Lees' syndrome: a case series

Fundamentals of deep brain stimulation for Parkinson's disease in clinical practice: part 1

Deep brain stimulation (DBS) is recognized as an established therapy for Parkinson's disease (PD) and other movement disorders in the light of the developments seen over the past three decades. Long-term efficacy is established for PD with documented improvement in the cardinal motor symptoms of PD and levodopa-induced complications, such as motor fluctuations and dyskinesias. Timing of patient selection is crucial to obtain optimal benefits from DBS therapy, before PD complications become irreversible. The objective of this first part review is to examine the fundamental concepts of DBS for PD in clinical practice, discussing the historical aspects, patient selection, potential effects of DBS on motor and non-motor symptoms, and the practical management of patients after surgery.

Neuropsychiatric Features of Punding and Hobbyism in Parkinson's Disease

BACKGROUND

Little is known about the cognitive and neuropsychiatric profile associated with punding and hobbyism in Parkinson's disease (PD).

OBJECTIVE

To compare the clinical and neuropsychological features of PD patients with punding and hobbyism to PD controls.

METHODS

The Questionnaire for Impulsive-Compulsive Disorders in Parkinson's Disease-Rating Scale (QUIP-RS) was used as a screening tool, and a structured interview was used to diagnose punding/hobbyism. Clinical and neuropsychological assessment was conducted with validated questionnaires/scales.

RESULTS

Twenty-one patients with PD and punding (PD + pu) were compared to 26 with hobbyism (PD + h) and 25 PD controls. PD + pu patients showed higher levels of anxiety, non-motor symptoms and motor symptoms, and lower Frontal Assessment Battery scores. The PD + h group exhibited similar levels of anxiety and motor fluctuations to the PD + pu group.

CONCLUSION

PD + pu showed increased anxiety and frontal lobe dysfunction, similar to PD + h. Hobbyism could be a prodromal phase with increased risk of leading to punding.

Tribute to Professor Andrew J. Lees

Abstract Professor Andrew John Lees, from the National Hospital for Neurology and Neurosurgery, a neurological hospital in Queen Square, London, UK, has contributed in a stupendous way to the development of the field of movement disorders in Brazil, with a constant and intense participation in numerous congresses and scientific meetings of this specialty since 1983.

Hypersexuality in Psychiatric Conditions Observer-Rated Scale (HIPCORS): Evaluation of Reliability and Validity

Hypersexual behavior is not uncommon in psychiatric presentations. Most available scales that measure hypersexual behavior are self-rated, often containing sexually explicit questions, unsuitable for use in mentally unwell people. Lack of a clinically suitable instrument may have resulted in underdetection and under-researching of hypersexuality in people with mental disorders, with potential to cause significant consequences for themselves and those around them, including family members, coclients, and clinicians. To address this need, we developed the Hypersexuality in Psychiatric Conditions Observer-Rated Scale (HIPCORS), a rater-rated, nonintrusive tool, designed for use in mentally unwell people. It has been shown to be a reliable and valid instrument.

Jumping to conclusions in untreated patients with Parkinson's disease

BACKGROUND

Jumping to conclusions due to impulsivity has been shown to be a sensitive marker for dopamine dysregulation and addictive behaviour patterns in treated patients with Parkinson's disease (PD). It is unknown whether drug naïve PD patients, who have never received dopaminergic therapy also have deficits in information sampling.

METHODS

Twenty five de novo PD patients and twenty matched healthy controls were recruited and tested on the beads task, which is a validated information sampling task to assess reflection impulsivity and a temporal discounting questionnaire.

RESULTS

Patients gathered significantly less information and made more irrational choices than matched controls. There was, however, no group difference on the temporal discounting questionnaire.

CONCLUSIONS

Poor information sampling and irrational decision making may be an inherent component of the neuropsychological deficit in Parkinson's disease. These findings suggest that underlying impulsivity detected by a metric task is common in de novo PD.

Delusional misidentification syndrome and other unusual delusions in advanced Parkinson's disease

BACKGROUND

Unusual delusional syndromes are rare protean diseases with speculative etiopathogenic mechanisms.

METHODS

Seven consecutive patients with advanced PD were evaluated over a 15-year period at the Movement Disorders Unit in the Neurology Service, Hospital de Clínicas, Federal University of Paraná, and the Paraná State Parkinson's Patients Association.

RESULTS

We describe advanced Parkinson's disease patients presenting with unusual delusional syndromes, including cases of Ekbom, Othello, Capgras' and Diogenes syndromes, reduplicative paramnesia and mirrored-self misidentification.

CONCLUSION

There are a few isolated reports of unusual neuropsychiatric disorders in patients with PD. We believe that these syndromes associated with advanced PD in elderly patients presenting with cognitive impairment and polypharmacy are probably often underestimated. Neurologists should be aware for these rare and treatable conditions.