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Chen L, Ye S, Murphy D, Wu J, Zhang H, Liu H, Zou B, Hou G, Zhang N, Yin T, Smith RA, Fan D. Chinese Translation and Validation of the Center for Neurologic Study Lability Scale. Neurol Ther 2024:10.1007/s40120-024-00605-w. [PMID: 38625649 DOI: 10.1007/s40120-024-00605-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 03/15/2024] [Indexed: 04/17/2024] Open
Abstract
INTRODUCTION Pseudobulbar palsy is a common symptom in patients with amyotrophic lateral sclerosis (ALS), but it is often underdiagnosed or misdiagnosed as other diseases. The Center for Neurologic Study Lability Scale (CNS-LS) is a self-report scale consisting of seven questions designed for evaluating pseudobulbar affect (PBA). The current study aimed to validate a Chinese version of the CNS-LS. METHODS The Chinese version of the CNS-LS was obtained through a standardized forward-backward translation and cultural adaptation. A total of 105 patients with ALS were recruited from the ALS database of Peking University Third Hospital in Beijing, China, to complete the CNS-LS. The reliability of the Chinese version was determined by the test-retest method, and receiver operating characteristic (ROC) analysis was performed for criterion validity. RESULTS Of 105 patients with ALS, 37 had symptoms of PBA and were diagnosed with that condition by neurologists. Forty-two patients completed the CNS-LS twice, and there was no statistically significant difference between the scores (Z = -0.896, p = 0.37). The Spearman correlation coefficient between the test and retest scores was 0.940 (p < 0.0005), and the Cronbach alpha coefficient was high (α = 0.905, n = 105). Scores of 12 or higher on the CNS-LS identified PBA with sensitivity of 0.919 and specificity of 0.882. The area under the ROC curve was 0.924. CONCLUSION The Chinese version of the CNS-LS demonstrated good sensitivity and specificity in the group of patients with ALS enrolled in this study. The CNS-LS should be a useful instrument for clinical and research purposes for patients in this language group.
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Affiliation(s)
- Lu Chen
- Department of Neurology, Peking University Third Hospital, Haidian District, 49 North Garden Road, Beijing, 100191, China
- Department of Neurology, Yan'an Hospital of Traditional Chinese Medicine, No. 26 Xuan Yuan Road, Bridge Ditch Street, Bao Ta District, Yan'an, 716000, Shaanxi Province, China
| | - Shan Ye
- Department of Neurology, Peking University Third Hospital, Haidian District, 49 North Garden Road, Beijing, 100191, China
| | - Davan Murphy
- Center for Neurological Study in La Jolla, 7590 Fay Avenue, Suite 517, La Jolla, CA, USA
| | - Jieying Wu
- Department of Neurology, Peking University Third Hospital, Haidian District, 49 North Garden Road, Beijing, 100191, China
| | - Hui Zhang
- Department of Neurology, Peking University Third Hospital, Haidian District, 49 North Garden Road, Beijing, 100191, China
| | - Hong Liu
- Department of Neurology, Peking University Third Hospital, Haidian District, 49 North Garden Road, Beijing, 100191, China
| | - Boliang Zou
- Department of Neurology, Peking University Third Hospital, Haidian District, 49 North Garden Road, Beijing, 100191, China
| | - Guanghao Hou
- Department of Neurology, Peking University Third Hospital, Haidian District, 49 North Garden Road, Beijing, 100191, China
| | - Nan Zhang
- Department of Neurology, Peking University Third Hospital, Haidian District, 49 North Garden Road, Beijing, 100191, China
| | - Tielun Yin
- Department of Neurology, Peking University Third Hospital, Haidian District, 49 North Garden Road, Beijing, 100191, China
| | - Richard A Smith
- Center for Neurological Study in La Jolla, 7590 Fay Avenue, Suite 517, La Jolla, CA, USA.
| | - Dongsheng Fan
- Department of Neurology, Peking University Third Hospital, Haidian District, 49 North Garden Road, Beijing, 100191, China.
- Key Laboratory for Neuroscience, National Health Commission/Ministry of Education, Peking University, 38 Xueyuan Road, Haidian District, Beijing, 100191, China.
- Beijing Key Laboratory of Biomarker and Translational Research in Neurodegenerative Diseases, Beijing, 100191, China.
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Ramirez-Bermudez J, Perez-Esparza R, Flores J, Leon-Ortiz P, Corona T, Restrepo-Martínez M. Involuntary Emotional Expression Disorder in a Patient With Toluene Leukoencephalopathy. Rev Colomb Psiquiatr (Engl Ed) 2022; 51:163-166. [PMID: 35803687 DOI: 10.1016/j.rcpeng.2020.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Accepted: 10/05/2020] [Indexed: 06/15/2023]
Abstract
OBJECTIVE Inhalant users may develop toluene leukoencephalopathy, a devastating neuropsychiatric disorder. We present a case of toluene-induced damage to the corticospinal and the corticonuclear tracts, which presented with involuntary emotional expression disorder. METHODS Case study of a 20-year-old man with a 3-year history of frequent solvent abuse was admitted to the Neuropsychiatry Unit of the National Institute of Neurology and Neurosurgery because "he could not speak or walk" but would keep "laughing and crying without reason". RESULTS Neuropsychiatric examination revealed pathological laughter and crying, facial and speech apraxia, a bilateral pyramidal syndrome, and lack of control of urinary sphincter. Magnetic resonance imaging revealed a highly selective bilateral damage to the pyramidal system and the somatosensory pathway. SPECT imaging showed left fronto-parietal hypoperfusion. CONCLUSIONS This document provides support for the understanding of involuntary emotional expression disorders as a differential diagnosis in the clinical practice of psychiatrists, as well as the functional anatomy of these conditions.
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Affiliation(s)
- Jesús Ramirez-Bermudez
- Department of Neuropsychiatry, National Institute of Neurology and Neurosurgery, Mexico.
| | - Rodrigo Perez-Esparza
- Department of Neuropsychiatry, National Institute of Neurology and Neurosurgery, Mexico
| | - Jose Flores
- Department of Neurology, National Institute of Neurology and Neurosurgery, Mexico
| | - Pablo Leon-Ortiz
- Department of Neuropsychiatry, National Institute of Neurology and Neurosurgery, Mexico
| | - Teresa Corona
- Department of Neurology, National Institute of Neurology and Neurosurgery, Mexico
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Huysman AS, Kostermans T, Cardoen S. Foix-Chavany-Marie syndrome due to bilateral opercular ischemic lesions. Acta Neurol Belg 2021; 121:1367-1369. [PMID: 34273088 DOI: 10.1007/s13760-021-01751-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Accepted: 07/12/2021] [Indexed: 11/27/2022]
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Abstract
Introduction Pseudobulbar palsy (PBP) is characterized by supranuclear lesions in the corticobulbar pathway. Neoplasia, inflammatory, demyelinating, and stroke are possible etiologies of this disorder. Case report We report an elderly female who presented with dysarthria. She was dysarthric with a hypernasal voice, no apraxia or aphasia was observed. Tongue movements were slow with limited amplitude. Her soft palate dropped bilaterally; gag reflex was present. Also, she reported swallowing difficulty and choking with her saliva. Bilateral vertical and horizontal gaze were intact to either voluntary or oculocephalic movements. A cranial CT scan was suggestive of artery of Percheron (AOP) infarction. Brain magnetic resonance imaging showed hypersignal on diffusion-weighted and T2-weighted images and hyposignal on apparent diffusion coefficient in both thalami. CT angiography scan revealed an AOP originating from the left posterior cerebral artery. The swallowing study with a videofluoroscopic demonstrated oral and pharyngeal phases with severe dysfunction. Conclusion To the authors' knowledge, there are two cases of individuals with artery of Percheron infarction who developed PBP associated with other clinical syndromes. Still, isolated PBP following infarction of Percheron's artery was not reported. We hypothesized that the PBP may have occurred because of the existence of vascular territory variations in the perforating arteries that arise from the AOP.
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Ramirez-Bermudez J, Perez-Esparza R, Flores J, Leon-Ortiz P, Corona T, Restrepo-Martínez M. Involuntary Emotional Expression Disorder in a Patient With Toluene Leukoencephalopathy. Rev Colomb Psiquiatr (Engl Ed) 2020; 51:S0034-7450(20)30087-1. [PMID: 33735011 DOI: 10.1016/j.rcp.2020.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Accepted: 10/05/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Inhalant users may develop toluene leukoencephalopathy, a devastating neuropsychiatric disorder. We present a case of toluene-induced damage to the corticospinal and the corticonuclear tracts, which presented with involuntary emotional expression disorder. METHODS Case study of a 20-year-old man with a 3-year history of frequent solvent abuse was admitted to the Neuropsychiatry Unit of the National Institute of Neurology and Neurosurgery because "he could not speak or walk" but would keep "laughing and crying without reason". RESULTS Neuropsychiatric examination revealed pathological laughter and crying, facial and speech apraxia, a bilateral pyramidal syndrome, and lack of control of urinary sphincter. Magnetic resonance imaging revealed a highly selective bilateral damage to the pyramidal system and the somatosensory pathway. SPECT imaging showed left fronto-parietal hypoperfusion. CONCLUSIONS This document provides support for the understanding of involuntary emotional expression disorders as a differential diagnosis in the clinical practice of psychiatrists, as well as the functional anatomy of these conditions.
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Affiliation(s)
- Jesús Ramirez-Bermudez
- Department of Neuropsychiatry, National Institute of Neurology and Neurosurgery, Mexico.
| | - Rodrigo Perez-Esparza
- Department of Neuropsychiatry, National Institute of Neurology and Neurosurgery, Mexico
| | - Jose Flores
- Department of Neurology, National Institute of Neurology and Neurosurgery, Mexico
| | - Pablo Leon-Ortiz
- Department of Neuropsychiatry, National Institute of Neurology and Neurosurgery, Mexico
| | - Teresa Corona
- Department of Neurology, National Institute of Neurology and Neurosurgery, Mexico
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Yoshii F, Sugiyama H, Kodama K, Irino T. Foix-Chavany-Marie Syndrome due to Unilateral Anterior Opercular Damage with Contralateral Infarction of Corona Radiata. Case Rep Neurol 2019; 11:319-324. [PMID: 31824287 DOI: 10.1159/000503856] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Accepted: 10/01/2019] [Indexed: 11/19/2022] Open
Abstract
Foix-Chavany-Marie syndrome (FCMS) is a rare type of pseudobulbar palsy characterized by automatic-voluntary dissociation of movements of the face, tongue, pharynx, and masticatory muscles. Most cases are due to bilateral ischemic lesions of the anterior operculum, but the syndrome has also been described after unilateral opercular damage, either isolated or associated with contralateral cortico-nuclear tract involvement. We report a patient with FCMS due to right anterior opercular lesion with contralateral infarction of the corona radiata. The patient presented with paralysis of the face and tongue with automatic and voluntary dissociation. To our knowledge, FCMS with this peculiar lesion topography has rarely been reported. We discuss the underlying mechanism with reference to MRI and diffusion tensor imaging.
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Affiliation(s)
- Fumihito Yoshii
- Department of Neurology, Saiseikai Shonan Hiratsuka Hospital, Hiratsuka, Japan.,Department of Neurology, Tokai University Oiso Hospital, Oiso, Japan
| | - Hiromi Sugiyama
- Department of Rehabilitation Technology, Saiseikai Shonan Hiratsuka Hospital, Hiratsuka, Japan
| | - Kazuyuki Kodama
- Department of Rehabilitation Technology, Saiseikai Shonan Hiratsuka Hospital, Hiratsuka, Japan
| | - Takahito Irino
- Department of Rehabilitation Technology, Saiseikai Shonan Hiratsuka Hospital, Hiratsuka, Japan
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Digby R, Wells A, Menon D, Helmy A. Foix-Chavany-Marie syndrome secondary to bilateral traumatic operculum injury. Acta Neurochir (Wien) 2018; 160:2303-5. [PMID: 30328523 DOI: 10.1007/s00701-018-3702-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Accepted: 10/08/2018] [Indexed: 11/05/2022]
Abstract
This report describes a case of a 62-year-old man who developed Foix-Chavany-Marie syndrome subsequent to traumatic brain injury. The initial presentation of the syndrome was profound loss of voluntary control of orofacial muscles, causing a loss of speech and impairment of swallow. Over subsequent months, a remarkable recovery of these functions was observed. The natural history of FCMS in this case was favourable, with good improvement in function over months. Furthermore, the pattern of bilateral opercular injury was more readily recognised on MRI than on CT, supporting the role of MRI in cases of traumatic brain injury.
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Oz Tuncer G, Teber S, Kutluk MG, Albayrak P, Deda G. Hashimoto's encephalopathy presenting as pseudobulbar palsy. Childs Nerv Syst 2018; 34:1251-4. [PMID: 29368307 DOI: 10.1007/s00381-018-3720-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 01/03/2018] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Hashimoto's encephalopathy (HE) is an autoimmune condition with varied neurological and psychiatric features. HE is very unusual as a cause of pseudobulbar palsy (PSP). CASE PRESENTATION A 14-year-old male was admitted with right-sided weakness, dysphagia, speech disorder, and aggressiveness. Brain magnetic resonance imaging showed increased intensity in bilateral temporal, insular cortex, amygdala, and parahippocampal area on T2-weighted and fluid-attenuated inversion recovery images. Autoimmune encephalitis was considered as the patient had subacute onset of psychiatric and motor disturbances with normal findings for cerebrospinal fluid. N-methyl-D-aspartate receptor, anti-glutamate-type α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid 1 and 2, anti-contactin-associated protein-like 2, anti-gamma-aminobutyric acid receptor, anti-Leucine-rich, and glioma-inactivated 1 antibodies were negative but the anti-thyroperoxidase (antiTPO) level was greater than 998 IU/ML (n:0-9). Steroid therapy was initiated as pulse therapy and maintained with 2-mg/kg/day dose with the diagnosis of HE. He was symptom free for 6 months. In the follow-up period, he had two recurrences which responded to steroid therapy. CONCLUSION The common causes of PSP are demyelinating, vascular, and motor neuron diseases and congenital malformations of the opercular or insular cortex. However, there are no cases of PSP developing after any autoimmune encephalitis. This case highlights the importance of early detection of antiTPO antibodies with the findings of PSP due to autoimmune encephalitis.
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Liu X, Chen F, Chu J, Bao Y. Effects of nape acupuncture combined with swallowing rehabilitation on dysphagia in pseudobulbar palsy. J TRADIT CHIN MED 2018; 38:117-124. [PMID: 32185960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To evaluate the therapeutic effects of nape acupuncture combined with rehabilitative swallowing training for dysphagia caused by pseudobulbar palsy, and to compare it with rehabilitative swallowing training alone, and to observe the improvement in quality of life after the therapy. METHODS One hundred patients were randomly divided into two groups: the rehabilitative swallowing training group (control group, n=50) and the nape acupuncture combined with rehabilitative swallowing training group (experimental group, n=50). Each group had 8 weeks' therapy, 5 times a week. Patients in the control group received rehabilitative swallowing training, while those in the experimental group received nape acupuncture therapy based on swallowing rehabilitation. The outcomes were assessed by the repetitive saliva-swallowing test (RSST), water swallow test (WST), standardized swallowing assessment (SSA), and a swallow quality-of-life questionnaire (SWAL-QOL). Correlations of onset age, onset frequency and lesion location with the efficacy of the acupuncture treatment were also observed. RESULTS The scores for RSST, WST, and SSA in both groups were lower than before the therapy (P<0.001), although the changes were more marked in the experimental group than in the control group (RSST and WST, P<0.005; SSA, P<0.001). Both groups recorded changes in SWAL-QOL index after the therapy (P<0.001); and the experimental group scored higher than the control group (P<0.001). The efficacy of acupuncture was not correlated with location (P>0.05), but was related to onset age (P<0.05) and onset frequency (P<0.01). CONCLUSION Nape acupuncture combined with rehabilitative swallowing training has an effect on dysphagia caused by pseudobulbar palsy and improves quality of life.
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Affiliation(s)
- Xiaoping Liu
- Department of Acupuncture-Moxibustion and Rehabilitation, Hangzhou Hospital of Traditional Chinese Medicine, Hangzhou 310007, China
| | - Feiyu Chen
- Department of Acupuncture-Moxibustion and Rehabilitation, Hangzhou Hospital of Traditional Chinese Medicine, Hangzhou 310007, China
| | - Jiamei Chu
- Department of Acupuncture-Moxibustion and Rehabilitation, Hangzhou Hospital of Traditional Chinese Medicine, Hangzhou 310007, China
| | - Yehua Bao
- Department of Acupuncture-Moxibustion and Rehabilitation, Hangzhou Hospital of Traditional Chinese Medicine, Hangzhou 310007, China
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Lee HY, Kim MJ, Kim BR, Koh SE, Lee IS, Lee J. Acute Pseudobulbar Palsy After Bilateral Paramedian Thalamic Infarction: A Case Report. Ann Rehabil Med 2016; 40:751-6. [PMID: 27606284 PMCID: PMC5012989 DOI: 10.5535/arm.2016.40.4.751] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Accepted: 02/02/2016] [Indexed: 11/06/2022] Open
Abstract
Bilateral paramedian thalamic infarction is a rare subtype of stroke caused by occlusion of the artery of Percheron, an uncommon variant originating from one of the posterior cerebral arteries. This type of stroke has several major clinical presentations: altered mental status, behavioral amnestic impairment, aphasia or dysarthria, ocular movement disorders, motor deficits, cerebellar signs, and others. Few cases of bilateral paramedian thalamic infarction-related pseudobulbar palsy characterized by dysarthria, dysphagia, and facial and tongue weakness have been reported. We report here a rare case of acute severe pseudobulbar palsy as a manifestation of bilateral paramedian thalamic infarction.
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Affiliation(s)
- Hye Yeon Lee
- Department of Rehabilitation Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Min Jeong Kim
- Department of Rehabilitation Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Bo-Ram Kim
- Department of Rehabilitation Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Seong-Eun Koh
- Department of Rehabilitation Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - In-Sik Lee
- Department of Rehabilitation Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Jongmin Lee
- Department of Rehabilitation Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea.; International Healthcare Research Institute, Konkuk University, Seoul, Korea
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Nicastro N, Ghika J, Pollak P, Horvath J. Pseudobulbar palsy due to deep-brain stimulation of the thalamic ventral intermediate nuclei. Clin Neurol Neurosurg 2015; 133:61-3. [PMID: 25839917 DOI: 10.1016/j.clineuro.2015.03.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Revised: 02/19/2015] [Accepted: 03/12/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Nicolas Nicastro
- Neurology Department, Geneva University Hospitals, 4, rue G. Perret-Gentil, 1205 Geneva, Switzerland(1).
| | - Joseph Ghika
- Neurology Department, Hopital du Valais, 80, Avenue du Grand-Champsec, 1951 Sion, Switzerland
| | - Pierre Pollak
- Neurology Department, Geneva University Hospitals, 4, rue G. Perret-Gentil, 1205 Geneva, Switzerland(1)
| | - Judit Horvath
- Neurology Department, Geneva University Hospitals, 4, rue G. Perret-Gentil, 1205 Geneva, Switzerland(1)
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Abstract
The clinical and neuroradiological findings of three patients with marked palilalia due to different neurological disorders are reported. These cases and others in the literature suggest the possibility of different variations. "Spasmodic, heterophonic palilalia" is typically observed in Parkinson's syndrome and pseudobulbar palsy: the content of palilalia is characteristically changed by interruption. "Atonic, homophonic, autoecholalic palilalia" is mainly seen in Pick's disease, and is not affected by external interruption.
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Affiliation(s)
- M Ikeda
- Department of Neuropsychiatry, Osaka University Medical School, Fukushima, Osaka, 553 Japan
| | - H Tanabe
- Department of Neuropsychiatry, Osaka University Medical School, Fukushima, Osaka, 553 Japan
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