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Liu J, Kanno S, Iseki C, Kawakami N, Kakinuma K, Katsuse K, Matsubara S, Ota S, Endo K, Takanami K, Osawa SI, Kawaguchi T, Endo H, Mugikura S, Suzuki K. The grasp reflex in patients with idiopathic normal pressure hydrocephalus. J Neurol 2024:10.1007/s00415-024-12341-0. [PMID: 38587636 DOI: 10.1007/s00415-024-12341-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 03/18/2024] [Accepted: 03/19/2024] [Indexed: 04/09/2024]
Abstract
OBJECTIVE To investigate the prevalence and intensity of grasp reflexes and to examine changes in these reflexes after shunt surgery in patients with idiopathic normal pressure hydrocephalus (iNPH). METHODS We enrolled 147 patients with probable iNPH. A standard procedure was used to determine the presence of grasp reflexes, and the intensity of these reflexes was assessed using a four-category classification. Clinical rating scales and their correlation with grasp reflexes were also evaluated. Grasp reflexes were reassessed in 72 patients 1 year after surgery. RESULTS We found that approximately 50.3% of patients with iNPH exhibited a positive grasp reflex. Among these patients, 69% exhibited bilateral positivity, while the remaining patients showed unilateral positivity. Furthermore, the intensity of the grasp reflex was significantly correlated with the severity of gait and with cognitive, urinary, motor, and behavioural symptoms. Surgical interventions led to a reduction (41.7%) or maintenance (30.6%) of the reflex intensity in 72.3% of iNPH patients. The changes in reflex intensity showed significant positive correlations with changes in the number of steps of the Timed Up and Go test and Trail Making Test-A scores but not with changes in total scores on the iNPH Grading Scale. CONCLUSION This retrospective study identified grasp reflexes as a highly prevalent phenomenon in patients with iNPH. These reflexes can assist in evaluating the severity of various symptoms, including cognitive, gait, urinary, motor and emotional symptoms.
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Affiliation(s)
- Junyan Liu
- Department of Behavioral Neurology and Cognitive Neuroscience, Tohoku University Graduate School of Medicine, 2-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
| | - Shigenori Kanno
- Department of Behavioral Neurology and Cognitive Neuroscience, Tohoku University Graduate School of Medicine, 2-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan.
| | - Chifumi Iseki
- Department of Behavioral Neurology and Cognitive Neuroscience, Tohoku University Graduate School of Medicine, 2-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
| | - Nobuko Kawakami
- Department of Behavioral Neurology and Cognitive Neuroscience, Tohoku University Graduate School of Medicine, 2-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
| | - Kazuo Kakinuma
- Department of Behavioral Neurology and Cognitive Neuroscience, Tohoku University Graduate School of Medicine, 2-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
| | - Kazuto Katsuse
- Department of Behavioral Neurology and Cognitive Neuroscience, Tohoku University Graduate School of Medicine, 2-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
- Department of Neurology, The University of Tokyo, Tokyo, Japan
| | - Shiho Matsubara
- Department of Behavioral Neurology and Cognitive Neuroscience, Tohoku University Graduate School of Medicine, 2-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
| | - Shoko Ota
- Department of Behavioral Neurology and Cognitive Neuroscience, Tohoku University Graduate School of Medicine, 2-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
| | - Keiko Endo
- Department of Rehabilitation, Tohoku University Hospital, Sendai, Japan
| | - Kentaro Takanami
- Department of Diagnostic Radiology, Tohoku University Hospital, Sendai, Japan
| | - Shin-Ichiro Osawa
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | | | - Hidenori Endo
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Shunji Mugikura
- Department of Diagnostic Radiology, Tohoku University Hospital, Sendai, Japan
- Division of Image Statistics, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
| | - Kyoko Suzuki
- Department of Behavioral Neurology and Cognitive Neuroscience, Tohoku University Graduate School of Medicine, 2-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
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Magliacano A, Catalano L, Sagliano L, Estraneo A, Trojano L. Spontaneous eye blinking during an auditory, an interoceptive and a visual task: The role of the sensory modality and the attentional focus. Cortex 2023; 168:49-61. [PMID: 37659289 DOI: 10.1016/j.cortex.2023.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 07/15/2023] [Accepted: 07/31/2023] [Indexed: 09/04/2023]
Abstract
Previous evidence suggested that spontaneous eye blinking changes as a function of the attentional focus. In particular, eye blink rate (EBR) tends to increase when attention is directed to internal versus environmental processing. Most studies on this issue compared eye blinking during visual and mental imagery tasks, and interpreted the increase in EBR as a mechanism to focus cognitive resources on internal processing by disengaging attention from interfering information. However, since eye blinking also depends on the sensory modality of the task, the findings might be influenced by a modality-specific effect. In the present Registered Report we aim at investigating whether the environmental versus internal attentional focus can affect spontaneous blinking behaviour in non-visual tasks as well, in conditions where visual stimuli are not relevant. In a within-subject design, healthy participants performed an interoceptive task (i.e., heartbeat counting) and an auditory task in which pre-recorded heartbeats were presented aurally; during both tasks irrelevant visual stimuli were also presented. In a further control condition with the same auditory and visual stimuli, the participants were required to focus their attention on visual stimuli. Participants' EBR was recorded during each task by means of an eye-tracking system. We found that, although the interoceptive task was more difficult than the auditory and visual tasks, participants' EBR decreased by a comparable level in all tasks with respect to a rest condition, with no differences between internal versus environmental conditions. The present findings do not support the idea that EBR is modulated by an internal versus external focus of attention, at least in presence of controlled visual stimulation.
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Affiliation(s)
| | - Laura Catalano
- Department of Psychology, University of Campania "Luigi Vanvitelli", Caserta, Italy
| | - Laura Sagliano
- Department of Psychology, University of Campania "Luigi Vanvitelli", Caserta, Italy
| | | | - Luigi Trojano
- Department of Psychology, University of Campania "Luigi Vanvitelli", Caserta, Italy.
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Fontanelli L, Pizzanelli C, Milano C, Cassano Cassano R, Galimberti S, Rossini MI, Santo I, Turco F, Bonanni E, Siciliano G, Orciuolo E, Baldacci F. Pre-existing frontal lobe dysfunction signs as predictors of subsequent neurotoxicity in CAR T cell therapy: insights from a case series. Neurol Sci 2023; 44:3291-3297. [PMID: 37160803 PMCID: PMC10170036 DOI: 10.1007/s10072-023-06841-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 05/02/2023] [Indexed: 05/11/2023]
Abstract
BACKGROUND Chimeric Antigen Receptor (CAR) T cell therapies are innovative treatments against hematological malignancies, with increasing therapeutic indications. Despite their great efficacy, these therapies are hampered by high rates of neurotoxicity (immune effector cell-associated neurotoxicity (ICANS)). In the past few years, several risk factors have been associated with ICANS and grouped together in the attempt to build validated models able to predict neurologic complications. However, little is known about pre-existing neurologic conditions possibly related to the development of neurotoxicity. METHODS AND RESULTS In our case series, including sixteen consecutive patients treated with CAR T cells, we observed that (i) neurotoxicity only occurred in the two patients who presented subtle clinical signs of frontal lobe impairment at baseline and (ii) neurologic manifestations of ICANS consisted of language disturbances and cortical frontal myoclonus, which were both manifestations of a frontal predominant dysfunction. DISCUSSION Based on our experience, we suggest that a pre-existing frontal lobe impairment, even if at a subclinical level, may eventually drive to ICANS, which in turn shows symptoms compatible with a frontal encephalopathy. It is remarkable that this focal neurotoxicity involved the same CNS regions that were responsible of subtle neurological signs at baseline. Future studies on larger numbers of patients are needed to confirm the possible role of baseline frontal lobe dysfunction as a predictor of ICANS, in order to enhance efforts to safely deliver CAR T cell therapy.
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Affiliation(s)
- Lorenzo Fontanelli
- Department of Clinical and Experimental Medicine, Neurology Unit, University of Pisa, Pisa, Italy
| | - Chiara Pizzanelli
- Department of Clinical and Experimental Medicine, Neurology Unit, University of Pisa, Pisa, Italy.
| | - Chiara Milano
- Department of Clinical and Experimental Medicine, Neurology Unit, University of Pisa, Pisa, Italy
| | | | - Sara Galimberti
- Department of Clinical and Experimental Medicine, Haematology Unit, University of Pisa, Pisa, Italy
| | - Maria Ida Rossini
- Department of Clinical and Experimental Medicine, Haematology Unit, University of Pisa, Pisa, Italy
| | - Ignazio Santo
- Department of Clinical and Experimental Medicine, Haematology Unit, University of Pisa, Pisa, Italy
| | - Francesco Turco
- Department of Clinical and Experimental Medicine, Neurology Unit, University of Pisa, Pisa, Italy
| | - Enrica Bonanni
- Department of Clinical and Experimental Medicine, Neurology Unit, University of Pisa, Pisa, Italy
| | - Gabriele Siciliano
- Department of Clinical and Experimental Medicine, Neurology Unit, University of Pisa, Pisa, Italy
| | - Enrico Orciuolo
- Department of Clinical and Experimental Medicine, Haematology Unit, University of Pisa, Pisa, Italy
| | - Filippo Baldacci
- Department of Clinical and Experimental Medicine, Neurology Unit, University of Pisa, Pisa, Italy
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Diagnostic accuracy of glabellar tap sign for Parkinson's disease. J Neural Transm (Vienna) 2021; 128:1655-1661. [PMID: 34328563 PMCID: PMC8536581 DOI: 10.1007/s00702-021-02391-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 07/22/2021] [Indexed: 11/30/2022]
Abstract
Glabellar tap or reflex (GR) is an old bedside clinical test used in the diagnostics of Parkinson’s disease (PD), but its diagnostic value is unclear. This study examines the diagnostic validity and reliability of GR in PD in relation to brain dopaminergic activity. GR was performed on 161 patients with PD, 47 patients with essential tremor (ET) and 40 healthy controls immediately prior to dopamine transporter (DAT) [123I]FP-CIT SPECT scanning. The binding ratios were investigated with consideration of the GR result (normal/abnormal). In addition, the consistency of the GR was investigated with 89 patients after a mean follow-up of 2.2 years. PD and ET patients had higher GR scores than healthy controls (p < 0.001), but there was no difference in GR between PD and ET patients (p = 0.09). There were no differences in the ratio of abnormal to normal GRs between the PD and ET groups (73% vs. 64% abnormal, respectively, p = 0.13) or in DAT binding between PD patients with abnormal and normal GRs (p > 0.36). Over follow-up, the GR changed from abnormal to normal in 20% of PD patients despite the presence of clinically typical disease. The sensitivity and specificity of GR for differentiating PD from ET were 78.3% and 36.2%, respectively. Although GR has been used by clinicians in the diagnostics of PD, it does not separate PD from ET. It also shows considerable inconsistency over time, and abnormal GR has no relationship with dopamine loss. Its usefulness should be tested for other clinical diagnostic purposes.
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Price BH, Perez DL, Rapalino O, Oakley DH. Case 41-2020: A 62-Year-Old Man with Memory Loss and Odd Behavior. N Engl J Med 2020; 383:2666-2675. [PMID: 33382934 DOI: 10.1056/nejmcpc1916251] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Bruce H Price
- From the Department of Neurology, McLean Hospital, Belmont, MA (B.H.P.); and the Departments of Neurology (B.H.P., D.L.P.), Psychiatry (D.L.P.), Radiology (O.R.), and Pathology (D.H.O.), Massachusetts General Hospital, and the Departments of Neurology (B.H.P., D.L.P.), Radiology (O.R.), and Pathology (D.H.O.), Harvard Medical School - both in Boston
| | - David L Perez
- From the Department of Neurology, McLean Hospital, Belmont, MA (B.H.P.); and the Departments of Neurology (B.H.P., D.L.P.), Psychiatry (D.L.P.), Radiology (O.R.), and Pathology (D.H.O.), Massachusetts General Hospital, and the Departments of Neurology (B.H.P., D.L.P.), Radiology (O.R.), and Pathology (D.H.O.), Harvard Medical School - both in Boston
| | - Otto Rapalino
- From the Department of Neurology, McLean Hospital, Belmont, MA (B.H.P.); and the Departments of Neurology (B.H.P., D.L.P.), Psychiatry (D.L.P.), Radiology (O.R.), and Pathology (D.H.O.), Massachusetts General Hospital, and the Departments of Neurology (B.H.P., D.L.P.), Radiology (O.R.), and Pathology (D.H.O.), Harvard Medical School - both in Boston
| | - Derek H Oakley
- From the Department of Neurology, McLean Hospital, Belmont, MA (B.H.P.); and the Departments of Neurology (B.H.P., D.L.P.), Psychiatry (D.L.P.), Radiology (O.R.), and Pathology (D.H.O.), Massachusetts General Hospital, and the Departments of Neurology (B.H.P., D.L.P.), Radiology (O.R.), and Pathology (D.H.O.), Harvard Medical School - both in Boston
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Magliacano A, Fiorenza S, Estraneo A, Trojano L. Eye blink rate increases as a function of cognitive load during an auditory oddball paradigm. Neurosci Lett 2020; 736:135293. [PMID: 32771601 DOI: 10.1016/j.neulet.2020.135293] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 05/08/2020] [Accepted: 08/03/2020] [Indexed: 01/21/2023]
Abstract
Previous evidence suggests that changes in spontaneous eye blink rate (EBR) in human adults might reflect the amount of attentional demand (i.e. cognitive load) during cognitive tasks. However, the actual direction of this relation is uncertain, since most studies investigated the role of cognitive load on EBR by employing visual tasks only. Here we aimed at elucidating the relationship between EBR and cognitive load in non-visual tasks. Sixteen healthy participants performed two auditory oddball tasks, i.e. passive listening to auditory tones versus active counting of target tones; each oddball task was immediately followed by a rest phase. Throughout the oddball tasks we assessed EBR and recorded the P300 on ERPs as an electrophysiological measure of attention. The results showed that participants' EBR increased during the active task compared to the respective rest phase. Amplitude and latency of the P300 too differed between passive and active tasks, but changes in EBR and P300 features were not correlated with each other. Our findings demonstrated that an increase in cognitive load is associated with an increase in EBR in cognitive tasks not involving visual attention. These findings are consistent with previous evidence suggesting shared neurobiological bases between attention and EBR.
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Affiliation(s)
- Alfonso Magliacano
- Department of Psychology, University of Campania "Luigi Vanvitelli", Caserta, Italy.
| | - Salvatore Fiorenza
- Istituti Clinici Scientifici Maugeri IRCCS, SB S.p.A., Laboratorio di Valutazione Multimodale dei Disordini della Coscienza, Telese Terme BN, Italy
| | | | - Luigi Trojano
- Department of Psychology, University of Campania "Luigi Vanvitelli", Caserta, Italy
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Leon-Ariza JS, Prada DG, Leon-Ariza DS, Castillo C, Leon-Sarmiento FE. The Three Nociceptive Responses of the Orbicularis Oculi Reflex in Alzheimer's Disease: State of the Evidence and Meta-analysis. Clin EEG Neurosci 2019; 50:354-360. [PMID: 30642208 DOI: 10.1177/1550059418825169] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
There is an emerging belief that electrically elicited blink reflexes (BR) may distinguish Alzheimer's disease (AD) from other disorders characterized by memory dysfunction. To qualitatively and quantitatively distinguish the effects that electrical stimulation has over the blink reflex (eBR) recorded from patients with AD and healthy controls (HCs), we did a systematic review of the literature, and conducted a meta-analysis. Following our selected criteria, 94 AD patients and 97 HCs were identified from articles published in English between 1950 and 2017. Although the 3 responses (R1, R2 and R3) of the eBR were studied in a number of patients, only the R2 response was quantified in all studies. Thresholds and stimulation intensities parameters were found to be used in a miscellaneous form, and the majority of times, such parameters deviated from validated guidelines. The stimulation frequencies used to elicit the BR responses ranged between 0.14 and 0.2 Hz. These frequencies favored HCs compared with AD patients (odds ratio = 1.08; 95% CI = 0.30-1.85), I2 = 0% [P = .99]; Q = 271.89 [df = 7, P < .000]). Egger's regression test suggested publication bias (intercept = 32.38; 95% CI = -8.98 to -3.2; P = .001). Our results unveiled key shortcomings in the data reported; such shortcomings need to be corrected in future AD research looking for obtaining more reliable and reproducible eBR studies; otherwise, interventions may be misleading.
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Affiliation(s)
- Juan S Leon-Ariza
- 1 School of Medicine, Universidad de La Sabana, Chía, Colombia.,2 Mediciencias Research Group, Unicolciencias/Universidad Nacional, Bogota, Colombia
| | - Diddier G Prada
- 3 Universidad Nacional Autónoma de México-UNAM, Mexico City, Mexico.,4 Unidad de Investigación Biomédica en Cáncer, Instituto Nacional de Cancerología, Mexico City, Mexico
| | - Daniel S Leon-Ariza
- 2 Mediciencias Research Group, Unicolciencias/Universidad Nacional, Bogota, Colombia.,5 School of Medicine, Universidad de Santander-UDES, Bucaramanga, Colombia
| | - Camilo Castillo
- 6 Department of Neurological Surgery, University of Louisville, Louisville, KY, USA
| | - Fidias E Leon-Sarmiento
- 2 Mediciencias Research Group, Unicolciencias/Universidad Nacional, Bogota, Colombia.,7 Smell and Taste Center, Department of Otorhinolaryngology: Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Abstract
This review describes the oculo-visual problems likely to be encountered in Parkinson's disease (PD) with special reference to three questions: (1) are there visual symptoms characteristic of the prodromal phase of PD, (2) is PD dementia associated with specific visual changes, and (3) can visual symptoms help in the differential diagnosis of the parkinsonian syndromes, viz. PD, progressive supranuclear palsy (PSP), dementia with Lewy bodies (DLB), multiple system atrophy (MSA), and corticobasal degeneration (CBD)? Oculo-visual dysfunction in PD can involve visual acuity, dynamic contrast sensitivity, colour discrimination, pupil reactivity, eye movement, motion perception, and visual processing speeds. In addition, disturbance of visuo-spatial orientation, facial recognition problems, and chronic visual hallucinations may be present. Prodromal features of PD may include autonomic system dysfunction potentially affecting pupil reactivity, abnormal colour vision, abnormal stereopsis associated with postural instability, defects in smooth pursuit eye movements, and deficits in visuo-motor adaptation, especially when accompanied by idiopathic rapid eye movement (REM) sleep behaviour disorder. PD dementia is associated with the exacerbation of many oculo-visual problems but those involving eye movements, visuo-spatial function, and visual hallucinations are most characteristic. Useful diagnostic features in differentiating the parkinsonian symptoms are the presence of visual hallucinations, visuo-spatial problems, and variation in saccadic eye movement dysfunction.
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de la Espriella RA, Hernández JF, Espejo LM. [Cortical Release Signs in Patients with Schizophrenia, Depressive Disorders, and Bipolar Affective Disorder]. REVISTA COLOMBIANA DE PSIQUIATRIA 2013; 42:311-319. [PMID: 26573115 DOI: 10.1016/s0034-7450(13)70027-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Accepted: 05/28/2013] [Indexed: 06/05/2023]
Abstract
BACKGROUND AND OBJECTIVES Determining the presence of cortical release signs associated with white matter damage, is a clinically easy method to perform. The objective of this study is to determine the presence of cortical release signs in patients with mental illnesses and cerebrovascular disease, as well as its clinical usefulness, given that it indicates cortical damage. MATERIAL AND METHODS A review was made of cortical release signs in patients hospitalized in clinical psychiatry and general hospitals with bipolar affective disorder (40), depression (37), schizophrenia (33), cardiovascular disease (33) and dementia (37). RESULTS The signs of cortical release do not have the same importance as cortical damage. For example, the glabellar reflex was found in all the groups, that of paratonia, particularly in the group with schizophrenia, and others signs in the group of patients with dementia. CONCLUSIONS It is suggested that these signs imply subcortical white matter damage. The appearance of these signs shows the need for a follow up of patients diagnosed with bipolar affective disorder, depression and schizophrenia.
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Affiliation(s)
- Ricardo Andrés de la Espriella
- Médico especialista en Psiquiatría, terapeuta sistémico, magíster en epidemiología clínica; Docente en Departamento de Psiquiatría, Universidad Pontificia Javeriana; Gestor de Docencia e Investigación, Clínica Nuestra Señora de La Paz, Bogotá, Colombia.
| | | | - Lina María Espejo
- Médico especialista en Psiquiatría, Clínica Nuestra Señora de La Paz, Bogotá, Colombia
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Primitive reflexes distinguish vascular parkinsonism from Parkinson's disease. Clin Neurol Neurosurg 2008; 110:562-5. [PMID: 18375052 DOI: 10.1016/j.clineuro.2008.02.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2007] [Revised: 02/14/2008] [Accepted: 02/17/2008] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Although vascular parkinsonism (VP) occurs frequently in the elderly, its clinical features have not been investigated in detail, particularly in comparison with Parkinson's disease (PD). The goal of this study is to clarify the diagnostic value of pathological reflexes in differentiating between VP and PD. PATIENTS AND METHODS In 132 patients with PD and 55 with VP, pathological reflexes, including snout reflex (SR), palmomental reflex (PMR), corneomandibular reflex (CMR), jaw reflex (JR), Hoffmann reflex (HR), and extensor plantar response (EPR), were evaluated. RESULTS The percentage of each pathological reflex elicited in two groups (VP:PD) was as follows: SR (78:30), PMR (53:26), CMR (9:6), JR (33:12), HR (29:11), and EPR (25:8). The prevalence of pathological reflexes, except for CMR, was significantly higher in the VP patients than in the PD patients. In particular, SR and PMR were more frequent than upper motor neuron signs in the VP patients. The sensitivity and specificity of either SR or PMR for VP were 84% and 82%. CONCLUSION Snout and palmomental reflexes are useful tools in the differentiation between VP and PD.
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Abstract
OBJECTIVE To describe 3 cases of patients with alcohol dependence whose primitive reflexes resolved upon initiation of acamprosate 666 mg 3 times daily. CASE SUMMARIES A 57-year-old man had a long-standing history of alcohol dependence and a prominent snout reflex. The snout reflex resolved within 24 hours of starting treatment with acamprosate. A 45-year-old man with a long history of alcohol dependence had both a snout and a grasp reflex. These reflexes were present throughout 3 admissions for alcohol detoxification and continued until the end of his third admission, when he elected to begin treatment with acamprosate. Within 24 hours of starting treatment, the snout and grasp reflexes were absent. A 55-year-old man who drank heavily for 35 years presented with both a snout and a grasp reflex on admission. These persisted throughout his detoxification until the day after he had begun treatment with acamprosate. His primitive reflexes remained resolved through the next 4 days until discharge. All 3 of these patients remained on acamprosate at discharge. DISCUSSION Alcohol dependence is a common, debilitating disorder. One of the difficulties in treating alcohol dependence is its adverse effect on the brain, as higher aspects of cortical function necessary to maintain abstinence are eroded by alcohol. Acamprosate is a drug intended to help prevent relapse among patients with alcohol dependence. Unexpectedly, acamprosate may resolve primitive reflexes--a neurologic finding that suggests cognitive impairment--among patients with alcohol dependence. CONCLUSIONS Acamprosate may relieve snout and grasp reflexes among patients with alcohol dependence.
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Affiliation(s)
- Patrycya Guzik
- School of Medicine, University of Texas Health Science Center at San Antonio, USA
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Abstract
OBJECTIVE To review the role of cortical release signs (CRS) in neuropsychiatry. METHOD A thorough literature review was conducted using Medline and Psychlit databases, and other relevant references available to the authors. RESULTS A number of neurological abnormalities are reported at elevated rates in neuropsychiatric conditions. CRS are a group of primitive reflexes that are present in the neonate but become inhibited as the infant central nervous system (CNS) develops, only to later re-emerge in the context of CNS disease. The clinical elicitation and interpretation of each CRS is described with reference to its neurobiology. The prevalence of CRS in schizophrenia, affective disorder, obsessive-compulsive disorder, Alzheimer's disease, vascular dementia, frontotemporal dementia and other neuropsychiatric illness allows for their use in the clinical management of these patients, including diagnostic assessment, treatment monitoring and prognosis. CONCLUSIONS A number of issues complicate their interpretation in neuropsychiatric illness, including the apparent high base rate of some CRS in non-clinical populations, their increasing prevalence with age, lack of specificity and uncertainty over what constitutes an 'abnormal' response. In some circumstances, CRS may assist in diagnostic differentiation and illness staging.
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Affiliation(s)
- Mark Walterfang
- Neuropsychiatry Centre, University of Melbourne, Melbourne, Australia.
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Brodsky H, Dat Vuong K, Thomas M, Jankovic J. Glabellar and palmomental reflexes in parkinsonian disorders. Neurology 2004; 63:1096-8. [PMID: 15452308 DOI: 10.1212/01.wnl.0000140249.97312.76] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The authors examined the glabellar reflex and the palmomental reflex in 100 subjects, including patients with Parkinson disease (n = 41), patients with progressive supranuclear palsy (n = 12), patients with multiple system atrophy (n = 7), and healthy, age-matched, controls (n = 40). The study provides evidence that these reflexes, particularly glabellar reflex, are relatively sensitive signs of parkinsonian disorders, but they lack specificity as they do not differentiate among the three most common parkinsonian disorders.
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Affiliation(s)
- Harris Brodsky
- Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, TX 77030, USA
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Zafeiriou DI. Primitive reflexes and postural reactions in the neurodevelopmental examination. Pediatr Neurol 2004; 31:1-8. [PMID: 15246484 DOI: 10.1016/j.pediatrneurol.2004.01.012] [Citation(s) in RCA: 95] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2003] [Accepted: 01/23/2004] [Indexed: 11/21/2022]
Abstract
The primitive reflexes and the postural reactions comprise one of the earliest, simplest, and most frequently used tools among child neurologists to assess the central nervous system integrity of infants and young children. Infants with cerebral palsy have been known to manifest persistence or delay in the disappearance of primitive reflexes and pathologic or absent postural reactions. The clinical significance of asymmetric tonic neck reflex, Moro, palmar grasp, plantar grasp, Galant, Babinski, Rossolimo, crossed extensor, suprapubic extensor, and heel reflex, alone or in combination, as well as their contribution to the early diagnosis and differential diagnosis of cerebral palsy, have been demonstrated in a number of studies. Moreover, infants with 5 or more abnormal postural reactions have developed either cerebral palsy or developmental retardation as reported in a number of studies. Although a comprehensive neurologic examination in the context of a motor assessment instrument is preferable to an informal list of items, the combined examination of primitive reflexes and postural reactions should be considered by the child neurologist, as a simple but predictive screening test for the early identification of infants at risk for cerebral palsy. It is quick and easy to perform, both in nonhospital environments and in underdeveloped countries, where time and specific recourses are limited. The combined examination is also useful in developed countries because many developmental disorders such as cerebral palsy appear in nonrisk groups whereas others are not detected by metabolic screening programs.
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Affiliation(s)
- Dimitrios I Zafeiriou
- Neurodevelopmental Center "A Fokas", First Department of Pediatrics, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Abstract
Primitive reflexes are typically present in childhood, suppressed during normal development, and may reappear with diseases of the brain, particularly those affecting the frontal lobes. In this review we discuss some historical aspects surrounding these reflexes, how they might be elicited and interpreted, and their potential clinical utility in modern neurological practice.
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Affiliation(s)
- J M Schott
- Dementia Research Group, National Hospital for Neurology and Neurosurgery, Institute of Neurology, University College, London, UK
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