Adult head-banging and stereotypic movement disorders

Self-injurious behaviour in movement disorders: systematic review

Self-injurious behaviours (SIBs) are defined as deliberate, repetitive and persistent behaviours that are directed towards the body and lead to physical injury and are not associated with sexual arousal and without suicidal intent. In movement disorders, SIBs are typically associated with tic disorders, most commonly Tourette syndrome, and neurometabolic conditions, such as classic Lesch-Nyhan syndrome. However, beyond these well-known aetiologies, a range of other movement disorder syndromes may also present with SIBs, even though this clinical association remains less well-known. Given the scarcity of comprehensive works on this topic, here we performed a systematic review of the literature to delineate the spectrum of movement disorder aetiologies associated with SIBs. We report distinct aetiologies, which are clustered in five different categorical domains, namely, neurodevelopmental, neurometabolic and neurodegenerative disorders, as well as disorders with characteristic structural brain changes and heterogeneous aetiologies (eg, autoimmune and drug-induced). We also provide insights in the pathophysiology of SIBs in these patients and discuss neurobiological key risk factors, which may facilitate their manifestation. Finally, we provide a list of treatments, including practical measures, such as protective devices, as well as behavioural interventions and pharmacological and neurosurgical therapies.

Construct Validity and Cross Validity of a Test Battery Modeling Autism Spectrum Disorder (ASD) in Mice

Modeling in other organism species is one of the crucial stages in ascertaining the association between gene and psychiatric disorder. Testing Autism Spectrum Disorder (ASD) in mice is very popular but construct validity of the batteries is not available. We presented here the first factor analysis of a behavioral model of ASD-like in mice coupled with empirical validation. We defined fourteen measures aligning mouse-behavior measures with the criteria defined by DSM-5 for the diagnostic of ASD. Sixty-five mice belonging to a heterogeneous pool of genotypes were tested. Reliability coefficients vary from .68 to .81. The factor analysis resulted in a three- factor solution in line with DSM criteria: social behavior, stereotypy and narrowness of the field of interest. The empirical validation with mice sharing a haplo-insufficiency of the zinc-finger transcription factor TSHZ3/Tshz3 associated with ASD shows the discriminant power of the highly loaded items.

Sleep related rhythmic movement disorder revisited

To classify sleep related rhythmic movement disorder (SRMD) based on clinical, polysomnographic and videometric evaluation in a predominantly adult population, twenty-four patients (four females) aged 11-67 years identified by polysomnography and videometry were classified for type of SRMD, its duration and frequency during wakefulness and in the different sleep stages. SRMD persisted unto child- and adulthood in all patients. SRMD is not restricted to sleep-wake transition, occurs most frequently in wake, stages NREM 1 and 2, but also in REM and slow wave sleep. Most patients have one form of SRMD, few have two forms in one night. Longest duration is in wakefulness. Duration does not differ from one sleep cycle to another. Sleep is not fragmented by SRMD, and sleep stages generally do not change when SRMD occurs. Only few patients have short awakenings after SRMD. In four patients with sleep apnea SRMD coincided frequently with the onset of the apnea related arousal. Two patients had a family history of SRMD. In contrast to the ICSD-2 SRMD seems to persist into adulthood frequently with male preponderance. Familial forms are rare. SRMD in the investigated population is always occurring during sleep, even if patients reported it to occur strictly at wake-sleep transition. Polysomnography is a useful method to uncover SRMD aggravated by other sleep disorders and allows insight in some aspects of the pathology of this disorder, which is not well understood. In the adult patients it is not associated with mental pathologies and can be triggered by sleep apnea.

Two- or Four-Hour Lying Deprivation on the Behavior of Lactating Dairy Cows

Cows are often temporarily deprived of the opportunity to lie down while waiting for veterinary or reproductive procedures. Sixty cows were deprived of the opportunity to lie down for 0, 2, or 4 h by confining them in pairs in a small indoor pen. Behavior was recorded during deprivation and for 40 h afterwards. In the first 2 and 4 h of the experiment, cows that were not deprived chose to lie down for 70 and 142 min, respectively. When cows were discouraged from lying, they regularly stomped their legs, repositioned themselves, but never lay down. In the 4-h treatment, both stomping and repositioning increased after the first hour. Butting and weight shifting (displacing weight from one side of the body to the other) increased during deprivation, indicating restlessness. Cows deprived for 4 h sniffed and rubbed their heads against the housing more than cows deprived for 0 or 2 h. Time spent feeding and standing without ruminating increased with the duration of deprivation, especially during the early stages; standing ruminating also increased in the final stages. After deprivation, feeding time decreased, which compensated for the increase during deprivation. By 40 h after deprivation, the lying-deprived cows had recovered approximately 40% of their lost lying time. Milk yield was not affected by lying deprivation. It is concluded that cows experience discomfort during short periods of lying deprivation, after which they recover some, but not all, of the lost lying time by rescheduling feeding and standing time.

Rett syndrome: An overlooked diagnosis in women with stereotypic hand movements, psychomotor retardation, Parkinsonism, and dystonia?

Rett syndrome is an X-linked neurodevelopmental disorder resulting in profound psychomotor retardation. It is usually diagnosed by a pediatrician or pediatric neurologist. Adult neurologists may, therefore, overlook the possibility of Rett syndrome in women with psychomotor retardation of unknown etiology. We report the case of a woman diagnosed with Rett syndrome at age 49 years. This report emphasizes the diagnostic value of movement disorders, including hand stereotypies, Parkinsonism, and dystonia, in adults with Rett syndrome.

Stereotypical movements and frontotemporal dementia

Stereotypical movements are characteristic of autism or mental retardation but can also occur in patients with dementia, particularly frontotemporal dementia (FTD). In this study, we administered the Abnormal Involuntary Movement Scale (AIMS) to 18 patients with FTD and to 18 patients with the most common form of dementia, Alzheimer's disease (AD). The AIMS scores were gathered at the initial presentation of patients who had not received antipsychotic medications. Compared to the AD patients, the FTD patients had significantly more stereotypical movements, including frequent rubbing behaviors and some self-injurious acts. All the FTD patients with stereotypical movements had compulsive-like behaviors, suggesting a similar pathophysiologic cause, and most had a decrease in their stereotypical movements with the administration of sertraline, a serotonin selective reuptake inhibitor.