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Bavdhankar K, Jain N, Agrawal S, Maheshkar P, Andugulapati SS, Puntambekar S, Ravat SH, Agarwal PA. Unusual Head Drops, Neck and Truncal Dystonia and Sleep Orthopnea with a Favorable Treatment Response in IgLon5 Antibody Disease. Mov Disord Clin Pract 2024; 11:575-577. [PMID: 38477436 PMCID: PMC11078475 DOI: 10.1002/mdc3.14012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 01/21/2024] [Accepted: 02/13/2024] [Indexed: 03/14/2024] Open
Affiliation(s)
| | - Neeraj Jain
- Department of NeurologySeth GS Medical College and KEM HospitalMumbaiIndia
| | - Shruti Agrawal
- Department of NeurologySeth GS Medical College and KEM HospitalMumbaiIndia
| | - Parag Maheshkar
- Department of NeurologySeth GS Medical College and KEM HospitalMumbaiIndia
| | | | | | - Sangeeta H. Ravat
- Department of NeurologySeth GS Medical College and KEM HospitalMumbaiIndia
| | - Pankaj A. Agarwal
- Department of NeurologySeth GS Medical College and KEM HospitalMumbaiIndia
- Movement Disorders Clinic, Department of NeurologyGleneagles Global HospitalsMumbaiIndia
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2
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Nilles C, Amorelli G, Pringsheim TM, Martino D. "Unvoluntary" Movement Disorders: Distinguishing between Tics, Akathisia, Restless Legs, and Stereotypies. Semin Neurol 2023; 43:123-146. [PMID: 36854394 DOI: 10.1055/s-0043-1764164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
Tics, stereotypies, akathisia, and restless legs fall at different places on the spectrum of discrete, unwanted and potentially disabling motor routines. Unlike tremor, chorea, myoclonus, or dystonia, this subgroup of abnormal movements is characterized by the subject's variable ability to inhibit or release undesired motor patterns on demand. Though it may be sometimes clinically challenging, it is crucial to distinguish these "unvoluntary" motor behaviors because secondary causes and management approaches differ substantially. To this end, physicians must consider the degree of repetitiveness of the movements, the existence of volitional control, and the association with sensory symptoms, or cognitive-ideational antecedent. This review aims to summarize the current existing knowledge on phenomenology, diagnosis, and treatment of tics, stereotypies, akathisia, and restless leg syndrome.
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Affiliation(s)
- Christelle Nilles
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Gabriel Amorelli
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Tamara M Pringsheim
- Department of Clinical Neurosciences, Psychiatry, Pediatrics and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.,Mathison Centre for Mental Health Research and Education, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Davide Martino
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Mathison Centre for Mental Health Research and Education, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
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3
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Defazio G, Belvisi D, Comella C, Hallett M, Jinnah HA, Cimino P, Latorre A, Mascia MM, Rocchi L, Gigante AF, Ercoli T, Berardelli A. Validation of a guideline to reduce variability in diagnosing cervical dystonia. J Neurol 2023; 270:2606-2612. [PMID: 36790546 PMCID: PMC10129917 DOI: 10.1007/s00415-023-11585-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 01/19/2023] [Accepted: 01/20/2023] [Indexed: 02/16/2023]
Abstract
BACKGROUND Cervical dystonia is characterized by a variable pattern of neck muscle involvement. Due to the lack of a diagnostic test, cervical dystonia diagnosis is based on clinical examination and is therefore subjective. The present work was designed to provide practical guidance for clinicians in confirming or refuting suspected cervical dystonia. METHODS Participants were video recorded according to a standardized protocol to assess 6 main clinical features possibly contributing to cervical dystonia diagnosis: presence of repetitive, patterned head/neck movements/postures inducing head/neck deviation from neutral position (item 1); sensory trick (item 2); and red flags related to conditions mimicking dystonia that should be absent in dystonia (items 3-6). Inter-/intra-rater agreement among three independent raters was assessed by k statistics. To estimate sensitivity and specificity, the gold standard was cervical dystonia diagnosis reviewed at each site by independent senior neurologists. RESULTS The validation sample included 43 idiopathic cervical dystonia patients and 41 control subjects (12 normal subjects, 6 patients with isolated head tremor, 4 with chorea, 6 with tics, 4 with head ptosis due to myasthenia or amyotrophic lateral sclerosis, 7 with orthopedic/rheumatologic neck diseases, and 2 with ocular torticollis). The best combination of sensitivity and specificity was observed considering all the items except for an item related to capability to voluntarily suppress spasms (sensitivity: 96.1%; specificity: 81%). CONCLUSIONS An accurate diagnosis of cervical dystonia can be achieved if, in addition to the core motor features, we also consider some clinical features related to dystonia mimics that should be absent in dystonia.
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Affiliation(s)
- Giovanni Defazio
- Department of Medical Sciences and Public Health, Institute of Neurology, University of Cagliari, 09042, Cagliari, Italy.,Institute of Neurology, Azienda Ospedaliero Universitaria di Cagliari, SS 554 km 4.500, 09042, Monserrato, Cagliari, Italy
| | - Daniele Belvisi
- IRCCS Neuromed, Via Atinense 18, 86077, Pozzilli, IS, Italy.,Department of Human Neurosciences, Sapienza University of Rome, Viale dell' Università, 30, 00185, Rome, Italy
| | | | - Mark Hallett
- Human Motor Control Section, NINDS, NIH, Bethesda, MD, USA
| | - Hyder A Jinnah
- Department of Neurology and Human Genetics, Emory University, Atlanta, GA, USA
| | - Paola Cimino
- Department of Medical Sciences and Public Health, Institute of Neurology, University of Cagliari, 09042, Cagliari, Italy
| | - Anna Latorre
- Department of Clinical and Movement Neurosciences UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Marcello Mario Mascia
- Institute of Neurology, Azienda Ospedaliero Universitaria di Cagliari, SS 554 km 4.500, 09042, Monserrato, Cagliari, Italy
| | - Lorenzo Rocchi
- Department of Medical Sciences and Public Health, Institute of Neurology, University of Cagliari, 09042, Cagliari, Italy.,Institute of Neurology, Azienda Ospedaliero Universitaria di Cagliari, SS 554 km 4.500, 09042, Monserrato, Cagliari, Italy
| | | | - Tommaso Ercoli
- Department of Medical Sciences and Public Health, Institute of Neurology, University of Cagliari, 09042, Cagliari, Italy.
| | - Alfredo Berardelli
- IRCCS Neuromed, Via Atinense 18, 86077, Pozzilli, IS, Italy.,Department of Human Neurosciences, Sapienza University of Rome, Viale dell' Università, 30, 00185, Rome, Italy
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Dal Pai J, da Silva JC, Sanabria V, Amorim RP, Predebon G, Cossa AC, Trindade-Filho E, Amado D. Non-Status Epilepticus female rats show seizure-like behaviors in the chronic phase of Pilocarpine experimental model. BRAZ J BIOL 2023; 83:e237412. [DOI: 10.1590/1519-6984.237412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 06/04/2021] [Indexed: 11/22/2022] Open
Abstract
Abstract Only few studies have focus on animals that received Pilocarpine (Pilo) and did not develop behavioral status epilepticus (SE) and, whether they may become epileptic in the model’s chronic phase. Previews works observed mossy fiber sprouting in the hippocampus of Non-SE (NSE) rats, while others observed spontaneous and recurrent seizures (SRS) 6 - 8 months after animals received Pilo. It is known that neuronal excitability is influenced by female hormones, as well as, the occurrence of SE in castrated and non-castrated female rats. However, it is not known whether females that received Pilo and did not show SE, may have SRS. The aim of this work was to investigate whether castrated and non-castrated female rats that did not show behavioral SE after Pilo, will develop SRS in the following one-year. For that, animals received 360 mg/kg of Pilo and were video monitored for 12 months. SE females from castrated and non-castrated groups became epileptic since the first month after drug injection. Epileptic behaviors were identified watching video monitoring recordings in the fast speed. Castrated and Non-castrated NSE animals showed behaviors resembling seizures described by Racine Scale stages 1 - 3. Motor alterations showed by NSE groups could be observed only when recordings were analyzed in slow speed. In addition, behavioral manifestations as, rhythmic head movements, sudden head movements, whole body movements and immobility were also observed in both, SE and NSE groups. We concluded that NSE female rats may have become epileptic. Adding to it, slow speed analysis of motor alterations was essential for the observation of NSE findings, which suggests that possibly many motor alterations have been underestimated in epilepsy experimental research.
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Affiliation(s)
- J. Dal Pai
- Universidade Federal de São Paulo, Brasil
| | - J. C. da Silva
- Universidade Estadual de Ciências da Saúde de Alagoas, Brasil; Centro Universitário CESMAC, Brasil
| | | | | | | | | | - E. Trindade-Filho
- Universidade Estadual de Ciências da Saúde de Alagoas, Brasil; Centro Universitário CESMAC, Brasil
| | - D. Amado
- Universidade Federal de São Paulo, Brasil
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Abstract
Narcolepsy with cataplexy is a severe lifelong disorder characterized, among others, by sudden loss of bilateral face muscle tone triggered by emotions (cataplexy). A recent approach for the diagnosis of the disease is based on a completely manual analysis of video recordings of patients undergoing emotional stimulation made on-site by medical specialists, looking for specific facial behavior motor phenomena. We present here the CAT-CAD tool for automatic detection of cataplexy symptoms, with the double aim of (1) supporting neurologists in the diagnosis/monitoring of the disease and (2) facilitating the experience of patients, allowing them to conduct video recordings at home. CAT-CAD includes a front-end medical interface (for the playback/inspection of patient recordings and the retrieval of videos relevant to the one currently played) and a back-end AI-based video analyzer (able to automatically detect the presence of disease symptoms in the patient recording). Analysis of patients’ videos for discovering disease symptoms is based on the detection of facial landmarks, and an alternative implementation of the video analyzer, exploiting deep-learning techniques, is introduced. Performance of both approaches is experimentally evaluated using a benchmark of real patients’ recordings, demonstrating the effectiveness of the proposed solutions.
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Peeters I, Wiels W, De Raedt S, Flamez A. Unusual Head Movements in Anti-IgLON5 Disease. Mov Disord Clin Pract 2020; 7:708-709. [PMID: 32775523 DOI: 10.1002/mdc3.13016] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 06/08/2020] [Accepted: 06/24/2020] [Indexed: 11/10/2022] Open
Affiliation(s)
- Ilse Peeters
- Department of Neurology, Universitair Ziekenhuis Brussel Center for Neurosciences, Vrije Universiteit Brussel Brussels Belgium
| | - Wietse Wiels
- Department of Neurology, Universitair Ziekenhuis Brussel Center for Neurosciences, Vrije Universiteit Brussel Brussels Belgium
| | - Sylvie De Raedt
- Department of Neurology, Universitair Ziekenhuis Brussel Center for Neurosciences, Vrije Universiteit Brussel Brussels Belgium
| | - Anja Flamez
- Department of Neurology, Universitair Ziekenhuis Brussel Center for Neurosciences, Vrije Universiteit Brussel Brussels Belgium
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Freitas ME, Ruiz-Lopez M, Dalmau J, Erro R, Privitera M, Andrade D, Fasano A. Seizures and movement disorders: phenomenology, diagnostic challenges and therapeutic approaches. J Neurol Neurosurg Psychiatry 2019; 90:920-928. [PMID: 30796133 DOI: 10.1136/jnnp-2018-320039] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 02/06/2019] [Accepted: 02/07/2019] [Indexed: 02/07/2023]
Abstract
Seizures and movement disorders (MDs) are distinct neurological conditions presenting with abnormal movements. Despite sharing an overlap in phenomenology, these movements have different origins. In order to explore the overlaps and the narrow boundaries between these two conditions, we performed a review of the literature to explore the risk of seizures in MDs. We discussed the mimics and chameleons including MDs that look like seizure (eg, paroxysmal dyskinesia, status dystonicus) and seizures that look like MDs (eg, epilepsia partialis continua, nocturnal frontal lobe epilepsy). Additionally, we examined the therapeutic challenges as well as the anatomical and chemical pathways relevant in the interplay between epilepsy and MDs. Finally, we proposed an algorithm to guide clinicians towards the final diagnosis of conditions characterised by the co-occurrence of MDs and seizures.
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Affiliation(s)
- Maria Eliza Freitas
- Medicine, McMaster University Division of Neurology, Hamilton, Ontario, Canada
| | - Marta Ruiz-Lopez
- Service of Neurology, Fundación Jimenez Diaz University Hospital, Madrid, Spain
| | - Josep Dalmau
- Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Roberto Erro
- Department of Medicine, Surgery and Dentistry 'Scuola Medica Salernitana', University of Salerno, UCL Institute of Neurology, Baronissi, Italy
| | - Michael Privitera
- Epilepsy Center, University of Cincinnati Gardner Neuroscience Institute, Cincinnati, Ohio, USA
| | | | - Alfonso Fasano
- Neurology, Krembil Brain Institute; Movement Disorders Centre and the Edmond J Safra Program in Parkinson's Disease, Toronto, Ontario, Canada
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Movement disorders phenomenology in focal motor seizures. Parkinsonism Relat Disord 2019; 61:161-165. [DOI: 10.1016/j.parkreldis.2018.10.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 09/30/2018] [Accepted: 10/15/2018] [Indexed: 11/20/2022]
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Balint B, Lang AE. Expert comment to: Novel Xp21.1 deletion associated with unusual features in large McLeod syndrome kindred. Parkinsonism Relat Disord 2019; 79:133-134. [PMID: 30858069 DOI: 10.1016/j.parkreldis.2019.02.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Bettina Balint
- UCL Queen Square Institute of Neurology, Department of Clinical and Movement Neurosciences, London, United Kingdom; Department of Neurology, University Hospital, Heidelberg, Germany.
| | - Anthony E Lang
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital - UHN, Division of Neurology, University of Toronto, Toronto, Ontario, Canada
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10
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A standardized test to document cataplexy. Sleep Med 2019; 53:197-204. [DOI: 10.1016/j.sleep.2017.08.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 08/11/2017] [Accepted: 08/14/2017] [Indexed: 11/21/2022]
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11
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Antelmi E, Plazzi G. Head drops: electromyography may give the way. Sleep Med 2017; 33:68-69. [DOI: 10.1016/j.sleep.2016.11.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Revised: 10/11/2016] [Accepted: 11/08/2016] [Indexed: 01/09/2023]
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