibility to the development of posthypoxic movement disorders? Why do patients who have similar clinical hypoxic insults develop markedly dis-similar movement disorders? Why are the basal ganglia especially vulnerable to cerebral hypoxia? Why do some movement disorders occur in delayed fashion and progress for years after the hypoxic insult? Is the pathogenesis of progressive posthypoxic movement disorders related to that of neurodegenerative diseases? What are the most effective medications for the various posthypoxic movement disorders? Is there a role for deep brain stimulation in the treatment of posthypoxic movement disorders? We anticipate that current and future research in the area of posthypoxic movement disorders will reveal answers to some of these important questions.
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Affiliation(s)
- Arun Venkatesan
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.
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Krystkowiak P, Delval A, Dujardin K, Bleuse S, Blatt JL, Bourriez JL, Derambure P, Destée A, Defebvre L. Gait abnormalities induced by acquired bilateral pallidal lesions. J Neurol 2006; 253:594-600. [PMID: 16525880 DOI: 10.1007/s00415-006-0066-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2005] [Revised: 10/12/2005] [Accepted: 10/21/2005] [Indexed: 11/24/2022]
Abstract
BACKGROUND Bilateral pallidal lesions induce a range of cognitive and motor disorders, principally a parkinsonian syndrome in which severe disturbances of gait and gait initiation are frequently reported. However, the precise clinical features of these disorders (and the role of the pallidum therein) remain to be established. OBJECTIVES The goal of this study was to characterise gait and gait initiation disorders within the context of a parkinsonian syndrome in patients with acquired, bilateral, pallidal lesions (PAL patients), to compare these disorders to those seen in Parkinson's disease (PD), and to assess the corresponding physiopathological implications. PATIENTS AND METHODS By using a video motion analysis system (VICON), we studied gait kinematic parameters in two patients presenting with bilateral, pallidal lesions. Kinematic and kinetic parameters were also determined during gait initiation. The two patients were compared with a group of 17 PD patients and to 20 healthy controls. RESULTS In both PAL and PD patients, kinematic parameters (gait and gait initiation) and kinetic parameters (gait initiation) were similarly impaired, evidenced by akinesia (difficulty in initiating gait characterized by impairment of anticipatory postural adjustments). Hypokinesia and bradykinesia (respectively reduced stride length and reduced speed during gait) were also noted. CONCLUSION The gait and gait initiation disorders seen in cases of bilateral pallidal lesions (namely akinesia, hypokinesia and bradykinesia) are similar to those observed in PD. Subject to confirmation in more extensive studies, we hypothesize that bipallidal patients may present higher level gait disorders,with potential mediation by cognitive impairment.
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Affiliation(s)
- P Krystkowiak
- Neurologie A, Hôpital R. Salengro, CHRU de Lille, 59037, Lille Cedex, France.
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Kuoppamäki M, Rothwell JC, Brown RG, Quinn N, Bhatia KP, Jahanshahi M. Parkinsonism following bilateral lesions of the globus pallidus: performance on a variety of motor tasks shows similarities with Parkinson's disease. J Neurol Neurosurg Psychiatry 2005; 76:482-90. [PMID: 15774432 PMCID: PMC1739601 DOI: 10.1136/jnnp.2003.020800] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES The authors report the results of detailed investigations into the motor function of a patient who, after a heavy drinking binge and subsequent unconsciousness, respiratory acidosis, and initial recovery, developed parkinsonism characterised by hypophonic speech and palilalia, "fast micrographia", impaired postural reflexes, and brady/akinesia in proximal (but not distal) alternating upper limb movements. METHODS In addition to brain magnetic resonance imaging (MRI), different aspects of motor function were investigated using reaction time (RT) tasks, pegboard and finger tapping tasks, flex and squeeze tasks, movement related cortical potentials (MRCPs), and contingent negative variation (CNV). Cognitive function was also assessed. The results were compared to those previously reported in patients with Parkinson's disease (PD). RESULTS Brain MRI showed isolated and bilateral globus pallidus (GP) lesions covering mainly the external parts (GPe). These lesions were most probably secondary to respiratory acidosis, as other investigations failed to reveal an alternative cause. The results of the RT tasks showed that the patient had difficulties in preparing and maintaining preparation for a forthcoming movement. MRCP and CNV studies were in line with this, as the early component of the MRCP and CNV were absent prior to movement. The patient's performance on pegboard and finger tapping, and flex and squeeze tasks was normal when performed with one hand, but clearly deteriorated when using both hands simultaneously or sequentially. CONCLUSIONS In general, the present results were similar to those reported previously in patients with PD. This provides further indirect evidence that the output of globus pallidus is of major importance in abnormal motor function in PD. The possible similarities of the functional status of GP in PD and our case are discussed.
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Affiliation(s)
- M Kuoppamäki
- Departmernt of Neurology, Satakunta General Hospital and Satakunnan Neurologipalvelu Oy, Pori, Finland
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36
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Affiliation(s)
- Michel Panisset
- Movement Disorders Clinic and Departments of Neurology, Neurosurgery, McGill Centre for Studies in Aging, McGill University, 6825 LaSalle Blvd, Verdun (Montréal), Quebec H4H 1R3, Canada.
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Lee PH, Lee JS, Lee MH, Lee JD, Huh K. Subtraction brain SPECT imaging in a patient with gait ignition failure. Mov Disord 2004; 18:1542-5. [PMID: 14673896 DOI: 10.1002/mds.10608] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
The precise anatomical location and pathophysiology of gait ignition failure (GIF) is poorly understood. We investigated the cerebral perfusion patterns using subtraction brain single photon emission computed tomography (SPECT) in a patient with GIF. Subtraction brain SPECT imaging revealed an increased activity in the region of right ventrolateral midbrain and ventral medulla.
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Affiliation(s)
- Phil Hyu Lee
- Department of Neurology, School of Medicine, Ajou University, Suwon, South Korea.
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Lassinger BK, Kwak C, Walford RL, Jankovic J. Atypical parkinsonism and motor neuron syndrome in a Biosphere 2 participant: A possible complication of chronic hypoxia and carbon monoxide toxicity? Mov Disord 2004; 19:465-9. [PMID: 15077246 DOI: 10.1002/mds.20076] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Exogenous toxins and chronic hypoxia have been implicated in the etiopathogenesis of a variety of neurological disorders, but it is not always possible to establish a cause-effect relationships. We describe a patient who presented with an unusual gait disorder and progressive motor neuron disease after residing for 2 years within Biosphere 2, a scientifically engineered dome, tightly sealed to allow miniscule exchange of air between its atmosphere and the earth's atmosphere. We postulate that this unusual syndrome resulted from chronic hypoxia possibly coupled with carbon monoxide and nitrous oxide exposure.
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Affiliation(s)
- Brian K Lassinger
- Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, Texas 77030, USA
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Kuoppamäki M, Bhatia KP, Quinn N. Progressive delayed-onset dystonia after cerebral anoxic insult in adults. Mov Disord 2002; 17:1345-9. [PMID: 12465080 DOI: 10.1002/mds.10260] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The basal ganglia, especially the globi pallidi (GP), are highly vulnerable to generalized cerebral anoxia/hypoxia. We report on 2 new cases with delayed-onset generalized dystonia due to cerebral anoxia. The onset of dystonia in both of our patients was delayed by about 2 months. In both cases, the unusual feature was the progressive worsening and the spread of dystonia over many years after delayed onset. Dystonia progressed for 16 years in Case 1 and for 4 years in Case 2. Furthermore, initial magnetic resonance imaging (MRI) scan of Case 1 showed mild changes of the internal capsule sparing the basal ganglia. Years later, in line with clinical progression, the follow-up MRI scan showed isolated bilateral lesions involving the entire GP. MRI scans in Case 2 showed bilateral lesions of caudate and lentiform nuclei. There may be several mechanisms underlying delayed and progressive symptoms after time-limited brain anoxia. We hypothesize that anoxia-induced excitotoxicity resulting in mitochondrial dysfunction and subsequent apoptosis may explain, at least partly, the delayed-onset and progressive extrapyramidal syndromes seen in these patients.
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Affiliation(s)
- Mikko Kuoppamäki
- Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, Queen Square, London, United Kingdom
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Gait Disturbances in Parkinson’s Disease. MAPPING THE PROGRESS OF ALZHEIMER’S AND PARKINSON’S DISEASE 2002. [DOI: 10.1007/978-0-306-47593-1_57] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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41
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Pradat PF, Dupel-Pottier C, Lacomblez L, Salachas F, Meininger V, Lacomblez L, Spelle L, Bonnaud I, Ribeiro MJ, Remy P, Samson Y. Case report of pallido-pyramidal disease with supplementary motor area involvement. Mov Disord 2001; 16:762-4. [PMID: 11481707 DOI: 10.1002/mds.1126] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
An C-flumazenil positron emission tomography (PET) study in a patient with pallido-pyramidal disease revealed a marked decrease in benzodiazepine-receptor density in the precentral gyrus cortex and the mesial frontal cortex. We suggest that, in addition to dysfunction of basal ganglia-dependent systems, degeneration of the supplementary motor area could also be involved in the patient's bradykinesia.
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Affiliation(s)
- P F Pradat
- Fédération de Neurologie Mazarin, Hôpital de la Pitié-Salpétrière, Paris, France
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Armengol CG. Acute oxygen deprivation: neuropsychological profiles and implications for rehabilitation. Brain Inj 2000; 14:237-50. [PMID: 10759041 DOI: 10.1080/026990500120718] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVE To investigate areas of neuropsychological functioning in severe anoxia survivors that have received little prior attention but that have significant implications for rehabilitation. DESIGN Residents of a long-term neurobehavioural rehabilitation facility were administered comprehensive neuropsychological protocols. Areas assessed were arousal and attention, executive abilities, reasoning, language, visuospatial abilities, motor, praxis, memory, affective regulation, and insight into deficits. RESULTS Subjects were impaired in all areas except in performing automatized tasks. Areas of dysfunction not previously emphasized included praxis, affective regulation, and verbal fluency. CONCLUSION Areas of compromise not previously emphasized were identified. Their routine assessment can assist rehabilitation professionals in better serving anoxic encephalopathy survivors, particularly those with profound behavioural dysregulation.
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Affiliation(s)
- C G Armengol
- Counseling and Applied Educational Psychology Department, Northeastern University, Boston, MA 02115, USA.
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Abstract
We report the case of a female patient who was exhibiting slowly progressive, severe, generalized freezing of voluntary movement and disequilibrium. Brain magnetic resonance imaging showed a very low signal intensity in both pallidal nuclei, with a high signal intensity in the central portion, the so called 'eye-of-the-tiger' sign. Despite the unusual clinical features, we believe that this is a case of Hallervorden-Spatz syndrome, although without neuropathological examination we were unable to confirm the diagnosis with certainty. This case further demonstrates the complex role of the pallidum in voluntary movement.
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Affiliation(s)
- J Guimarães
- Servico de Neurologia, Hospital de Egas Moniz - Rua da Junqueira, 126-1300, Lisboa, Portugal
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Pirker W, Baumgartner C, Brugger S, Prayer D, Kandlhofer S, Asenbaum S, Deecke L, Brücke T, Lange KW. Severe akinetic syndrome resulting from a bilateral basal ganglia lesion following bone marrow transplantation. Mov Disord 1999; 14:525-8. [PMID: 10348486 DOI: 10.1002/1531-8257(199905)14:3<525::aid-mds1028>3.0.co;2-k] [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: 11/12/2022] Open
Affiliation(s)
- W Pirker
- Department of Neurology, University of Vienna, Austria
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Krack P, Pollak P, Limousin P, Hoffmann D, Benazzouz A, Benabid AL. Inhibition of levodopa effects by internal pallidal stimulation. Mov Disord 1998; 13:648-52. [PMID: 9686769 DOI: 10.1002/mds.870130407] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
We report three patients with bilateral GPi stimulation for stage 4 Parkinson's disease (PD) with severe levodopa-induced dyskinesias (LID). In all three it was possible to completely inhibit LID using high-stimulation parameters. Parallel to complete inhibition of LID, an inhibition of the anti-akinetic effect of levodopa was observed, whereas, at the same time, rigidity was markedly improved. GPi stimulation is adaptable over time, and stimulation parameters have to be programmed according to off- and on-period motor symptoms. The main interest of stimulation is the possibility of finding a compromise between LID alleviation in on-phase without loss of the beneficial motor effects and improvement in parkinsonism in off-phase. In some patients, residual dyskinesias have to be accepted so as not to aggravate on-period motor symptoms by a presumed overinhibition of basal ganglia outflow.
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Affiliation(s)
- P Krack
- Department of Clinical and Biological Neurosciences and INSERM U318, Joseph Fourier University of Grenoble, France
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47
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Fabre N, Brefel C, Sabatini U, Celsis P, Montastruc JL, Chollet F, Rascol O. Normal frontal perfusion in patients with frozen gait. Mov Disord 1998; 13:677-83. [PMID: 9686774 DOI: 10.1002/mds.870130412] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
We have studied the frontal perfusion in the resting condition of two groups of patients with frozen gait: 10 patients with the syndrome of "isolated gait ignition failure" (IGIF) and 8 patients with idiopathic Parkinson's disease (PD) and severe "off" freezing. These patients were compared with two other groups: one including 20 age-matched volunteers as normal control subjects and the other one including 12 patients with progressive supranuclear palsy (PSP) as a positive control with expected frontal hypoperfusion. Frontal perfusion was assessed using single photon emission computed tomography (SPECT) regional cerebral blood flow measurement with intravenous 133Xenon. A significant frontal hypoperfusion was only present in the PSP group but not in the three others. These results do not support the hypothesis that start hesitations and freezing when walking are related to a frontal lobe dysfunction. However, it is possible that frontal neuronal dysfunction occurs without measurable cerebral blood flow changes in the resting condition.
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Affiliation(s)
- N Fabre
- National Institute of Health and Medical Research, INSERM U 455, Department of Neurology, Toulouse, France
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Affiliation(s)
- A Govaerts
- Department of Neurology, A.Z. St-Jan, Brugge, Belgium
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Krack P, Pollak P, Limousin P, Hoffmann D, Benazzouz A, Le Bas JF, Koudsie A, Benabid AL. Opposite motor effects of pallidal stimulation in Parkinson's disease. Ann Neurol 1998; 43:180-92. [PMID: 9485059 DOI: 10.1002/ana.410430208] [Citation(s) in RCA: 250] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
We studied the effects--on parkinsonian signs, on levodopa-induced dyskinesias, and on levodopa response--of acute experimental high-frequency stimulation of the internal pallidum (GPi) during off-drug and on-drug phases. Thirteen quadripolar electrodes were evaluated in 8 patients with Parkinson's disease (PD). Stimulation of the most ventral contacts, lying at the ventral margin of or just below the GPi, led to pronounced improvement in rigidity and a complete arrest of levodopa-induced dyskinesias. The antiakinetic effect of levodopa was also blocked and the patients became severely akinetic. Stimulation of the most dorsal contacts, lying at the dorsal border of the GPi or inside the external pallidum, usually led to moderate improvement of off-drug akinesia and could also induce dyskinesias in some patients. When using an intermediate contact for chronic stimulation, a good compromise between these opposite effects was usually obtained, mimicking the effect of pallidotomy. We conclude that there are at least two different functional zones within the globus pallidus, at the basis of a different pathophysiology of the cardinal symptoms of PD. The opposite effects may explain the variable results of pallidal surgery reported in the literature and may also largely explain the paradox of PD surgery. A possible anatomical basis for these differential functional effects could be a functional somatotopy within the GPi, with the segregation of the pallidofugal fibers from the outer portion of the GPi, on one hand, forming the ventral ansa lenticularis and from the inner portion of the GPi, on the other hand, forming the dorsal lenticular fasciculus.
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Affiliation(s)
- P Krack
- Department of Clinical and Biological Neurosciences, and INSERM U318, Joseph Fourier University of Grenoble, France
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