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Liu YB, Arystarkhova E, Sacino AN, Szabari MV, Lutz CM, Terrey M, Morsci NS, Jakobs TC, Lykke-Hartmann K, Brashear A, Napoli E, Sweadner KJ. Phenotype Distinctions in Mice Deficient in the Neuron-Specific α3 Subunit of Na,K-ATPase: Atp1a3 tm1Ling/+ and Atp1a3 +/D801Y. eNeuro 2024; 11:ENEURO.0101-24.2024. [PMID: 39111836 PMCID: PMC11360364 DOI: 10.1523/eneuro.0101-24.2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Revised: 07/24/2024] [Accepted: 07/25/2024] [Indexed: 08/30/2024] Open
Abstract
ATP1A3 is a Na,K-ATPase gene expressed specifically in neurons in the brain. Human mutations are dominant and produce an unusually wide spectrum of neurological phenotypes, most notably rapid-onset dystonia parkinsonism (RDP) and alternating hemiplegia of childhood (AHC). Here we compared heterozygotes of two mouse lines, a line with little or no expression (Atp1a3tm1Ling/+) and a knock-in expressing p.Asp801Tyr (D801Y, Atp1a3 +/D801Y). Both mouse lines had normal lifespans, but Atp1a3 +/D801Y had mild perinatal mortality contrasting with D801N mice (Atp1a3 +/D801N), which had high mortality. The phenotypes of Atp1a3tm1Ling/+ and Atp1a3 +/D801Y were different, and testing of each strain was tailored to its symptom range. Atp1a3tm1Ling/+ mice displayed little at baseline, but repeated ethanol intoxication produced hyperkinetic motor abnormalities not seen in littermate controls. Atp1a3 +/D801Y mice displayed robust phenotypes: hyperactivity, diminished posture consistent with hypotonia, and deficiencies in beam walk and wire hang tests. Symptoms also included qualitative motor abnormalities that are not well quantified by conventional tests. Paradoxically, Atp1a3 +/D801Y showed sustained better performance than wild type on the accelerating rotarod. Atp1a3 +/D801Y mice were overactive in forced swimming and afterward had intense shivering, transient dystonic postures, and delayed recovery. Remarkably, Atp1a3 +/D801Y mice were refractory to ketamine anesthesia, which elicited hyperactivity and dyskinesia even at higher dose. Neither mouse line exhibited fixed dystonia (typical of RDP patients), spontaneous paroxysmal weakness (typical of AHC patients), or seizures but had consistent, measurable neurological abnormalities. A gradient of variation supports the importance of studying multiple Atp1a3 mutations in animal models to understand the roles of this gene in human disease.
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Affiliation(s)
- Yi Bessie Liu
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts 02114
| | - Elena Arystarkhova
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts 02114
- Harvard Medical School, Boston, Massachusetts 02115
| | - Amanda N Sacino
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts 02114
| | - Margit V Szabari
- Department Anesthesia, Massachusetts General Hospital, Boston, Massachusetts 02114
| | | | | | | | - Tatjana C Jakobs
- Harvard Medical School, Boston, Massachusetts 02115
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary/Schepens Eye Research Institute, Harvard Medical School, Boston, Massachusetts 02114
| | | | - Allison Brashear
- Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York 14203
| | - Elenora Napoli
- Department of Neurology, University of California Davis School of Medicine, Sacramento, California 95817
| | - Kathleen J Sweadner
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts 02114
- Harvard Medical School, Boston, Massachusetts 02115
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Tomic S, Zjalic M, Popovic Z, Krivdic Dupan Z, Heffer M, Snajder Mujkic D, Mandic D, Guljas S, Petrovic IN. Case report: Rapid-onset parkinsonism after a hornet sting. Front Neurol 2024; 15:1365199. [PMID: 38633540 PMCID: PMC11021691 DOI: 10.3389/fneur.2024.1365199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 03/18/2024] [Indexed: 04/19/2024] Open
Abstract
Neurological manifestations with basal ganglia involvement following Hymenoptera stings are rare and clinically ill-defined conditions. We present a patient with acute parkinsonism non-responsive to levodopa, who developed striatal lesions after a hornet sting. We report his response to immunomodulatory treatment and subsequent clinical and brain magnetic resonance imaging (MRI) follow-up. We also searched the literature for patients with acute extrapyramidal syndromes following an insect sting. Fourteen cases have been published; 12 of them are reviewed here. The majority of cases presented with symmetric akinetic syndrome with axial rigidity and/or gait impairment. Six patients were treated with levodopa and only two of these had a modest response to therapy. Brain MRI/computed tomography scan revealed lesions of the basal ganglia, which resulted in fatal outcome in four patients, whereas only one achieved complete recovery. Clinicians should be aware of this rare but devastating cause of acute-onset parkinsonism and specific clinical presentation of this condition, and should consider prompt and prolonged immunomodulatory treatment to prevent irreversible basal ganglia damage.
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Affiliation(s)
- Svetlana Tomic
- Department of Neurology, Osijek University Hospital Center, Osijek, Croatia
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - Milorad Zjalic
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
- Department of Molecular Medicine and Biotechnology, Faculty of Medicine, University of Rijeka, Rijeka, Croatia
| | - Zvonimir Popovic
- Department of Neurology, Osijek University Hospital Center, Osijek, Croatia
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - Zdravka Krivdic Dupan
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
- Department of Radiology, Osijek University Hospital Center, Osijek, Croatia
| | - Marija Heffer
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - Darija Snajder Mujkic
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
- Institute of Nuclear Medicine and Radiation Protection, Osijek University Hospital Center, Osijek, Croatia
| | - Dario Mandic
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
- Institute of Laboratory Diagnostics, Osijek University Hospital Center, Osijek, Croatia
| | - Silva Guljas
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
- Department of Radiology, Osijek University Hospital Center, Osijek, Croatia
| | - Igor N. Petrovic
- Department of Neurology, University Clinical Center of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
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Kumbhare D, Weistroffer G, Goyanaga S, Huang ZL, Blagg J, Baron MS. Parkinsonism originates in a discrete secondary and dystonia in a primary motor cortical-basal ganglia subcircuit. J Neurosci Res 2024; 102:e25328. [PMID: 38651310 DOI: 10.1002/jnr.25328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 02/07/2024] [Accepted: 03/21/2024] [Indexed: 04/25/2024]
Abstract
Although manifesting contrasting phenotypes, Parkinson's disease and dystonia, the two most common movement disorders, can originate from similar pathophysiology. Previously, we demonstrated that lesioning (silencing) of a discrete dorsal region in the globus pallidus (rodent equivalent to globus pallidus externa) in rats and produced parkinsonism, while lesioning a nearby ventral hotspot-induced dystonia. Presently, we injected fluorescent-tagged multi-synaptic tracers into these pallidal hotspots (n = 36 Long Evans rats) and permitted 4 days for the viruses to travel along restricted connecting pathways and reach the motor cortex before sacrificing the animals. Viral injections in the Parkinson's hotspot fluorescent labeled a circumscribed region in the secondary motor cortex, while injections in the dystonia hotspot labeled within the primary motor cortex. Custom probability mapping and N200 staining affirmed the segregation of the cortical territories for Parkinsonism and dystonia to the secondary and primary motor cortices. Intracortical microstimulation localized territories specifically to their respective rostral and caudal microexcitable zones. Parkinsonian features are thus explained by pathological signaling within a secondary motor subcircuit normally responsible for initiation and scaling of movement, while dystonia is explained by abnormal (and excessive) basal ganglia signaling directed at primary motor corticospinal transmission.
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Affiliation(s)
- Deepak Kumbhare
- Department of Neurosurgery, Virginia Commonwealth University Health System, Richmond, Virginia, USA
- Richmond Institute for Veterans Research, Richmond Veterans Affairs Medical Center, Richmond, Virginia, USA
- Department of Neurosurgery, Louisiana State University Health Science Center, Shreveport, Louisiana, USA
| | - George Weistroffer
- Richmond Institute for Veterans Research, Richmond Veterans Affairs Medical Center, Richmond, Virginia, USA
- Department Biomedical Engineering, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Sofia Goyanaga
- Richmond Institute for Veterans Research, Richmond Veterans Affairs Medical Center, Richmond, Virginia, USA
- Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - Zi Ling Huang
- Richmond Institute for Veterans Research, Richmond Veterans Affairs Medical Center, Richmond, Virginia, USA
- Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - Jacob Blagg
- Richmond Institute for Veterans Research, Richmond Veterans Affairs Medical Center, Richmond, Virginia, USA
| | - Mark S Baron
- Southeast Parkinson's Disease Research, Education and Clinical Center (PADRECC), Richmond Veterans Affairs Medical Center, Richmond, Virginia, USA
- Department of Neurology, Virginia Commonwealth University Health System, Richmond, Virginia, USA
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Marquez JS, Hasan SMS, Siddiquee MR, Luca CC, Mishra VR, Mari Z, Bai O. Neural Correlates of Freezing of Gait in Parkinson's Disease: An Electrophysiology Mini-Review. Front Neurol 2020; 11:571086. [PMID: 33240199 PMCID: PMC7683766 DOI: 10.3389/fneur.2020.571086] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 09/23/2020] [Indexed: 12/13/2022] Open
Abstract
Freezing of gait (FoG) is a disabling symptom characterized as a brief inability to step or by short steps, which occurs when initiating gait or while turning, affecting over half the population with advanced Parkinson's disease (PD). Several non-competing hypotheses have been proposed to explain the pathophysiology and mechanism behind FoG. Yet, due to the complexity of FoG and the lack of a complete understanding of its mechanism, no clear consensus has been reached on the best treatment options. Moreover, most studies that aim to explore neural biomarkers of FoG have been limited to semi-static or imagined paradigms. One of the biggest unmet needs in the field is the identification of reliable biomarkers that can be construed from real walking scenarios to guide better treatments and validate medical and therapeutic interventions. Advances in neural electrophysiology exploration, including EEG and DBS, will allow for pathophysiology research on more real-to-life scenarios for better FoG biomarker identification and validation. The major aim of this review is to highlight the most up-to-date studies that explain the mechanisms underlying FoG through electrophysiology explorations. The latest methodological approaches used in the neurophysiological study of FoG are summarized, and potential future research directions are discussed.
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Affiliation(s)
- J. Sebastian Marquez
- Department of Electrical and Computer Engineering, Florida International University, Miami, FL, United States
| | - S. M. Shafiul Hasan
- Department of Electrical and Computer Engineering, Florida International University, Miami, FL, United States
| | - Masudur R. Siddiquee
- Department of Electrical and Computer Engineering, Florida International University, Miami, FL, United States
| | - Corneliu C. Luca
- Department of Neurology, University of Miami Hospital, Miami, FL, United States
| | - Virendra R. Mishra
- Lou Ruvo Center for Brain Health, Cleveland Clinic, Las Vegas, NV, United States
| | - Zoltan Mari
- Lou Ruvo Center for Brain Health, Cleveland Clinic, Las Vegas, NV, United States
| | - Ou Bai
- Department of Electrical and Computer Engineering, Florida International University, Miami, FL, United States
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Bloem BR, Monje MHG, Obeso JA. Understanding motor control in health and disease: classic single (n = 1) observations. Exp Brain Res 2020; 238:1593-1600. [PMID: 32172352 PMCID: PMC7413913 DOI: 10.1007/s00221-020-05763-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 02/25/2020] [Indexed: 02/06/2023]
Abstract
The field of neuroscience is increasingly dominated by a preferred use of big data, where analysis of large numbers has become an essential area of development. We here draw attention to the importance of smaller numbers, and more specifically, to the historical and continued importance of detailed and judiciously performed studies in single healthy volunteers or single patients with a unique clinical presentation, as an important approach to study normal functions of the nervous system, and to understand the pathophysiology underlying neurological movement disorders. We illustrate this by discussing several historical examples and by summarising Professor John Rothwell's impressive body of work in single-patient studies, highlighting some of his seminal n = 1 studies that have had a great impact on the field. In doing so, we hope to provide a powerful incentive for the next generation of neuroscientists to keep appreciating the value of detailed analyses of single observations.
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Affiliation(s)
- Bastiaan R Bloem
- Department of Neurology, Centre of Expertise for Parkinson and Movement Disorders, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, PO Box 9101 (947), 6500 HB, Nijmegen, The Netherlands.
| | - Mariana H G Monje
- HM-CINAC, Hospital Universitario HM Puerta del Sur, Universidad CEU-San Pablo, 28938, Móstoles, Madrid, Spain
| | - Jose A Obeso
- HM-CINAC, Hospital Universitario HM Puerta del Sur, Universidad CEU-San Pablo, 28938, Móstoles, Madrid, Spain.
- Medical School, CEU-San Pablo University, Madrid, Spain.
- CIBERNED (Center for Networked Biomedical Research on Neurodegenerative Diseases), Instituto Carlos III, Madrid, Spain.
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Greater Sensorimotor Deficits and Abnormally Lower Globus Pallidus Fractional Anisotropy in HIV+ Women than in HIV+ Men. J Neuroimmune Pharmacol 2020; 16:334-345. [PMID: 32323137 DOI: 10.1007/s11481-020-09915-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 03/10/2020] [Indexed: 12/11/2022]
Abstract
AIMS Cognitive impairment may be greater in HIV-positive (HIV+) women than in HIV+ men. Whether sex-specific differences exist in brain microstructure of HIV+ individuals is unknown and was evaluated. METHOD 39 HIV+ (21 men, 18 women) and 45 seronegative (SN, 20 men, 25 women) participants were assessed with brain diffusion tensor imaging and cognitive assessments (7 neuropsychological domains). Fractional anisotropy (FA) and mean diffusivity (MD) were measured with an automated atlas in selected brain regions. Group comparisons were assessed with linear mixed effects models, with sub-regions and hemisphere (left/right) as repeated factors for each region. RESULTS HIV+ women, but not HIV+ men, were slower than sex-matched SN controls on sensorimotor function (Dominant-hand: interaction-p = 0.007; Non-dominant hand: interaction-p = 0.039). Similarly, only HIV+ women had lower FA in the globus pallidus (GP, interaction-p = 0.011). Additionally, regardless of sex, the HIV+ group had poorer Fluency, Speed, and Attention than SN-controls (p = 0.006-0.008), as well as lower FA and higher MD in multiple brain regions (p = <0.001-0.044). Across all participants, performance on Attention was predicted by uncinate-FA (p < 0.001, r = 0.5) and corpus callosum (CC)-FA (p = 0.038, r = 0.23), while the Speed of Information Processing was predicted by CC-FA (p = 0.009, r = 0.3). Furthermore, faster sensorimotor function correlated with higher CC-FA and uncinate-FA in men but not in women (Sex*DTI-interaction-p = 0.03-0.06). CONCLUSIONS The relatively poorer sensorimotor function and abnormally lower GP_FA, suggesting lesser neuronal integrity, in HIV+ women demonstrate sex-specific effects from HIV-infection on these measures. These findings may be related to the greater immune activation and neuroinflammation in HIV+ women compared to HIV+ men. Graphical Abstract.
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Calabresi P, Standaert DG. Dystonia and levodopa-induced dyskinesias in Parkinson's disease: Is there a connection? Neurobiol Dis 2019; 132:104579. [PMID: 31445160 PMCID: PMC6834901 DOI: 10.1016/j.nbd.2019.104579] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 08/01/2019] [Accepted: 08/14/2019] [Indexed: 11/24/2022] Open
Abstract
Dystonia and levodopa-induced dyskinesia (LID) are both hyperkinetic movement disorders. Dystonia arises most often spontaneously, although it may be seen after stroke, injury, or as a result of genetic causes. LID is associated with Parkinson's disease (PD), emerging as a consequence of chronic therapy with levodopa, and may be either dystonic or choreiform. LID and dystonia share important phenomenological properties and mechanisms. Both LID and dystonia are generated by an integrated circuit involving the cortex, basal ganglia, thalamus and cerebellum. They also share dysregulation of striatal cholinergic signaling and abnormalities of striatal synaptic plasticity. The long duration nature of both LID and dystonia suggests that there may be underlying epigenetic dysregulation as a proximate cause. While both may improve after interventions such as deep brain stimulation (DBS), neither currently has a satisfactory medical therapy, and many people are disabled by the symptoms of dystonia and LID. Further study of the fundamental mechanisms connecting these two disorders may lead to novel approaches to treatment or prevention.
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Affiliation(s)
- Paolo Calabresi
- Neurological Clinic, Department of Medicine, "Santa Maria della Misericordia" Hospital, University of Perugia, Perugia 06132, Italy; IRCCS Fondazione Santa Lucia, Rome, Italy
| | - David G Standaert
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL 35294, USA.
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Mainka T, Balint B, Gövert F, Kurvits L, van Riesen C, Kühn AA, Tijssen MAJ, Lees AJ, Müller-Vahl K, Bhatia KP, Ganos C. The spectrum of involuntary vocalizations in humans: A video atlas. Mov Disord 2019; 34:1774-1791. [PMID: 31651053 DOI: 10.1002/mds.27855] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 07/22/2019] [Accepted: 08/21/2019] [Indexed: 12/11/2022] Open
Abstract
In clinical practice, involuntary vocalizing behaviors are typically associated with Tourette syndrome and other tic disorders. However, they may also be encountered throughout the entire tenor of neuropsychiatry, movement disorders, and neurodevelopmental syndromes. Importantly, involuntary vocalizing behaviors may often constitute a predominant clinical sign, and, therefore, their early recognition and appropriate classification are necessary to guide diagnosis and treatment. Clinical literature and video-documented cases on the topic are surprisingly scarce. Here, we pooled data from 5 expert centers of movement disorders, with instructive video material to cover the entire range of involuntary vocalizations in humans. Medical literature was also reviewed to document the range of possible etiologies associated with the different types of vocalizing behaviors and to explore treatment options. We propose a phenomenological classification of involuntary vocalizations within different categorical domains, including (1) tics and tic-like vocalizations, (2) vocalizations as part of stereotypies, (3) vocalizations as part of dystonia or chorea, (4) continuous vocalizing behaviors such as groaning or grunting, (5) pathological laughter and crying, (6) vocalizations resembling physiological reflexes, and (7) other vocalizations, for example, those associated with exaggerated startle responses, as part of epilepsy and sleep-related phenomena. We provide comprehensive lists of their associated etiologies, including neurodevelopmental, neurodegenerative, neuroimmunological, and structural causes and clinical clues. We then expand on the pathophysiology of the different vocalizing behaviors and comment on available treatment options. Finally, we present an algorithmic approach that covers the wide range of involuntary vocalizations in humans, with the ultimate goal of improving diagnostic accuracy and guiding appropriate treatment. © 2019 The Authors. Movement Disorders published by Wiley Periodicals, Inc. on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Tina Mainka
- Department of Neurology, Charité University Medicine Berlin, Berlin, Germany
| | - Bettina Balint
- Department of Clinical and Movement Neurosciences, Queen Square Institute of Neurology, University College London, London, UK.,Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany
| | - Felix Gövert
- Department of Neurology, University Hospital Schleswig-Holstein, Christian-Albrechts-University, Kiel, Germany
| | - Lille Kurvits
- Department of Neurology, Charité University Medicine Berlin, Berlin, Germany
| | - Christoph van Riesen
- Department of Neurology, Charité University Medicine Berlin, Berlin, Germany.,Department of Neurology, University Medicine Göttingen, Göttingen, Germany
| | - Andrea A Kühn
- Department of Neurology, Charité University Medicine Berlin, Berlin, Germany
| | - Marina A J Tijssen
- Department of Neurology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Andrew J Lees
- Reta Lila Weston Institute of Neurological Studies, UCL, Institute of Neurology, London, UK
| | - Kirsten Müller-Vahl
- Clinic of Psychiatry, Socialpsychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Kailash P Bhatia
- Department of Clinical and Movement Neurosciences, Queen Square Institute of Neurology, University College London, London, UK
| | - Christos Ganos
- Department of Neurology, Charité University Medicine Berlin, Berlin, Germany
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Yoon WT. Comparison of dystonia between Parkinson's disease and atypical parkinsonism: The clinical usefulness of dystonia distribution and characteristics in the differential diagnosis of parkinsonism. Neurol Neurochir Pol 2017; 52:48-53. [PMID: 29196058 DOI: 10.1016/j.pjnns.2017.11.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 09/19/2017] [Accepted: 11/05/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Dystonia is occasionally found in patients with Parkinson's disease (PD) and atypical parkinsonisms. However, systematic comparative analysis of the association between dystonia and parkinsonism have seldom been reported. The goals of this study are to compare the clinical characteristics and distributions of dystonia between PD, multiple system atrophy (MSA), progressive supranuclear palsy (PSP) and corticobasal degeneration (CBD). METHODS We prospectively enrolled 176 patients who presented with dystonia and parkinsonism out of 1278 patients with parkinsonism. We analyzed the clinical features of dystonia and parkinsonism. RESULTS The frequencies of dystonia were 11.0% in PD, 20.9% in MSA, 40.7% in PSP and 66.7% in CBD. Dystonia symptoms were most frequent in CBD and relatively more frequent in PSP and MSA (p<0.001). Moreover, multiple types of dystonia occurred most frequently in MSA (p=0.034). According to the distribution of dystonia, cranio-facial dystonia (CFD) and cervical dystonia (CD) were more frequently observed in atypical parkinsonism (p=0.001). In contrast, limb dystonia (LD) was more frequently observed in both PD and CBD, and truncal dystonia (TD) was more frequently detected in PD (p<0.001). Levodopa medication related dystonia was markedly more frequent in PD than in atypical parkinsonism (p=0.030). CONCLUSIONS In this long-term, observational, prospective study, we concluded that levodopa medication related LD and TD were more frequently observed in PD than in atypical parkinsonism. Conversely, levodopa medication non-related CFD and CD were more frequently observed in atypical parkinsonism, and coexisting of some types of multiple dystonia may be unique features of atypical parkinsonism. TD or multiple types of LD, might be representative of PD rather than atypical parkinsonism.
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Affiliation(s)
- Won Tae Yoon
- Department of Neurology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Republic of Korea.
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Kumbhare D, Holloway KL, Baron MS. Parkinsonism and dystonia are differentially induced by modulation of different territories in the basal ganglia. Neuroscience 2017; 353:42-57. [DOI: 10.1016/j.neuroscience.2017.03.063] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Revised: 03/28/2017] [Accepted: 03/30/2017] [Indexed: 10/19/2022]
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Park SC, Lee CS, Kim SM, Choi EJ, Lee JK. Comparison of the Stereotactic Accuracies of Function-Guided Deep Brain Stimulation, Calculated Using Multitrack Target Locations Geometrically Inferred from Three-Dimensional Trajectory Rotations, and of Magnetic Resonance Imaging-Guided Deep Brain Stimulation and Outcomes. World Neurosurg 2017; 98:734-749.e7. [DOI: 10.1016/j.wneu.2016.11.046] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2016] [Revised: 11/08/2016] [Accepted: 11/10/2016] [Indexed: 12/26/2022]
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12
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Movement-related potentials in Parkinson’s disease. Clin Neurophysiol 2016; 127:2509-19. [DOI: 10.1016/j.clinph.2016.04.004] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 03/29/2016] [Accepted: 04/01/2016] [Indexed: 11/20/2022]
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Inzelberg R, Plotnik M, Harpaz NK, Flash T. Micrographia, much beyond the writer's hand. Parkinsonism Relat Disord 2016; 26:1-9. [PMID: 26997656 DOI: 10.1016/j.parkreldis.2016.03.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 02/12/2016] [Accepted: 03/06/2016] [Indexed: 12/17/2022]
Abstract
INTRODUCTION This review on micrographia aims to draw the clinician's attention to non-Parkinsonian etiologies, provide clues to differential diagnosis, and summarize current knowledge on the phenomenology, etiology, and mechanisms underlying micrographia. METHODS A systematic review of the existing literature was performed. RESULTS Micrographia, namely small sized handwriting has long been attributed to Parkinson's disease. However, it has often been observed as part of the clinical picture of additional neurodegenerative disorders, sometimes antedating the motor signs, or following focal basal ganglia lesions without any accompanying parkinsonism, suggesting that bradykinesia and rigidity are not sine-qua-non for the development of this phenomenon. Therefore, micrographia in a patient with no signs of parkinsonism may prompt the clinician to perform imaging in order to exclude a focal basal ganglia lesion. Dopaminergic etiology in this and other cases is doubtful, since levodopa ameliorates letter stroke size only partially, and only in some patients. Parkinsonian handwriting is often characterized by lack of fluency, slowness, and less frequently by micrographia. Deviations from kinematic laws of motion that govern normal movement, including the lack of movement smoothness and inability to scale movement amplitude to the desired size, may reflect impairments in motion planning, possible loss of automaticity and reduced movement vigor. CONCLUSIONS The etiology, neuroanatomy, mechanisms and models of micrographia are discussed. Dysfunction of the basal ganglia circuitry induced by neurodegeneration or disruption by focal damage give rise to micrographia.
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Affiliation(s)
- Rivka Inzelberg
- Department of Neurology and Neurosurgery, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Center of Advanced Technologies in Rehabilitation, Sheba Medical Center, Tel Hashomer, Israel; Department of Applied Mathematics and Computer Science, The Weizmann Institute of Science, Rehovot, Israel.
| | - Meir Plotnik
- Department of Pharmacology and Physiology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel; Center of Advanced Technologies in Rehabilitation, Sheba Medical Center, Tel Hashomer, Israel; Gonda Brain Research Center, Bar Ilan University, Ramat Gan, Israel.
| | - Naama Kadmon Harpaz
- Department of Applied Mathematics and Computer Science, The Weizmann Institute of Science, Rehovot, Israel.
| | - Tamar Flash
- Department of Applied Mathematics and Computer Science, The Weizmann Institute of Science, Rehovot, Israel.
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Day MR, Mulcahy H, Leahy-Warren P, Downey J. Self-neglect: a case study and implications for clinical practice. Br J Community Nurs 2015; 20:110, 112-5. [PMID: 25754778 DOI: 10.12968/bjcn.2015.20.3.110] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Self-neglect is a worldwide and serious public health issue that can have serious adverse outcomes and is more common in older people. Cases can vary in presentation, but typically present as poor self-care, poor care of the environment and service refusal. Community nurses frequently encounter self-neglect cases and health and social care professionals play a key role in the identification, management and prevention of self-neglect. Self-neglect cases can give rise to ethical, personal and professional challenges. The aim of this article is to create a greater understanding of the concept of self-neglect among community nurses.
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Serbruyns L, Leunissen I, Huysmans T, Cuypers K, Meesen RL, van Ruitenbeek P, Sijbers J, Swinnen SP. Subcortical volumetric changes across the adult lifespan: subregional thalamic atrophy accounts for age-related sensorimotor performance declines. Cortex 2015; 65:128-38. [PMID: 25682047 DOI: 10.1016/j.cortex.2015.01.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Revised: 11/28/2014] [Accepted: 01/05/2015] [Indexed: 01/01/2023]
Abstract
Even though declines in sensorimotor performance during healthy aging have been documented extensively, its underlying neural mechanisms remain unclear. Here, we explored whether age-related subcortical atrophy plays a role in sensorimotor performance declines, and particularly during bimanual manipulative performance (Purdue Pegboard Test). The thalamus, putamen, caudate and pallidum of 91 participants across the adult lifespan (ages 20-79 years) were automatically segmented. In addition to studying age-related changes in the global volume of each subcortical structure, local deformations within these structures, indicative of subregional volume changes, were assessed by means of recently developed shape analyses. Results showed widespread age-related global and subregional atrophy, as well as some notable subregional expansion. Even though global atrophy failed to explain the observed performance declines with aging, shape analyses indicated that atrophy in left and right thalamic subregions, specifically subserving connectivity with the premotor, primary motor and somatosensory cortical areas, mediated the relation between aging and performance decline. It is concluded that subregional volume assessment by means of shape analyses offers a sensitive tool with high anatomical resolution in the search for specific age-related associations between brain structure and behavior.
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Affiliation(s)
- Leen Serbruyns
- Motor Control Laboratory, Movement Control and Neuroplasticity Research Group, Biomedical Sciences Group, Department of Kinesiology, KU Leuven, Belgium
| | - Inge Leunissen
- Motor Control Laboratory, Movement Control and Neuroplasticity Research Group, Biomedical Sciences Group, Department of Kinesiology, KU Leuven, Belgium
| | - Toon Huysmans
- Vision Lab, Department of Physics, University of Antwerp, Belgium
| | - Koen Cuypers
- Motor Control Laboratory, Movement Control and Neuroplasticity Research Group, Biomedical Sciences Group, Department of Kinesiology, KU Leuven, Belgium; REVAL Rehabilitation Research Centre, Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
| | - Raf L Meesen
- Motor Control Laboratory, Movement Control and Neuroplasticity Research Group, Biomedical Sciences Group, Department of Kinesiology, KU Leuven, Belgium; REVAL Rehabilitation Research Centre, Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
| | - Peter van Ruitenbeek
- Motor Control Laboratory, Movement Control and Neuroplasticity Research Group, Biomedical Sciences Group, Department of Kinesiology, KU Leuven, Belgium
| | - Jan Sijbers
- Vision Lab, Department of Physics, University of Antwerp, Belgium
| | - Stephan P Swinnen
- Motor Control Laboratory, Movement Control and Neuroplasticity Research Group, Biomedical Sciences Group, Department of Kinesiology, KU Leuven, Belgium; Leuven Research Institute for Neuroscience & Disease (LIND), KU Leuven, Belgium.
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Kicinski M, Vrijens J, Vermier G, Hond ED, Schoeters G, Nelen V, Bruckers L, Sioen I, Baeyens W, Van Larebeke N, Viaene MK, Nawrot TS. Neurobehavioral function and low-level metal exposure in adolescents. Int J Hyg Environ Health 2015; 218:139-46. [DOI: 10.1016/j.ijheh.2014.09.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Revised: 09/15/2014] [Accepted: 09/16/2014] [Indexed: 11/16/2022]
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Brabo NC, Minett TSC, Ortiz KZ. Fluency in Parkinson’s disease: disease duration, cognitive status and age. ARQUIVOS DE NEURO-PSIQUIATRIA 2014; 72:349-55. [DOI: 10.1590/0004-282x20140018] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2013] [Accepted: 01/10/2014] [Indexed: 11/22/2022]
Abstract
The objective of this study was to determine the frequency of occurrence and to characterize the typology of dysfluencies in individuals with Parkinson’s disease (PD), including the variables age, gender, schooling, disease duration, score on the Hoehn and Yahr scale and cognitive status (score on Mini-Mental State Examination). A cross-sectional study of a sample comprising 60 adults matched for gender, age and schooling was conducted. Group I comprised 30 adults with idiopathic PD, and Group II comprised 30 healthy adults. For assessment of fluency of speech, subjects were asked to utter a narrative based on a sequence of drawings and a transcription of 200 fluent syllables was performed to identify speech dysfluencies. PD patients exhibited a higher overall number of dysfluencies in speech with a large number of atypical dysfluencies. Additionally, results showed an influence of the variables cognitive status, disease duration and age on occurrence of dysfluencies.
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Fasano A. Methcathinone-induced parkinsonism results from permanent brain damage: a message for the masses. Eur J Neurol 2013; 21:181-2. [PMID: 23834461 DOI: 10.1111/ene.12229] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- A Fasano
- Division of Neurology, TWH, UHN, Movement Disorders Center, University of Toronto, Toronto, ON, Canada.
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19
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[Subacute Parkinson's disease after suicide attempt with diazepam]. DER NERVENARZT 2012; 84:223-5. [PMID: 23224133 DOI: 10.1007/s00115-012-3690-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Abstract
INTRODUCTION Palilalia is an acquired speech disorder characterised by involuntary and spontaneous repetition of words or phrases two or more times in a row. It can occur in a variety of disorders including postencephalic parkinsonism, pseudobulbar palsy, schizophrenia, Gilles de la Tourette syndrome and others. CLINICAL CASE We describe a case of a 28-year-old man with refractory schizophrenia that developed palilalia with 300 mg of clozapine. In the patient evaluation we found unspecific alterations in the electroencephalogram, with normal blood tests and cerebral magnetic resonance imaging. Palilalia disappeared with lowering doses of clozapine. DISCUSSION The appearance of palilalia induced by clozapine is a rare pharmacologic side-effect which physicians should be familiarised with when evaluating this symptom presentation.
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Affiliation(s)
| | - Rui Lopes
- Department of Psychiatry, Hospital São João, Porto, Portugal
| | - Rosário Curral
- Department of Psychiatry, Oporto Medical School, Porto, Portugal
| | - Manuel F Esteves
- Department of Psychiatry, Oporto Medical School, Porto, Portugal
| | - Rui Coelho
- Department of Psychiatry, Hospital São João, Porto, Portugal
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Ling H, Massey LA, Lees AJ, Brown P, Day BL. Hypokinesia without decrement distinguishes progressive supranuclear palsy from Parkinson's disease. ACTA ACUST UNITED AC 2012; 135:1141-53. [PMID: 22396397 DOI: 10.1093/brain/aws038] [Citation(s) in RCA: 100] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Repetitive finger tapping is commonly used to assess bradykinesia in Parkinson's disease. The Queen Square Brain Bank diagnostic criterion of Parkinson's disease defines bradykinesia as 'slowness of initiation with progressive reduction in speed and amplitude of repetitive action'. Although progressive supranuclear palsy is considered an atypical parkinsonian syndrome, it is not known whether patients with progressive supranuclear palsy have criteria-defined bradykinesia. This study objectively assessed repetitive finger tap performance and handwriting in patients with Parkinson's disease (n = 15), progressive supranuclear palsy (n = 9) and healthy age- and gender-matched controls (n = 16). The motion of the hand and digits was recorded in 3D during 15-s repetitive index finger-to-thumb tapping trials. The main finding was hypokinesia without decrement in patients with progressive supranuclear palsy, which differed from the finger tap pattern in Parkinson's disease. Average finger separation amplitude in progressive supranuclear palsy was less than half of that in controls and Parkinson's disease (P < 0.001 in both cases). Change in tap amplitude over consecutive taps was computed by linear regression. The average amplitude slope in progressive supranuclear palsy was nearly zero (0.01°/cycle) indicating a lack of decrement, which differed from the negative slope in patients with Parkinson's disease OFF levodopa (-0.20°/cycle, P = 0.002). 'Hypokinesia', defined as <50% of control group's mean amplitude, combined with 'absence of decrement', defined as mean positive amplitude slope, were identified in 87% of finger tap trials in the progressive supranuclear palsy group and only 12% in the Parkinson's disease OFF levodopa group. In progressive supranuclear palsy, the mean amplitude was not correlated with disease duration or other clinimetric scores. In Parkinson's disease, finger tap pattern was compatible with criteria-defined bradykinesia, characterized by slowness with progressive reduction in amplitude and speed and increased variability in speed throughout the tap trial. In Parkinson's disease, smaller amplitude, slower speed and greater speed variability were all associated with a more severe Unified Parkinson's Disease Rating Scale motor score. Analyses of handwriting showed that micrographia, defined as smaller than 50% of the control group's mean script size, was present in 75% of patients with progressive supranuclear palsy and 15% of patients with Parkinson's disease (P = 0.022). Most scripts performed by patients with progressive supranuclear palsy did not exhibit decrements in script size. In conclusion, patients with progressive supranuclear palsy have a specific finger tap pattern of 'hypokinesia without decrement' and they do not have criteria-defined limb bradykinesia. Similarly, 'micrographia' and 'lack of decrement in script size' are also more common in progressive supranuclear palsy than in Parkinson's disease.
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Affiliation(s)
- Helen Ling
- Sara Koe PSP Research Centre, Institute of Neurology, University College London, UK.
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Wagle Shukla A, Ounpraseuth S, Okun MS, Gray V, Schwankhaus J, Metzer WS. Micrographia and related deficits in Parkinson's disease: a cross-sectional study. BMJ Open 2012; 2:bmjopen-2011-000628. [PMID: 22734114 PMCID: PMC3383984 DOI: 10.1136/bmjopen-2011-000628] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To determine the prevalence and clinical features associated with micrographia in Parkinson's Disease (PD). SETTING This study was conducted at a Movement Disorders clinic located in a Veteran Administration Hospital. PARTICIPANTS PD subjects were included only if they satisfied UK Parkinson's Disease Society criteria for diagnosis. Subjects with history of severe tremors, dystonia, dyskinesia, strokes, peripheral neuropathy and dementia were excluded. DESIGN This was a case-control study where PD subjects were prospectively enrolled and their demographics, Hoehn & Yahr stage, Unified Parkinson's Disease Rating Scale and Mini Mental Status examination (MMSE) scores were recorded. All subjects were specifically asked for micrographia on history and the handwritings were quantitatively documented. Bradykinesia was determined by history and quantified by a finger tap, Purdue pegboard and a timed walk test. Similarly, hypophonia was determined by history and the volume of speech quantified using a decibel meter. Controls were enrolled for validation of handwriting test scores and decibel meter recordings. PRIMARY OUTCOME MEASURES Prevalence of micrographia in the PD cohort and the clinical factors that correlate with micrographia. RESULTS 68 subjects with PD were enrolled (68 men; mean age 72.3 years). Micrographia was identified in 63.2% of the cohort on verbal history and in 50% of the cohort when the handwriting test was used for ascertainment. Micrographia ascertained on history correlated significantly with disease severity (Hoehn & Yahr stage), motor impairment (Unified Parkinson's Disease Rating Scale), cognitive impairment (MMSE) and both bradykinesia and hypophonia determined by history and quantitative testing. Micrographia on handwriting test correlated with age (p=0.02), MMSE testing (p=0.04), hypophonia by history (p=0.01) and bradykinesia by quantitative testing (p=0.04). CONCLUSION Micrographia was found in nearly half of the PD cohort. Disease severity and impaired cognition were important clinical correlates. Micrographia had a significant relationship with bradykinesia and hypophonia, suggesting a possible overlap in their pathophysiology.
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Affiliation(s)
- Aparna Wagle Shukla
- Department of Neurology, University of Florida, Center for Movement Disorders and Neurorestoration, Gainesville, Florida, USA
| | - Songthip Ounpraseuth
- Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Michael S Okun
- Department of Neurology, University of Florida, Center for Movement Disorders and Neurorestoration, Gainesville, Florida, USA
| | - Vickie Gray
- Department of Neurology, University of Arkansas for Medical Sciences and the Central Arkansas Veterans Healthcare System (CAVHS), Little Rock, Arkansas, USA
| | - John Schwankhaus
- Department of Neurology, University of Arkansas for Medical Sciences and the Central Arkansas Veterans Healthcare System (CAVHS), Little Rock, Arkansas, USA
| | - Walter Steven Metzer
- Department of Neurology, University of Arkansas for Medical Sciences and the Central Arkansas Veterans Healthcare System (CAVHS), Little Rock, Arkansas, USA
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Rankin KP, Mayo MC, Seeley WW, Lee S, Rabinovici G, Gorno-Tempini ML, Boxer AL, Weiner MW, Trojanowski JQ, DeArmond SJ, Miller BL. Behavioral variant frontotemporal dementia with corticobasal degeneration pathology: phenotypic comparison to bvFTD with Pick's disease. J Mol Neurosci 2011; 45:594-608. [PMID: 21881831 PMCID: PMC3208125 DOI: 10.1007/s12031-011-9615-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2011] [Accepted: 07/21/2011] [Indexed: 10/17/2022]
Abstract
Patients with corticobasal degeneration (CBD) pathology present with diverse clinical syndromes also associated with other neuropathologies, including corticobasal syndrome, progressive nonfluent aphasia, and an Alzheimer's-type dementia. Some present with behavioral variant frontotemporal dementia (bvFTD), though this subtype still requires more detailed clinical characterization. All patients with CBD pathology and clinical assessment were reviewed (N = 17) and selected if they initially met criteria for bvFTD [bvFTD(CBD), N = 5]. Available bvFTD patients with Pick's [bvFTD(Pick's), N = 5] were selected as controls. Patients were also compared to healthy older controls [N = 53] on neuropsychological and neuroimaging measures. At initial presentation, bvFTD(CBD) showed few neuropsychological or motor differences from bvFTD(Pick's). Neuropsychiatrically, they were predominantly apathetic with less florid social disinhibition and eating disturbances, and were more anxious than bvFTD(Pick's) patients. Voxel-based morphometry revealed similar patterns of predominantly frontal atrophy between bvFTD groups, though overall degree of atrophy was less severe in bvFTD(CBD), who also showed comparative preservation of the frontoinsular rim, with dorsal > ventral frontal atrophy, and sparing of temporal and parietal structures relative to bvFTD(Pick's) patients. Despite a remarkable overlap between the two patient types, bvFTD patients with underlying CBD pathology show subtle clinical features that may distinguish them from patients with Pick's disease neuropathology.
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Criswell S, Sterling C, Swisher L, Evanoff B, Racette BA. Sensitivity and specificity of the finger tapping task for the detection of psychogenic movement disorders. Parkinsonism Relat Disord 2009; 16:197-201. [PMID: 20005766 DOI: 10.1016/j.parkreldis.2009.11.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2009] [Revised: 11/09/2009] [Accepted: 11/16/2009] [Indexed: 10/20/2022]
Abstract
Psychogenic movement disorders (PMD) represent a diagnostically challenging group of patients in movement disorders. Finger tapping tests (FTT) have been used in neuropsychiatric evaluations to identify psychogenic conditions, but their use in movement disorders has been limited to the quantification of upper extremity disability in idiopathic Parkinson disease (IPD). We evaluated the ability of the FTT to objectively identify PMD by screening 195 individuals from a movement disorder clinic with IPD, dystonia, essential tremor, or PMD and compared them to 130 normal adults. All subjects performed six-30 s trials using alternate hands. We compared mean FTT score and the coefficient of variation between diagnostic groups. FTT scores in IPD were inversely correlated with Hoehn and Yahr stage (p < 0.001) and the United Parkinson Disease Rating Scale III (motor) subscale (p < 0.001). FTT scores were significantly lower in PMD (mean = 41.72) when compared to the other diagnostic groups after controlling for age. The coefficient of variation was not significantly different between diagnostic groups. ROC analysis identified a cutoff FTT ratio of 0.670 or less was 89.1% specific and 76.9% sensitive for the diagnosis of PMD. We conclude the FTT can provide supportive evidence for the diagnosis of PMD.
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Affiliation(s)
- Susan Criswell
- Department of Neurology, Washington University School of Medicine, 660 South Euclid Ave, Box 8111, St Louis, MO 63110, USA.
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25
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Fasano A, Mazzone P, Piano C, Quaranta D, Soleti F, Bentivoglio AR. GPi-DBS in Huntington's disease: results on motor function and cognition in a 72-year-old case. Mov Disord 2009; 23:1289-92. [PMID: 18512756 DOI: 10.1002/mds.22116] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Huntington's disease (HD) produces debilitating motor abnormalities that are poorly responsive to medical therapy. Deep brain stimulation (DBS) of the posteroventral globus pallidus internus (GPi) may offer a treatment option for patients with diskinetic phenotype and minimal cognitive impairment, but its role in the management of HD remains unclear and to date only two cases have been reported. We report the outcome of GPi-DBS in a 72-year-old man with HD. Stimulation at 130 Hz caused a rapid amelioration of chorea producing the worsening of bradykinesia, whereas 40 Hz stimulation (maintaining constant the total electrical energy delivered) improved chorea while preserving the ability to walk. At 1-year follow-up, chorea has completely disappeared; however, the patient was unable to stand and walk. The cognitive profile showed a progressive deterioration, with an extension of deficit from the mainly dysexecutive alterations at baseline to a more diffused cognitive deterioration.
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Affiliation(s)
- Alfonso Fasano
- Istituto di Neurologia, Università Cattolica del Sacro Cuore, Roma, Italia.
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26
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The basal ganglia. Clin Neuroradiol 2008. [DOI: 10.1017/cbo9780511551925.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Haaxma CA, Bloem BR, Borm GF, Horstink MW. Comparison of a timed motor test battery to the Unified Parkinson's Disease Rating Scale-III in Parkinson's disease. Mov Disord 2008; 23:1707-17. [DOI: 10.1002/mds.22197] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Van Borsel J, Bontinck C, Coryn M, Paemeleire F, Vandemaele P. Acoustic features of palilalia: a case study. BRAIN AND LANGUAGE 2007; 101:90-6. [PMID: 16890278 DOI: 10.1016/j.bandl.2006.06.118] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2006] [Revised: 03/16/2006] [Accepted: 06/24/2006] [Indexed: 05/11/2023]
Abstract
While a number of authors have suggested that patients with palilalia typically show a tendency to repeat words or phrases with an increasing rate, others maintain that an accelerating speech rate is not essential. The present paper reports the results of an instrumental analysis of the reiterations in a 60-year-old man with palilalia. Results indicate that there is not necessarily an increasing rapidity in palilalia. Duration of the repetition trains, duration of the pauses between the trains, and average number and average duration of the components within a train were variable but did not show a pattern indicative of a systematically increasing rate. The variation in the reiterations suggests that novel or varying motor processes are deployed to produce the elements in a sequence rather than an invariant motor program.
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Lalonde R, Strazielle C. Brain regions and genes affecting postural control. Prog Neurobiol 2007; 81:45-60. [PMID: 17222959 DOI: 10.1016/j.pneurobio.2006.11.005] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2006] [Revised: 08/05/2006] [Accepted: 11/08/2006] [Indexed: 12/24/2022]
Abstract
Postural control is integrated in all facets of motor commands. The role of cortico-subcortical pathways underlying postural control, including cerebellum and its afferents (climbing, mossy, and noradrenergic fibers), basal ganglia, motor thalamus, and parieto-frontal neocortex has been identified in animal models, notably through the brain lesion technique in rats and in mice with spontaneous and induced mutations. These studies are complemented by analyses of the factors underlying postural deficiencies in patients with cerebellar atrophy. With the gene deletion technique in mice, specific genes expressed in cerebellum encoding glutamate receptors (Grid2 and Grm1) and other molecules (Prkcc, Cntn6, Klf9, Syt4, and En2) have also been shown to affect postural control. In addition, transgenic mouse models of the synucleinopathies and of Huntington's disease cause deficiencies of motor coordination resembling those of patients with basal ganglia damage.
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Affiliation(s)
- R Lalonde
- Université de Rouen, Faculté de Médecine et de Pharmacie, INSERM U614, IFRMP, 76183 Rouen Cedex,
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