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Phua CS, Bhaskar S, Bertram K. Cough as a presenting symptom in Wilson's Disease. J Mov Disord 2024; 17:218-219. [PMID: 38062717 PMCID: PMC11082604 DOI: 10.14802/jmd.23221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 11/29/2023] [Accepted: 12/08/2023] [Indexed: 05/12/2024] Open
Affiliation(s)
- Chun Seng Phua
- Department of Neurology, Alfred Health, Melbourne, Australia
- Department of Neurosciences, Monash University, Melbourne, Australia
- Department of Neurology, University Technology Mara, Selangor, Malaysia
| | - Shalini Bhaskar
- Department of Neurology, University Technology Mara, Selangor, Malaysia
| | - Kelly Bertram
- Department of Neurology, Alfred Health, Melbourne, Australia
- Department of Neurosciences, Monash University, Melbourne, Australia
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2
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Rissardo JP, Vora NM, Tariq I, Batra V, Caprara ALF. Unraveling belly dancer's dyskinesia and other puzzling diagnostic contortions: A narrative literature review. Brain Circ 2024; 10:106-118. [PMID: 39036290 PMCID: PMC11259329 DOI: 10.4103/bc.bc_110_23] [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: 11/23/2023] [Revised: 01/17/2024] [Accepted: 01/30/2024] [Indexed: 07/23/2024] Open
Abstract
Belly dancer's dyskinesia (BDD) is characterized by involuntary abdominal wall movements that are rhythmic, repetitive, and dyskinetic. The present study aims to review BDD's etiology, pathophysiology, and management. We searched six databases to locate existing reports on BDD published from 1990 to October 2023 in electronic form. A total of 47 articles containing 59 cases were found. The majority of the patients affected by BDD were female, accounting for 61.01% (36/59) of the cases. The mean and median ages were 49.8 (standard deviation: 21.85) and 52 years (range: 7-85), respectively. The BDD was unilateral in only 3.38% (2/59). The most commonly reported causes associated with BDD were 17 idiopathic, 11 drug-induced, 11 postsurgical procedures, 5 pregnancies, and 4 Vitamin B12 deficiencies. BDD is a diagnosis of exclusion, and other more common pathologies with similar presentation should be ruled out initially. Differential diagnostic reasoning should include diaphragmatic myoclonus, cardiac conditions, truncal dystonia, abdominal motor seizures, propriospinal myoclonus, and functional or psychiatric disorders.
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Affiliation(s)
| | - Nilofar Murtaza Vora
- Department of Medicine, Terna Speciality Hospital and Research Centre, Navi Mumbai, Maharashtra, India
| | - Irra Tariq
- Department of Medicine, United Medical and Dental College, Karachi, Pakistan
| | - Vanshika Batra
- Department of Medicine, SGT University, Gurugram, Haryana, India
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3
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Akoumianaki E, Bolaki M, Prinianakis G, Konstantinou I, Panagiotarakou M, Vaporidi K, Georgopoulos D, Kondili E. Hiccup-like Contractions in Mechanically Ventilated Patients: Individualized Treatment Guided by Transpulmonary Pressure. J Pers Med 2023; 13:984. [PMID: 37373973 DOI: 10.3390/jpm13060984] [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: 05/19/2023] [Revised: 06/05/2023] [Accepted: 06/08/2023] [Indexed: 06/29/2023] Open
Abstract
Hiccups-like contractions, including hiccups, respiratory myoclonus, and diaphragmatic tremor, refer to involuntary, spasmodic, and inspiratory muscle contractions. They have been repeatedly described in mechanically ventilated patients, especially those with central nervous damage. Nevertheless, their effects on patient-ventilator interaction are largely unknown, and even more overlooked is their contribution to lung and diaphragm injury. We describe, for the first time, how the management of hiccup-like contractions was individualized based on esophageal and transpulmonary pressure measurements in three mechanically ventilated patients. The necessity or not of intervention was determined by the effects of these contractions on arterial blood gases, patient-ventilator synchrony, and lung stress. In addition, esophageal pressure permitted the titration of ventilator settings in a patient with hypoxemia and atelectasis secondary to hiccups and in whom sedatives failed to eliminate the contractions and muscle relaxants were contraindicated. This report highlights the importance of esophageal pressure monitoring in the clinical decision making of hiccup-like contractions in mechanically ventilated patients.
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Affiliation(s)
- Evangelia Akoumianaki
- Department of Intensive Care Unit, University Hospital of Heraklion, 71110 Crete, Greece
- School of Medicine, University of Crete, 71003 Heraklion, Greece
| | - Maria Bolaki
- Department of Intensive Care Unit, University Hospital of Heraklion, 71110 Crete, Greece
| | - Georgios Prinianakis
- Department of Intensive Care Unit, University Hospital of Heraklion, 71110 Crete, Greece
| | - Ioannis Konstantinou
- Department of Intensive Care Unit, University Hospital of Heraklion, 71110 Crete, Greece
| | - Meropi Panagiotarakou
- Department of Intensive Care Unit, University Hospital of Heraklion, 71110 Crete, Greece
| | - Katerina Vaporidi
- Department of Intensive Care Unit, University Hospital of Heraklion, 71110 Crete, Greece
- School of Medicine, University of Crete, 71003 Heraklion, Greece
| | | | - Eumorfia Kondili
- Department of Intensive Care Unit, University Hospital of Heraklion, 71110 Crete, Greece
- School of Medicine, University of Crete, 71003 Heraklion, Greece
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4
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Abstract
While the traditional lung function tests are used to assess lung capacity and pulmonary function, they cannot evaluate respiratory driving function and the integrity of the conduction pathway from the central nervous system to the respiratory motor neuron in the spinal cord and to the diaphragm. The inspiratory trigger is sent from the central nervous system through the phrenic nerve and drives the diaphragm to generate inspiratory movement. Therefore, phrenic nerve stimulation and diaphragmatic electromyography are two fundamental methods to assess respiratory function. There are several useful tools to assess respiratory motor system including electrical or magnetic phrenic nerve stimulation, diaphragmatic needle electromyography, and diaphragmatic ultrasound. By these means, physicians can assess current respiratory status in different neurological diseases that affect respiratory muscles, follow-up of the severity of respiratory impairment, help to predict the chance of successfully weaning from ventilatory support, and confirm clinical diagnoses such as diaphragmatic myoclonus. Although some of these tests require special training, applying these neurophysiological assessments in clinical practice is highly recommended.
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Affiliation(s)
- Yih-Chih Jacinta Kuo
- Department of Neurology, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan
| | - Kai-Hsiang Stanley Chen
- Department of Neurology, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan.
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5
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Chen R. Peribuccal and pharyngeal myorhythmia as a presenting symptom of hypertrophic olivary degeneration: Expert commentary. Parkinsonism Relat Disord 2021; 85:144-145. [PMID: 33771463 DOI: 10.1016/j.parkreldis.2021.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 03/14/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Robert Chen
- Division of Neurology, Department of Medicine, University of Toronto and the Edmond J. Safra Program in Parkinson's Disease, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada.
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6
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Chen KHS, Keng LT, Kuo YT, Tai YC, Chen R. Ultrasound-Guided Needle Electromyography for Assessing Diaphragmatic Myoclonus. Mov Disord Clin Pract 2020; 7:870-871. [PMID: 33043090 DOI: 10.1002/mdc3.13043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 07/22/2020] [Accepted: 07/27/2020] [Indexed: 11/08/2022] Open
Affiliation(s)
- Kai-Hsiang S Chen
- Department of Neurology National Taiwan University Hospital Hsin-Chu Branch Hsin-Chu Taiwan
| | - Li-Ta Keng
- Department of Internal Medicine National Taiwan University Hospital Hsin-Chu Branch Hsin-Chu Taiwan
| | - Yu-Ting Kuo
- Department of Neurology National Taiwan University Hospital Hsin-Chu Branch Hsin-Chu Taiwan
| | - Yi-Cheng Tai
- Department of Neurology E-Da Hospital, I-Shou University Kaohsiung Taiwan
| | - Robert Chen
- Krembil Research Institute University Health Network Toronto Ontario Canada.,Division of Neurology, Department of Medicine University of Toronto Toronto Ontario Canada.,Edmond J. Safra Program in Parkinson's Disease University Health Network Toronto Ontario Canada
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Chen KHS, Chen R. Principles of Electrophysiological Assessments for Movement Disorders. J Mov Disord 2020; 13:27-38. [PMID: 31986867 PMCID: PMC6987526 DOI: 10.14802/jmd.19064] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 10/21/2019] [Indexed: 12/22/2022] Open
Abstract
Electrophysiological studies can provide objective and quantifiable assessments of movement disorders. They are useful in the diagnosis of hyperkinetic movement disorders, particularly tremors and myoclonus. The most commonly used measures are surface electromyography (sEMG), electroencephalography (EEG) and accelerometry. Frequency and coherence analyses of sEMG signals may reveal the nature of tremors and the source of the tremors. The effects of voluntary tapping, ballistic movements and weighting of the limbs can help to distinguish between organic and functional tremors. The presence of Bereitschafts-potentials and beta-band desynchronization recorded by EEG before movement onset provide strong evidence for functional movement disorders. EMG burst durations, distributions and muscle recruitment orders may identify and classify myoclonus to cortical, subcortical or spinal origins and help in the diagnosis of functional myoclonus. Organic and functional cervical dystonia can potentially be distinguished by EMG power spectral analysis. Several reflex circuits, such as the long latency reflex, blink reflex and startle reflex, can be elicited with different types of external stimuli and are useful in the assessment of myoclonus, excessive startle and stiff person syndrome. However, limitations of the tests should be recognized, and the results should be interpreted together with clinical observations.
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Affiliation(s)
- Kai-Hsiang Stanley Chen
- Department of Neurology, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
| | - Robert Chen
- Krembil Research Institute, University Health Network, Toronto, ON, Canada.,Division of Neurology, Department of Medicine, University of Toronto, Toronto, ON, Canada.,Edmond J. Safra Program in Parkinson's Disease, University Health Network, Toronto, ON, Canada
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McAuley J, Taylor R, Simonds A, Chawda S. Respiratory difficulty with palatal, laryngeal and respiratory muscle tremor in adult-onset Alexander's disease. BMJ Case Rep 2017; 2017:bcr-2016-218484. [PMID: 28438749 DOI: 10.1136/bcr-2016-218484] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Sleep apnoea and respiratory difficulties are reported in adult-onset Alexander's disease (AOAD), an autosomal-dominant leukodystrophy that presents mainly with progressive ataxia. We demonstrate for the first time that the respiratory symptoms can result from association of palatal tremor with a similar tremor of laryngeal and respiratory muscles that interrupts normal inspiration and expiration.A 60-year-old woman presented with progressive ataxia, palatal tremor and breathlessness. MRI revealed medullary atrophy, bilateral T2 hyperintensities in the dentate nuclei and hypertrophic olivary degeneration (HOD). AOAD was confirmed genetically with a positive glial fibrillary acidic protein (GFAP) mutation. Electrophysiological study revealed 1.5 Hz rhythmic laryngeal and respiratory muscle activity. Her respiratory symptoms were significantly improved at night with variable positive pressure ventilation.This case illustrates that palatal tremor in AOAD, and potentially in other conditions, may be associated with treatable breathlessness due to a similar tremor of respiratory muscles.
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Affiliation(s)
- John McAuley
- Department of Neuroscience, Barking Havering and Redbridge University Hospitals NHS Trust, Romford, UK.,Department of Neuroscience, Queen Mary University of London, London, UK
| | - Rowena Taylor
- Department of Respiratory Medicine, Barts Health NHS Trust, London, UK
| | - Anita Simonds
- Sleep + Ventilation Unit, Royal Brompton Hospital, London, UK
| | - Sanjiv Chawda
- Department of Neuroradiology, BHR Hospitals, Romford, UK
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Llaneza Ramos VFM, Considine E, Karp BI, Lungu C, Alter K, Hallett M. Ultrasound as Diagnostic Tool for Diaphragmatic Myoclonus. Mov Disord Clin Pract 2016; 3:282-284. [PMID: 27430001 DOI: 10.1002/mdc3.12295] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Diaphragmatic myoclonus is a rare disorder of repetitive diaphragmatic contractions, acknowledged to be a spectrum that includes psychogenic features. Electromyography has been the diagnostic tool most commonly used in the literature. METHODS To test if we could perform a noninvasive technique to delineate the diaphragm as the source of abnormal movements and demonstrate distractibility and entrainability, we used B-mode ultrasound in a patient with diaphragmatic myoclonus. RESULTS Ultrasound imaging clearly delineated the diaphragm as the source of her abdominal movements. We were able to demonstrate entrainability of the diaphragm to hand tapping to a prescribed rhythm set by examiner. CONCLUSION We recommend the use of ultrasound as a noninvasive, convenient diagnostic tool for further studies of diaphragmatic myoclonus. We agree with previous findings that diaphragmatic myoclonus may be a functional movement disorder, as evidenced by distractibility and entrainability demonstrated on real-time video with ultrasonography.
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Affiliation(s)
| | - Elaine Considine
- Human Motor Control Section, National Institutes of Health, Bethesda, MD
| | | | - Codrin Lungu
- Office of the Clinical Director, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD
| | - Katharine Alter
- Functional and Applied Biomechanics Section, Rehabilitation Medicine Department, National Institutes of Health, Bethesda, MD and Mount Washington Pediatric Hospital, Washington, DC
| | - Mark Hallett
- Human Motor Control Section, National Institutes of Health, Bethesda, MD
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10
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Vrabelova D, Gilor C, Habing A, Schober KE, Johnson S. Synchronous Diaphragmatic Flutter Secondary to Primary Hypoparathyroidism in a Dog. J Am Anim Hosp Assoc 2015; 51:392-5. [PMID: 26535458 DOI: 10.5326/jaaha-ms-6235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A 3 yr old, spayed, female miniature mchnauzer was presented for rhythmic, spontaneous contractions of the abdominal wall and across the costal arches. The rate of contractions coincided with the heart rate and increased during exercise. The dog was diagnosed with primary hypoparathyroidism based on low plasma ionized calcium and serum parathyroid hormone (PTH) concentrations. Fluoroscopic exam confirmed the diagnosis of a synchronous diaphragmatic flutter. Treatment of the hypocalcemia led to resolution of the diaphragmatic flutter.
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Affiliation(s)
- Daniela Vrabelova
- From the Department of Veterinary Clinical Sciences Veterinary Medical Center The Ohio State University Columbus, OH
| | - Chen Gilor
- From the Department of Veterinary Clinical Sciences Veterinary Medical Center The Ohio State University Columbus, OH
| | - Amy Habing
- From the Department of Veterinary Clinical Sciences Veterinary Medical Center The Ohio State University Columbus, OH
| | - Karsten E Schober
- From the Department of Veterinary Clinical Sciences Veterinary Medical Center The Ohio State University Columbus, OH
| | - Susan Johnson
- From the Department of Veterinary Clinical Sciences Veterinary Medical Center The Ohio State University Columbus, OH
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11
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Ramírez J, Gonzales M, Hoyos J, Grisales L. Diaphragmatic flutter: A case report and literature review. NEUROLOGÍA (ENGLISH EDITION) 2015. [DOI: 10.1016/j.nrleng.2013.06.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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12
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Ramírez J, Gonzales M, Hoyos J, Grisales L. Aleteo diafragmático. Descripción de caso y revisión de la literatura. Neurologia 2015; 30:249-51. [DOI: 10.1016/j.nrl.2013.06.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2013] [Revised: 06/05/2013] [Accepted: 06/17/2013] [Indexed: 11/16/2022] Open
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Abstract
This chapter reviews focal dyskinesias that affect a restricted region of the body in isolation. Focal dyskinesias often affect body parts not commonly involved in isolation by movement disorders and are not readily classified into one of the major categories of movement disorders or peripheral nerve excitability syndromes. The clinical features and phenomenology of these "unusual focal dyskinesias" are discussed according to the region affected (ear, lip, chin, jaw, tongue, abdomen, and diaphragm (belly dancer's dyskinesias), back, scapula, and limbs). The phenomenology and origin of the unusual focal dyskinesias remain the subject of debate. Most are characterized by slow semirhythmic jerky movements at variable (usually slow) frequencies superimposed on sustained postures, consistent with dystonic movements. However, the body parts affected and pattern of occurrence (in repose rather than during action) are different to those usually seen in primary dystonia. Many of the unusual focal dyskinesias are associated with trauma and pain to the affected region, prompting the suggestion that the movements follow central sensorimotor reorganization occurring spontaneously or secondary to changes in the peripheral nervous system. In other cases, inconsistent signs and spontaneous recovery suggest a psychogenic origin.
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Affiliation(s)
- Annu Aggarwal
- Department of Neurology, Royal Adelaide Hospital and University Department of Medicine, University of Adelaide, Adelaide, Australia
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14
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Abstract
A 15-year-old girl gave a recent history of dyspnoea and "funny turns". She had congenital aortic stenosis, previous valvotomies, a mechanical valve replacement, permanent pacemaker, atrial tachyarrhythmias, impaired ventricular function, systemic hypotension, pulmonary hypertension, and anxiety. The diagnosis of diaphragmatic flutter was delayed due to all the differential diagnoses and rarity of the condition. It was confirmed by observation, respiratory band monitoring, volume-time spirogram and fluoroscopy during an attack.
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15
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Abstract
The paroxysmal nonepileptic events of childhood are a group of disorders, syndromes, and phenomena that mimic true epileptic seizures. Clinical experience and a clear description of the event in question will usually lead to a correct categorization. They span in age from neonate to young adult and are apt to be the most common diagnostic challenges clinicians face regularly. The key to diagnosis is a detailed history and careful observation. Despite the large number of discrete entities enumerated herein, common principles in clinical approach are successful and described. Each entity can pose a significant clinical challenge in identification, etiologic pathophysiology, genetics, and management. A simple division is offered here separating those episodes that are associated with an altered mental status or occurring during sleep and those without an altered mental status or occurring while awake.
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Affiliation(s)
- Francis J DiMario
- School of Medicine, The University of Connecticut, Farmington, CT 06106, USA.
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16
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Crone NE, Jinnah HA, Reich SG. Wilson's disease presenting with an unusual cough. Mov Disord 2005; 20:891-3. [PMID: 15806570 DOI: 10.1002/mds.20472] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
A 26-year-old man developed an unusual repetitive, nonproductive cough. Extensive pulmonary and otolaryngology investigations failed to disclose a cause. It was only after he developed additional neurological manifestations ultimately leading to the diagnosis of Wilson's disease (WD) that a neurological basis for the cough was suspected. Features of the cough suggest it was a form of respiratory dyskinesia, a previously unreported presentation of WD.
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Affiliation(s)
- Nathan E Crone
- Department of Neurology, Johns Hopkins University, Baltimore, Maryland 21287, USA
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Puls I, Oh SJ, Sumner CJ, Wallace KE, Floeter MK, Mann EA, Kennedy WR, Wendelschafer-Crabb G, Vortmeyer A, Powers R, Finnegan K, Holzbaur ELF, Fischbeck KH, Ludlow CL. Distal spinal and bulbar muscular atrophy caused by dynactin mutation. Ann Neurol 2005; 57:687-94. [PMID: 15852399 PMCID: PMC1351270 DOI: 10.1002/ana.20468] [Citation(s) in RCA: 151] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Impaired axonal transport has been postulated to play a role in the pathophysiology of multiple neurodegenerative disorders. In this report, we describe the results of clinical and neuropathological studies in a family with an inherited form of motor neuron disease caused by mutation in the p150Glued subunit of dynactin, a microtubule motor protein essential for retrograde axonal transport. Affected family members had a distinct clinical phenotype characterized by early bilateral vocal fold paralysis affecting the adductor and abductor laryngeal muscles. They later experienced weakness and atrophy in the face, hands, and distal legs. The extremity involvement was greater in the hands than in the legs, and it had a particular predilection for the thenar muscles. No clinical or electrophysiological sensory abnormality existed; however, skin biopsy results showed morphological abnormalities of epidermal nerve fibers. An autopsy study of one patient showed motor neuron degeneration and axonal loss in the ventral horn of the spinal cord and hypoglossal nucleus of the medulla. Immunohistochemistry showed abnormal inclusions of dynactin and dynein in motor neurons. This mutation of dynactin, a ubiquitously expressed protein, causes a unique pattern of motor neuron degeneration that is associated with the accumulation of dynein and dynactin in neuronal inclusions.
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Affiliation(s)
- Imke Puls
- From the Neurogenetics Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD
| | - Shin J. Oh
- Departments of Neurology and
- Pathology, University of Alabama at Birmingham, Birmingham, AL
| | - Charlotte J. Sumner
- From the Neurogenetics Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD
| | - Karen E. Wallace
- Department of Physiology, University of Pennsylvania School of Medicine, Philadelphia, PA
| | | | - Eric A. Mann
- Laryngeal and Speech Sections, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD
| | - William R. Kennedy
- Department of Neurology, University of Minnesota Medical Center, Minneapolis, MN; and
| | | | - Alexander Vortmeyer
- Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, Bethesda, MD
| | - Richard Powers
- Pathology, University of Alabama at Birmingham, Birmingham, AL
| | - Kimberly Finnegan
- Laryngeal and Speech Sections, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD
| | - Erika L. F. Holzbaur
- Department of Physiology, University of Pennsylvania School of Medicine, Philadelphia, PA
| | - Kenneth H. Fischbeck
- From the Neurogenetics Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD
| | - Christy L. Ludlow
- Laryngeal and Speech Sections, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD
- Address correspondence to Dr Ludlow, Laryngeal and Speech Section, Clinical Neurosciences Program, National Institute of Neurological Disorders and Stroke, Building 10 Room 5D 38, 10 Center Drive, MSC 1416, Bethesda, MD 20892-1416. E-mail:
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Perry JC, Sessler CN. Respiratory Myoclonus Produces High Airway Pressure and Tidal Volume During Automatic Tube Compensation Ventilation. Chest 2004. [DOI: 10.1378/chest.126.4_meetingabstracts.936s-a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Abstract
The EMG interference pattern, built up of single motor unit action potentials, may be analyzed subjectively, or objectively by computer aided, quantitative methods, like counting of zero-crossings, counting of spikes, amplitude measurements, integration of the area under the curve, decomposition techniques, power spectrum analysis and turn/amplitude analysis. Since the shape of the interference pattern of healthy muscles is dependent on age, sex, force, muscle, temperature, fatigue, fitness level, recording site and surrounding tissue, electrode type, sensitivity, filters, sampling frequency and threshold level, all methods of analyzing the IP have to be standardized. Quantitative methods of analyzing the EMG interference pattern may be used for monitoring botulinum toxin therapy of dystonia and spasticity, quantifying spontaneous activity, assessment of chronic muscle pain, neuro-urological and proctological function, and diagnosing neuromuscular disorders. For diagnostic purposes, the methods favored are those that use needle electrodes and do not require measurement or monitoring of muscle force. The most well-evaluated methods are those using turn/amplitude analysis, like the cloud methods and the peak-ratio analysis. Peak-ratio analysis has the advantage that reference limits are easy to obtain and that its utility is well established and confirmed by several investigations. Overall, automatic methods of EMG interference pattern analysis are powerful tools for diagnostic and non-diagnostic purposes.
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Affiliation(s)
- J Finsterer
- Ludwig Boltzmann Institute for Research in Neuromuscular Disorders, Postfach 348, 1180 Vienna, Austria.
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20
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Abstract
The interference pattern of the electrical activity of muscle can be quantified by amplitude measurements, different spike counting methods, and power spectrum analyses. Interference pattern analysis (IPA) methods are used to describe the degree of activation of different muscles, muscle fatigue, occupational work, muscles in chronic pain syndromes, disused muscle, and dystonic muscle treated with botulinum toxin. In patients with neuromuscular disorders, the turns/amplitude analysis is useful for diagnosis. High diagnostic yields can be obtained without force measurements, for example, by using the amplitude as an indicator of force (the peak ratio method) or plotting the amplitude against the turns (cloud analysis). The diagnostic possibilities of the power spectrum analysis and the motor unit firing rate obtained by decomposition techniques are still unclear.
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Affiliation(s)
- A Fuglsang-Frederiksen
- Department of Clinical Neurophysiology, Gentofte Hospital, Niels Andersens Vej 65, DK 2900 Hellerup, Denmark.
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Dietrichs E, Heier MS, Faye-Lund H, Nakstad PH. Bulbar myoclonus without palatal myoclonus. A hypothesis on pathophysiology. Eur J Neurol 1999; 6:367-70. [PMID: 10210921 DOI: 10.1046/j.1468-1331.1999.630367.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A 40-year-old woman with myoclonic contractions bilaterally in the infrahyoid neck muscles, especially in the left cricothyroid muscle, was presented and successfully treated with botulinum toxin injections. The patient had a wide, aberrant vessel curving into the left dorsolateral reticular formation of the medulla oblongata. Based on our observations, we propose that symptomatic bulbar and palatal myoclonus is caused by pathology in the dorsolateral reticular formation, and not by inferior olivary dysfunction as is currently thought.
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Affiliation(s)
- E Dietrichs
- Department of Neurology, Ullevål Hospital, N-0407 Oslo, Norway
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Collins SJ, Chen RE, Remtulla H, Parkes A, Bolton CF. Novel measurement for automated interference pattern analysis of the diaphragm. Muscle Nerve 1997; 20:1038-40. [PMID: 9236798 DOI: 10.1002/(sici)1097-4598(199708)20:8<1038::aid-mus17>3.0.co;2-r] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The automated interference pattern analysis for limb muscles was modified to take into account the unique features of the needle EMG of the diaphragm. The modification was successful in recording more accurately the number of small and large segments and the activity levels with inspiratory effort. "Clouds" were generated in ten healthy subjects. The techniques may prove useful in electrophysiological investigations.
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Affiliation(s)
- S J Collins
- Department of Clinical Neurosciences, St. Vincent's Hospital, Melbourne, Australia
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