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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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LaHue SC, Albers K, Goldman S, Lo RY, Gu Z, Leimpeter A, Fross R, Comyns K, Marras C, de Kleijn A, Smit R, Katz M, Ozelius LJ, Bressman S, Saunders-Pullman R, Comella C, Klingman J, Nelson LM, Van Den Eeden SK, Tanner CM. Cervical dystonia incidence and diagnostic delay in a multiethnic population. Mov Disord 2020; 35:450-456. [PMID: 31774238 PMCID: PMC10683845 DOI: 10.1002/mds.27927] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 09/02/2019] [Accepted: 09/12/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Current cervical dystonia (CD) incidence estimates are based on small numbers in relatively ethnically homogenous populations. The frequency and consequences of delayed CD diagnosis is poorly characterized. OBJECTIVES To determine CD incidence and characterize CD diagnostic delay within a large, multiethnic integrated health maintenance organization. METHODS We identified incident CD cases using electronic medical records and multistage screening of more than 3 million Kaiser Permanente Northern California members from January 1, 2003, to December 31, 2007. A final diagnosis was made by movement disorders specialist consensus. Diagnostic delay was measured by questionnaire and health utilization data. Incidence rates were estimated assuming a Poisson distribution of cases and directly standardized to the 2000 U.S. census. Multivariate logistic regression models were employed to assess diagnoses and behaviors preceding CD compared with matched controls, adjusting for age, sex, and membership duration. RESULTS CD incidence was 1.18/100,000 person-years (95% confidence interval [CI], 0.35-2.0; women, 1.81; men, 0.52) based on 200 cases over 15.4 million person-years. Incidence increased with age. Half of the CD patients interviewed reported diagnostic delay. Diagnoses more common in CD patients before the index date included essential tremor (odds ratio [OR] 68.1; 95% CI, 28.2-164.5), cervical disc disease (OR 3.83; 95% CI, 2.8-5.2), neck sprain/strain (OR 2.77; 95% CI, 1.99-3.62), anxiety (OR 2.24; 95% CI, 1.63-3.11) and depression (OR 1.94; 95% CI, 1.4-2.68). CONCLUSIONS CD incidence is greater in women and increases with age. Diagnostic delay is common and associated with adverse effects. © 2019 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Sara C. LaHue
- Department of Neurology, School of Medicine, University of California, San Francisco, California, USA
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, California, USA
| | - Kathleen Albers
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Samuel Goldman
- Department of Neurology, School of Medicine, University of California, San Francisco, California, USA
- San Francisco Veteran’s Administration Medical Center, San Francisco, California, USA
- Occupational and Environmental Medicine, School of Medicine, University of California, San Francisco, California, USA
| | - Raymond Y. Lo
- Hualien Tzu Chi Hospital/Tzu Chi University, Hualien, Taiwan
| | - Zhuqin Gu
- Department of Neurobiology, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Amethyst Leimpeter
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Robin Fross
- Department of Neurology, Kaiser Permanente Hayward Medical Center, Hayward, California, USA
| | - Kathleen Comyns
- Department of Neurology, School of Medicine, University of California, San Francisco, California, USA
| | - Connie Marras
- Morton and Gloria Shulman Movement Disorders Centre and the Edmond J Safra Program in Parkinson’s Research, University of Toronto, Toronto, Canada
| | - Annelie de Kleijn
- Department of Neurology, Radboud University Nijmegen, Nijmegen, Netherlands
| | - Robin Smit
- Department of Neurology, Radboud University Nijmegen, Nijmegen, Netherlands
| | - Maya Katz
- Department of Neurology, School of Medicine, University of California, San Francisco, California, USA
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, California, USA
- San Francisco Veteran’s Administration Medical Center, San Francisco, California, USA
| | - Laurie J. Ozelius
- Department of Neurology, Massachusetts General Hospital, Charlestown, Massachusetts, USA
| | - Susan Bressman
- Department of Neurology, Mount Sinai Beth Israel, New York, New York, USA
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Rachel Saunders-Pullman
- Department of Neurology, Mount Sinai Beth Israel, New York, New York, USA
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Cynthia Comella
- Department of Neurology, Rush University Medical Center, Chicago, Illinois, USA
| | - Jeffrey Klingman
- Department of Neurology, Kaiser Permanente Walnut Creek Medical Center, Walnut Creek, California, USA
| | - Lorene M. Nelson
- Department of Health Research and Policy, Stanford University, Stanford, California, USA
| | | | - Caroline M. Tanner
- Department of Neurology, School of Medicine, University of California, San Francisco, California, USA
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, California, USA
- San Francisco Veteran’s Administration Medical Center, San Francisco, California, USA
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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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Gao HM, Hong JS. Gene-environment interactions: key to unraveling the mystery of Parkinson's disease. Prog Neurobiol 2011; 94:1-19. [PMID: 21439347 PMCID: PMC3098527 DOI: 10.1016/j.pneurobio.2011.03.005] [Citation(s) in RCA: 102] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2010] [Revised: 01/26/2011] [Accepted: 03/16/2011] [Indexed: 12/21/2022]
Abstract
Parkinson's disease (PD) is the second most common neurodegenerative disease. The gradual, irreversible loss of dopamine neurons in the substantia nigra is the signature lesion of PD. Clinical symptoms of PD become apparent when 50-60% of nigral dopamine neurons are lost. PD progresses insidiously for 5-7 years (preclinical period) and then continues to worsen even under the symptomatic treatment. To determine what triggers the disease onset and what drives the chronic, self-propelling neurodegenerative process becomes critical and urgent, since lack of such knowledge impedes the discovery of effective treatments to retard PD progression. At present, available therapeutics only temporarily relieve PD symptoms. While the identification of causative gene defects in familial PD uncovers important genetic influences in this disease, the majority of PD cases are sporadic and idiopathic. The current consensus suggests that PD develops from multiple risk factors including aging, genetic predisposition, and environmental exposure. Here, we briefly review research on the genetic and environmental causes of PD. We also summarize very recent genome-wide association studies on risk gene polymorphisms in the emergence of PD. We highlight the new converging evidence on gene-environment interplay in the development of PD with an emphasis on newly developed multiple-hit PD models involving both genetic lesions and environmental triggers.
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Affiliation(s)
- Hui-Ming Gao
- Neuropharmacology Section, Laboratory of Toxicology & Pharmacology, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC 27709, USA.
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Abstract
The cause of progressive supranuclear palsy (PSP), the most common form of the atypical parkinsonian disorders, is unknown. PSP is characterized by four-repeat tau aggregates in neurons (neurofibrillary tangles) and glia in specific basal ganglia and brainstem areas. A thorough literature review led us to hypothesize that genetic and/or environmental factors contribute to its development. It is likely that inheritance of the H1/H1 tau genotype represents a predisposition to develop PSP requiring other environmental or genetic factors. Less likely, a relatively rare mutation with low penetrance could contribute to the abnormal tau aggregation present in this disorder. The possible role of chemicals in the diet or occupation, hypertension, traumatic brain injury, coffee, and inflammation or oxidative injury are reviewed.
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Affiliation(s)
- Irene Litvan
- Movement Disorder Program, University of Louisville School of Medicine, Louisville, Kentucky, USA.
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Liu B, Gao HM, Hong JS. Parkinson's disease and exposure to infectious agents and pesticides and the occurrence of brain injuries: role of neuroinflammation. ENVIRONMENTAL HEALTH PERSPECTIVES 2003; 111:1065-73. [PMID: 12826478 PMCID: PMC1241555 DOI: 10.1289/ehp.6361] [Citation(s) in RCA: 195] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Idiopathic Parkinson's disease (PD) is a devastating movement disorder characterized by selective degeneration of the nigrostriatal dopaminergic pathway. Neurodegeneration usually starts in the fifth decade of life and progresses over 5-10 years before reaching the fully symptomatic disease state. Despite decades of intense research, the etiology of sporadic PD and the mechanism underlying the selective neuronal loss remain unknown. However, the late onset and slow-progressing nature of the disease has prompted the consideration of environmental exposure to agrochemicals, including pesticides, as a risk factor. Moreover, increasing evidence suggests that early-life occurrence of inflammation in the brain, as a consequence of either brain injury or exposure to infectious agents, may play a role in the pathogenesis of PD. Most important, there may be a self-propelling cycle of inflammatory process involving brain immune cells (microglia and astrocytes) that drives the slow yet progressive neurodegenerative process. Deciphering the molecular and cellular mechanisms governing those intricate interactions would significantly advance our understanding of the etiology and pathogenesis of PD and aid the development of therapeutic strategies for the treatment of the disease.
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Affiliation(s)
- Bin Liu
- Neuropharmacology Section, Laboratory of Pharmacology and Chemistry, National Institute of Environmental Health Sciences/National Institutes of Health, Research Triangle Park, North Carolina, USA.
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7
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Abstract
We report on 8 patients with adult-onset motor tics and vocalisations. Three had compulsive tendencies in childhood and 3 had a family history of tics or obsessive-compulsive behaviour. In comparison with DSM-classified, younger-onset Gilles de la Tourette syndrome, adult-onset tic disorders are more often associated with severe symptoms, greater social morbidity, a potential trigger event, increased sensitivity, and poorer response to neuroleptic medication.
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Affiliation(s)
- Valsamma Eapen
- Department of Psychiatry and Behavioural Sciences, Royal Free and University College, London Medical School, London, United Kingdom
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8
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Lai BCL, Marion SA, Teschke K, Tsui JKC. Occupational and environmental risk factors for Parkinson's disease. Parkinsonism Relat Disord 2002; 8:297-309. [PMID: 15177059 DOI: 10.1016/s1353-8020(01)00054-2] [Citation(s) in RCA: 110] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2001] [Revised: 10/26/2001] [Accepted: 10/26/2001] [Indexed: 12/21/2022]
Abstract
The etiology of Parkinson's disease (PD) remains obscure. Current research suggests that a variety of occupational and environmental risk factors may be linked to PD. This paper provides an overview of major occupational and environmental factors that have been associated with the development of PD and tries to assess current thinking about these factors and their possible mechanisms of operation. While clear links to rural living, dietary factors, exposure to metals, head injury, and exposure to infectious diseases during childhood have not been established, there is general agreement that smoking and exposure to pesticides affect the probability of developing PD.
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Affiliation(s)
- B C L Lai
- Department of Medicine, Division of Neurology, Neurodegenerative Disorders Centre, The University of British Columbia, Purdy Pavilion, 2221 Wesbrook Mall, Vancouver, BC, Canada V6T 2B5
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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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Nobrega JCMD, Campos CR, Limongi JCP, Teixeira MJ, Lin TY. Movement disorders induced by peripheral trauma. ARQUIVOS DE NEURO-PSIQUIATRIA 2002; 60:17-20. [PMID: 11965403 DOI: 10.1590/s0004-282x2002000100004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Movement disorders induced by central nervous system trauma are well recognized. However, over the last few years, attention has been drawn to the role of peripherally induced movement disorders. We describe three patients presenting respectively dystonia, tremor and choreoathetosis associated with tremor and dystonia of the body parts previously exposed to traumatic injuries. Pathophysiological mechanisms underlying these phenomena are not entirely known, but functional changes in afferent neuronal input to the spinal cord and secondary affection of higher brain stem and subcortical centers are probably involved.
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12
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Müller SV, von Schweder AJ, Frank B, Dengler R, Münte TF, Johannes S. The effects of proprioceptive stimulation on cognitive processes in patients after traumatic brain injury. Arch Phys Med Rehabil 2002; 83:115-21. [PMID: 11782841 DOI: 10.1053/apmr.2002.27472] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To investigate the hypothesis that proprioceptive stimulation may be effective in the treatment of brain injury, using neurophysiologic and neuropsychologic measures. DESIGN Cohort analytic study. SETTING Patients recovering from traumatic brain injury (TBI) in a neurologic rehabilitation hospital were examined. PARTICIPANTS Eleven patients with TBI (Glasgow Coma Scale score > 3) and 11 healthy control subjects matched for age and education. INTERVENTIONS Subjects were examined with the event-related potential (ERP) technique during a computerized choice-reaction-time task, in which they had to discriminate between even and odd digits. There were experimental runs with and without vibratory stimuli applied to the left forearm serving as proprioceptive stimulation. In addition, ERPs were recorded to vibratory stimuli without any additional task. MAIN OUTCOME MEASURES Outcome measures included latencies and amplitudes of the P300 ERP component and of the late negative component. RESULTS In the passive vibration condition, both groups showed the same ERP distribution. In the choice-reaction-time task, latencies and amplitudes of the P300 differed between the 2 groups. The patient group showed longer P300 latencies, which were shortened by vibratory stimuli. In contrast, the control subjects were not affected by vibratory stimuli. CONCLUSION Our findings support the hypothesis that pathologic cognitive processes after TBI can be improved by proprioceptive stimulation. Muscle vibration has positive effects on pathologically slowed cognitive processes but not in healthy subjects.
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Affiliation(s)
- Sandra V Müller
- Department of Neurology, Medical School Hannover, Hannover, Germany.
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Abstract
The etiology of tic disorder includes idiopathic, postencephalitic, head injury, carbon monoxide poisoning, stroke, and developmental syndromes. We report a case of new-onset complex motor and vocal tics that began after hemorrhage of an arteriovenous malformation located in the left frontal lobe. We have found no reported cases of new-onset tics related to arteriovenous malformations or hemorrhage into the frontal lobes. The patient is a 16-year-old right-hand-dominant boy who presented with generalized tonic-clonic seizures. Evaluation, including magnetic resonance imaging, revealed a left frontal arteriovenous malformation, confirmed by angiogram. Following resection, there was an intraparenchymal hemorrhage of the left frontal lobe with intraventricular hemorrhage, noted most prominently in the left lateral and IIIrd ventricles, and a subdural hematoma caudal to the craniotomy. The postoperative course was complicated by hemiparesis and global aphasia. During recovery, the patient developed what was thought to be a complex partial seizure evidenced by head turning to the right with vocalization and left upper extremity clonic jerks. These were brief and occurred multiple times per day. A trial of carbamazepine was given with no improvement. It was noted that the spells occurred more frequently under stress, as when the patient was frustrated with communication. The diagnosis was changed to complex motor tics and the therapy changed to clonidine. The tics subsequently improved by 80%, although they were still present. We believe the development of complex motor tics due to frontal hemorrhage represents a unique etiology and could complicate postsurgical recovery in similar cases.
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Affiliation(s)
- M R Yochelson
- Department of Child and Adolescent Neurology, Walter Reed Army Medical Center, Washington, DC 20307, USA.
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14
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Elster EL. Upper cervical chiropractic management of a patient with Parkinson's disease: a case report. J Manipulative Physiol Ther 2000; 23:573-7. [PMID: 11050615 DOI: 10.1067/mmt.2000.109673] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To discuss the use of upper cervical chiropractic management in managing a single patient with Parkinson's disease and to describe the clinical picture of the disease. CLINICAL FEATURES A 60-year-old man was diagnosed with Parkinson's disease at age 53 after a twitch developed in his left fifth finger. He later developed rigidity in his left leg, body tremor, slurring of speech, and memory loss among other findings. INTERVENTION AND OUTCOME This subject was managed with upper cervical chiropractic care for 9 months. Analysis of precision upper cervical radiographs determined upper cervical mis-alignment. Neurophysiology was monitored with paraspinal digital infrared imaging. This patient was placed on a specially designed knee-chest table for adjustment, which was delivered by hand to the first cervical vertebrae, according to radiographic findings. Evaluation of Parkinson's symptoms occurred by doctor's observation, the patient's subjective description of symptoms, and use of the Unified Parkinson's Disease Rating Scale. Reevaluations demonstrated a marked improvement in both subjective and objective findings. CONCLUSION Upper cervical chiropractic care aided by cervical radiographs and thermal imaging had a successful outcome for a patient with Parkinson's disease. Further investigation into upper cervical injury as a contributing factor to Parkinson's disease should be considered.
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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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16
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Affiliation(s)
- G M Wali
- Department of Neurology, Jawaharlal Nehru Medical College, Belgaum, India
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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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Micheli F, Torres L, Diaz M, Scorticati MC, Diaz S. Delayed onset limb dystonia following electric injury. Parkinsonism Relat Disord 1998; 4:39-42. [DOI: 10.1016/s1353-8020(98)00006-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Revised: 01/13/1998] [Indexed: 11/17/2022]
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Abstract
We describe three adult patients who presented with multifocal motor and vocal tics secondary to craniocerebral trauma. In one case, the tics were accompanied by marked obsessive-compulsive behavior. All patients were involved in motor vehicle accidents resulting in closed craniocerebral trauma. The latency of onset between head trauma and the movement disorder varied between 1 day and a few months. Magnetic resonance imaging, which was performed in all three patients, did not detect any structural lesions of the basal ganglia or the brainstem. Extensive bifrontal leukoencephalopathy was found in one patient who suffered severe head trauma.
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Affiliation(s)
- J K Krauss
- Department of Neurology, Baylor College of Medicine, Houston, Texas 77030, USA
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Krauss JK, Tränkle R, Kopp KH. Posttraumatic movement disorders after moderate or mild head injury. Mov Disord 1997; 12:428-31. [PMID: 9159742 DOI: 10.1002/mds.870120326] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
We examined the occurrence of posttraumatic movement disorders after moderate or mild head injury with a three-level follow-up study including questionnaires, telephone interviews, and personal examinations 4-6 years after the trauma (mean 5.2 years). Sixteen of 158 patients (10.1%) for whom a detailed follow-up was available had developed movement disorders most probably related to craniocerebral trauma. The most frequent finding was a low-amplitude postural/intention tremor that appeared to resemble enhanced physiological or essential tremor. Twelve patients reported transient tremor, two patients had persistent tremor, one patient had transient tremor and persistent hyperekplexia, and another patient had mild persistent cervical myoclonic twitches. Overall, the movement disorder was transient in 12 patients (7.6%) and persisted in only 4 patients (2.6%). These movement disorders were not disabling and did not require medical therapy. Taking into account possible bias by selection of the sample group, the frequency of movement disorders secondary to moderate or mild head trauma might be lower than 10.1%. Posttraumatic movement disorders occurred significantly more often in the group of patients with Glasgow Coma Scores between 9 and 14 than in those with a score of 15. Severe movement disorders such as low-frequency kinetic tremor or hemidystonia were not identified in this survey.
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Affiliation(s)
- J K Krauss
- Department of Neurosurgery, Albert-Ludwigs-Universität, Freiburg, Germany
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Tremor and dystonia after penetrating diencephalic-mesencephalic trauma. Parkinsonism Relat Disord 1997; 3:117-9. [DOI: 10.1016/s1353-8020(96)00043-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/10/1996] [Indexed: 11/22/2022]
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