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Coenen MA, Eggink H, van Egmond ME, Oterdoom DLM, van Dijk JMC, van Laar T, Spikman JM, Tijssen MAJ. Deep brain stimulation in dystonia: The added value of neuropsychological assessments. J Neuropsychol 2024; 18 Suppl 1:8-18. [PMID: 37309888 DOI: 10.1111/jnp.12331] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 05/27/2023] [Indexed: 06/14/2023]
Abstract
Deep brain stimulation (DBS) of the internal globus pallidus (GPi) is a recognized treatment for medication-refractory dystonia. Problems in executive functions and social cognition can be part of dystonia phenotypes. The impact of pallidal DBS on cognition appears limited, but not all cognitive domains have been investigated yet. In the present study, we compare cognition before and after GPi DBS. Seventeen patients with dystonia of various aetiology completed pre- and post-DBS assessment (mean age 51 years; range 20-70 years). Neuropsychological assessment covered intelligence, verbal memory, attention and processing speed, executive functioning, social cognition, language and a depression questionnaire. Pre-DBS scores were compared with a healthy control group matched for age, gender and education, or with normative data. Patients were of average intelligence but performed significantly poorer than healthy peers on tests for planning and for information processing speed. Otherwise, they were cognitively unimpaired, including social cognition. DBS did not change the baseline neuropsychological scores. We confirmed previous reports of executive dysfunctions in adult dystonia patients with no significant influence of DBS on cognitive functioning in these patients. Pre-DBS neuropsychological assessments appear useful as they support clinicians in counselling their patients. Decisions about post-DBS neuropsychological evaluations should be made on a case-by-case basis.
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Affiliation(s)
- Maraike A Coenen
- Department of Neurology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Expertise Center Movement Disorders Groningen, University Medical Center Groningen (UMCG), Groningen, The Netherlands
| | - Hendriekje Eggink
- Department of Neurology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Expertise Center Movement Disorders Groningen, University Medical Center Groningen (UMCG), Groningen, The Netherlands
| | - Martje E van Egmond
- Department of Neurology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Expertise Center Movement Disorders Groningen, University Medical Center Groningen (UMCG), Groningen, The Netherlands
| | - D L Marinus Oterdoom
- Expertise Center Movement Disorders Groningen, University Medical Center Groningen (UMCG), Groningen, The Netherlands
- Department of Neurosurgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - J Marc C van Dijk
- Expertise Center Movement Disorders Groningen, University Medical Center Groningen (UMCG), Groningen, The Netherlands
- Department of Neurosurgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Teus van Laar
- Department of Neurology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Expertise Center Movement Disorders Groningen, University Medical Center Groningen (UMCG), Groningen, The Netherlands
| | - Jacoba M Spikman
- Department of Neurology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Expertise Center Movement Disorders Groningen, University Medical Center Groningen (UMCG), Groningen, The Netherlands
| | - Marina A J Tijssen
- Department of Neurology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Expertise Center Movement Disorders Groningen, University Medical Center Groningen (UMCG), Groningen, The Netherlands
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Coenen MA, Sival D, Brandsma R, Eggink H, Timmerman ME, Tijssen MA, Spikman JM. Moving across disorders: A cross-sectional study of cognition in early onset ataxia and dystonia. Eur J Paediatr Neurol 2024; 49:100-105. [PMID: 38479210 DOI: 10.1016/j.ejpn.2024.02.016] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 01/18/2024] [Accepted: 02/29/2024] [Indexed: 05/03/2024]
Abstract
BACKGROUND Early onset ataxia (EOA) and Early Onset Dystonia (EOD) are movement disorders developing in young people (age <25 per definition). These disorders result from dysfunctional networks involving the cerebellum and basal ganglia. As these structures are also important for cognition, cognitive deficits can be expected in EOA and EOD. EOA and EOD sometimes co-occur, but in those cases the predominant phenotype is determining. A pending question is whether predominantly EOA and EOD have different profiles of cognitive impairment. OBJECTIVES We investigated whether cognitive functions were impaired in patients with either predominant EOA or predominant EOD and whether cognitive profiles differed between both patient groups. METHODS The sample consisted of 26 EOA and 26 EOD patients with varying etiology but similar duration and severity of the disorder. Patient samples were compared to a group of 26 healthy controls, all matched on age and gender. All participants underwent neuropsychological testing for verbal intelligence, memory, working memory, attention/cognitive speed, executive functions, emotion recognition and language. RESULTS EOA and EOD patients both performed significantly worse than healthy controls on tests of verbal intelligence, working memory and executive functions. Additionally, attention/cognitive speed and emotion recognition were impaired in the EOA group. Compared to EOD, EOA patients performed worse on attention/cognitive speed and verbal intelligence. CONCLUSIONS Our results show overall similar profiles of cognitive deficits in both patient groups, but deficits were more pronounced in the patients with EOA. This suggests that more severe cognitive impairment is related to more severe cerebellar network dysfunction.
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Affiliation(s)
- Maraike A Coenen
- University of Groningen, University Medical Center Groningen, Department of Neurology, Groningen, the Netherlands; UMCG Expertise Center Movement Disorders Groningen, University Medical Center Groningen (UMCG), Groningen, the Netherlands.
| | - Deborah Sival
- UMCG Expertise Center Movement Disorders Groningen, University Medical Center Groningen (UMCG), Groningen, the Netherlands; University of Groningen, University Medical Center Groningen, Department of Pediatrics, Beatrix Children's Hospital UMCG, Groningen, the Netherlands
| | - Rick Brandsma
- University of Utrecht, University Medical Center Utrecht, Department of Neurology, Utrecht, the Netherlands
| | - Hendriekje Eggink
- University of Groningen, University Medical Center Groningen, Department of Neurology, Groningen, the Netherlands; UMCG Expertise Center Movement Disorders Groningen, University Medical Center Groningen (UMCG), Groningen, the Netherlands
| | - Marieke E Timmerman
- University of Groningen, Faculty of Behavioral and Social Sciences, Psychometrics & Statistics, Groningen, the Netherlands
| | - Marina A Tijssen
- University of Groningen, University Medical Center Groningen, Department of Neurology, Groningen, the Netherlands; UMCG Expertise Center Movement Disorders Groningen, University Medical Center Groningen (UMCG), Groningen, the Netherlands
| | - Jacoba M Spikman
- University of Groningen, University Medical Center Groningen, Department of Neurology, Groningen, the Netherlands; UMCG Expertise Center Movement Disorders Groningen, University Medical Center Groningen (UMCG), Groningen, the Netherlands
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Martínez-Piédrola RM, Huertas-Hoyas E, Serrada-Tejeda S, Máximo-Bocanegra N, Sánchez-Herrera-Baeza P, García-Bravo C, Pérez-de-Heredia-Torres M, Martínez-Castrillo JC. The Impact of Anxiety and Upper Limb Disability on Participation Levels in People With Dystonia: An Observational Cross-Sectional Case-Control Study. Am J Phys Med Rehabil 2021; 100:77-81. [PMID: 32657815 DOI: 10.1097/phm.0000000000001525] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVE This study sought to evaluate the level of anxiety in people with dystonia and to examine a possible relationship between the level of participation, anxiety, and functional limitations. DESIGN This is an observational, cross-sectional, case-control study with 12 cases of focal dystonia and 12 healthy controls aged between 18 and 75 yrs. The Hamilton Anxiety Rating Scale, the QuickDASH scale, and the Measure of Participation and Activities were used. Differences in scores and effect size were analyzed through the Student t test and Cohen d test. A multiple regression model was performed to determine the relationship between variables. RESULTS People with dystonia obtained higher scores in the three subsections of the Hamilton Anxiety Rating Scale (total anxiety, psychiatric anxiety, and somatic anxiety; P < 0.05) and on the QuickDASH scale, together with lower scores in participation in activities of daily living of the Measure of Participation and Activities (P = 0.01). Greater upper limb disability was associated with a greater negative impact on participation in activities of daily living (P < 0.01); however, no significant relationship was found with anxiety (P > 0.05). CONCLUSIONS This study suggests that the ability of people with dystonia to participate in society is negatively affected by the level of disability of the upper limb, but even when anxiety-age-related differences were controlled for, no relationship was found between variables.
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Affiliation(s)
- Rosa M Martínez-Piédrola
- From the Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Rey Juan Carlos University, Alcorcón, Madrid, Spain (RMM-P, EH-H, SS-T, NM-B, PS-H-B, CG-B, MP-d-H-T); and Hospital Universitario Ramón y Cajal, Carretera de Colmenar Viejo, Madrid, Spain (JCM-C)
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Page AD, Siegel LH, Baylor CR, Adams SG, Yorkston KM. The Consequences of Oromandibular Dystonia on Communicative Participation: A Qualitative Study of the Insider's Experiences. Am J Speech Lang Pathol 2019; 28:771-783. [PMID: 31306592 DOI: 10.1044/2018_ajslp-msc18-18-0092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Purpose The purpose of this study was to obtain a self-reported account of the experience of living with oromandibular dystonia (OMD) to gain a better understanding of both the daily facilitators and barriers to communicative participation and the strategies used for adapting to life with OMD. Method Eight individuals with OMD and dysarthria participated in 1 face-to-face, semistructured interview. Interviews were audio-recorded and transcribed verbatim. Qualitative, phenomenological methods of coding, immersion, and emergence were used in the analysis of interview data. Results Three major themes and 7 subthemes emerged from the analysis of interview data. First, "speaking is different now" provided examples of how speech changes are manifested in various life situations. Second, "my roles have changed" addressed how OMD has impacted work, home, and social roles. Third, "I accept it and move on" involved finding strategies that help and adopting a different perspective. Conclusion We suggest that the management of OMD must take a more holistic approach by addressing consequences beyond the physical symptoms and be tailored to each individual based on his or her personal concerns and goals.
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Affiliation(s)
- Allyson D Page
- School of Communication Sciences and Disorders, Western University, London, Ontario, Canada
| | - Lauren H Siegel
- Health & Rehabilitation Sciences, Western University, London, Ontario, Canada
| | - Carolyn R Baylor
- Department of Rehabilitation Medicine, University of Washington, Seattle
| | - Scott G Adams
- School of Communication Sciences and Disorders, Western University, London, Ontario, Canada
| | - Kathryn M Yorkston
- Department of Rehabilitation Medicine, University of Washington, Seattle
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Vilanova TFDD, Borges V, Ferraz HB. Specific characteristics of the medical history of swallowing before and after application of botulinum toxin in patients with cervical dystonia. Clinics (Sao Paulo) 2019; 74:e776. [PMID: 30942281 PMCID: PMC6432842 DOI: 10.6061/clinics/2019/e776] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 01/09/2019] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES To compare signs and symptoms of dysphagia in individuals with cervical dystonia (CD) before and after application of botulinum toxin (BTX). METHODS A prospective study was conducted with 20 patients diagnosed with CD with indications for BTX application. We selected 18 patients who met the study inclusion criteria. All individuals were patients from the Movement Disorders Unit, Department of Neurology, Federal University of São Paulo. BTX was applied in the cervical region at the necessary dose for each individual. To identify signs/complaints of changes in swallowing, we used a specific questionnaire that was completed by patients and/or their companions on the day of BTX injection and repeated 10 to 15 days after BTX injection. RESULTS Among the 18 study subjects, 15 (83.3%) showed primary and three (16.7%) showed secondary cervical dystonia. The most frequent dystonic movements were rotation (18), tilt (5), forward shift (3), backward shift (7), shoulder elevation (12), shoulder depression (2), and cervical tremor (6). The main complaints reported before BTX application were voice changes in 10 (55.6%), need for adjustment of eating position in 10 (55.6%), coughing and/or choking while eating in nine (50%), and increased eating time in nine (50%) individuals. The main complaints reported after BTX application were coughing and/or choking while eating in 11 (61.1%), voice changes in nine (50%), sensation of food stuck in the throat in eight (44%), and increased eating time in eight (44%) individuals. CONCLUSION The administration of a swallowing-specific questionnaire to individuals with CD before and after BTX application enabled the identification of possible dysphagia symptoms prior to drug treatment resulting from CD, which are often subsequently interpreted as side effects of the drug treatment. Thus, dysphagia can be managed, and aspiration symptoms can be prevented.
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Affiliation(s)
- Tatiana Fonseca Del Debbio Vilanova
- Setor de Transtornos do Movimento, Departamento de Neurologia, Escola Paulista de Medicina, Universidade Federal de Sao Paulo (UNIFESP), Sao Paulo, SP, BR
- *Corresponding author. E-mail:
| | - Vanderci Borges
- Setor de Transtornos do Movimento, Departamento de Neurologia, Escola Paulista de Medicina, Universidade Federal de Sao Paulo (UNIFESP), Sao Paulo, SP, BR
| | - Henrique Ballalai Ferraz
- Setor de Transtornos do Movimento, Departamento de Neurologia, Escola Paulista de Medicina, Universidade Federal de Sao Paulo (UNIFESP), Sao Paulo, SP, BR
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Sienaert P, van Harten P, Rhebergen D. The psychopharmacology of catatonia, neuroleptic malignant syndrome, akathisia, tardive dyskinesia, and dystonia. Handb Clin Neurol 2019; 165:415-428. [PMID: 31727227 DOI: 10.1016/b978-0-444-64012-3.00025-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Although highly prevalent, motor syndromes in psychiatry and motor side effects of psychopharmacologic agents remain understudied. Catatonia is a syndrome with specific motor abnormalities that can be seen in the context of a variety of psychiatric and somatic conditions. The neuroleptic malignant syndrome is a lethal variant, induced by antipsychotic drugs. Therefore, antipsychotics should be used with caution in the presence of catatonic signs. Antipsychotics and other dopamine-antagonist drugs can also cause motor side effects such as akathisia, (tardive) dyskinesia, and dystonia. These syndromes share a debilitating impact on the functioning and well-being of patients. To reduce the risk of inducing these side effects, a balanced and well-advised prescription of antipsychotics is of utmost importance. Clinicians should be able to recognize motor side effects and be knowledgeable of the different treatment modalities.
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Affiliation(s)
- Pascal Sienaert
- Academic Center for ECT and Neuromodulation (AcCENT), University Psychiatric Center KU Leuven, Kortenberg, Belgium.
| | - Peter van Harten
- Research Department, GGz Centraal Innova, Amersfoort, and Department of Mental Health and Neuroscience, Faculty of Health Medicine and Life Sciences, University of Maastricht, Maastricht, The Netherlands
| | - Didi Rhebergen
- Department of Psychiatry and Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands
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Page AD, Siegel L, Jog M. Self-Rated Communication-Related Quality of Life of Individuals With Oromandibular Dystonia Receiving Botulinum Toxin Injections. Am J Speech Lang Pathol 2017; 26:674-681. [PMID: 28654948 DOI: 10.1044/2017_ajslp-16-0098] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 11/29/2016] [Indexed: 06/07/2023]
Abstract
PURPOSE In this preliminary study, we examined self-rated communication-related quality of life (CR-QoL) of 10 control participants and 10 individuals with oromandibular dystonia (OMD) and dysarthria receiving therapeutic botulinum toxin (BoNT-A) injections. METHOD Participants with OMD and associated dysarthria self-rated CR-QoL pre- and post- BoNT-A injection using the American Speech-Language-Hearing Association's Quality of Communication Life Scale (ASHA QCL; Paul et al., 2004). Control participants self-rated CR-QoL during a single experimental visit. RESULTS Significant differences were found between control participants and participants with OMD on ratings of CR-QoL across all 5 domains and subdomains of the ASHA QCL. No significant differences in CR-QoL were found over the course of the BoNT-A treatment cycle. CONCLUSIONS CR-QoL was rated lower by participants with OMD as compared with control participants across all ASHA QCL domains/subdomains with "socialization/activities" and "confidence/self-concept" having the largest effect sizes. No differences in CR-QoL were found over the course of the treatment cycle. We advocate for outcome measures that include patient report. The use of patient-reported outcome measures in conjunction with objective or impairment-based outcome measures can help inform meaningful clinical indicators of treatment success. This study adds novel information that may aid our understanding of the experience of living with OMD in this underserviced clinical population.
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Affiliation(s)
- Allyson D Page
- School of Communication Sciences and Disorders, Western University, London, ON, CanadaHealth and Rehabilitation Sciences, Western University, London, ON, Canada
| | - Lauren Siegel
- Health and Rehabilitation Sciences, Western University, London, ON, Canada
| | - Mandar Jog
- Department of Clinical Neurological Sciences, Western University, London, ON, Canada
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Baizabal-Carvallo JF, Jankovic J. Examiner manoeuvres 'sensory tricks' in functional (psychogenic) movement disorders. J Neurol Neurosurg Psychiatry 2017; 88:453-455. [PMID: 27986829 DOI: 10.1136/jnnp-2016-315120] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 11/29/2016] [Accepted: 11/30/2016] [Indexed: 11/03/2022]
Affiliation(s)
- José Fidel Baizabal-Carvallo
- Department of Neurology, Parkinson's Disease Center and Movement Disorders Clinic, Baylor College of Medicine, Houston, Texas, USA
- University of Guanajuato, Mexico
| | - Joseph Jankovic
- Department of Neurology, Parkinson's Disease Center and Movement Disorders Clinic, Baylor College of Medicine, Houston, Texas, USA
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Sandhu H, Bernstein CJ, Davies G, Tang NKY, Belhag M, Tingle A, Field M, Foss J, Lindahl A, Underwood M, Ellard DR. Combined cognitive-behavioural and mindfulness programme for people living with dystonia: a proof-of-concept study. BMJ Open 2016; 6:e011495. [PMID: 27496234 PMCID: PMC4985914 DOI: 10.1136/bmjopen-2016-011495] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVES To design and test the delivery of an intervention targeting the non-motor symptoms of dystonia and pilot key health and well-being questionnaires in this population. DESIGN A proof-of-concept study to test the delivery, acceptability, relevance, structure and content for a 3-day group residential programme for the management of dystonia. SETTING Participants were recruited from a single botulinum toxin clinic. The intervention was delivered in the community. PARTICIPANTS 14 participants consented to take part (2 withdrew prior to the starting of intervention). The average age was 60 years (range 44-77), 8 of whom were female. After drop-out, 9 participants completed the 3-day programme. INTERVENTION A 3-day group residential programme. PRIMARY AND SECONDARY OUTCOME MEASURES Process evaluation and interviews were carried out before and after the intervention to explore participant's views and expectations, as well as experiences of the intervention. Select questionnaires were completed at baseline, 1-month and 3-month follow-up. RESULTS Although participants were not sure what to expect from the programme, they found it informative and for many this together with being in a group with other people with dystonia legitimised their condition. Mindfulness was accepted and adopted as a coping strategy. This was reflected in the 1-month follow-up. CONCLUSIONS We successfully delivered a 3-day residential programme to help those living with dystonia manage their condition. Further improvements are suggested. The quantitative outcome measures were acceptable to this group of patients with dystonia.
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Affiliation(s)
- H Sandhu
- Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - C J Bernstein
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - G Davies
- University of Southampton, Southampton, UK
| | - N K Y Tang
- Department of Psychology, University of Warwick, Coventry, UK
| | - M Belhag
- Department of Neurology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - A Tingle
- The Dystonia Society (West Midlands Group), West Midlands, UK
| | - M Field
- The Dystonia Society (West Midlands Group), West Midlands, UK
| | - J Foss
- Department of Computer Science, University of Warwick, Coventry, UK
| | - A Lindahl
- Department of Neurology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - M Underwood
- Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - D R Ellard
- Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
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Kernbach-Wighton G, Hess C, Madea B. Interrupted (self -)medication with pancuronium(bromide) and fatal outcome. Arch Kriminol 2016; 238:33-41. [PMID: 29894602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Pancuronium(bromide) is used because of its relaxing effect on striated muscles and usually requires artificial respiration. A 52-year-old woman suffered from long-standing "generalized dystonia", which had become resistant to conventional therapy. Therefore, an anesthetist established a permanent medication scheme with pancuronium using a PCA pump. This pump had been controlled by the patient herself ensuring an acceptable quality of life with broad personal autonomy. Finally, the woman was found dead in her flat by a member of a home nursing service. The infusion hose showed a fixed knot and further blocking by a clamp. The autopsy findings were non-specific, except for the presence of opioid tablets in the colon. Toxicological analyses showed 72ng/ml pancuronium and 21 ng/ml oxycodone (therapeutic) in the femoral venous blood. The range of published pancuronium levels varies from approx. 80 to 2,000 ng/ml. Thus it had to be assumed that the pancuronium level was too low (72 ng/ml) so that symptoms of dystonia recurred. Based on extensive literature research, the described case can be qualified as unique. The therapy concept had been innovative, sufficient and effective for more than 10 years. It allowed the patient to enjoy a maximum of autonomy. Ultimately, death was due to the blocked pancuronium infusion. The relatively low pancuronium level had provoked the dystonia to return with generalized spasms also involving the respiratory muscles resulting in respiratory arrest. During the police investigations, two previous suicide attempts came to light.
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Abstract
An emerging body of literature in sociology has demonstrated that diagnosis is a useful focal point for understanding the social dimensions of health and illness. This article contributes to this work by drawing attention to the relationship between diagnostic spaces and the way in which clinicians use their own bodies during the diagnostic process. As a case study, we draw upon fieldwork conducted with a multidisciplinary clinical team providing deep brain stimulation (DBS) to treat children with a movement disorder called dystonia. Interviews were conducted with team members and diagnostic examinations were observed. We illustrate that clinicians use communicative body work and verbal communication to transform a material terrain into diagnostic space, and we illustrate how this diagnostic space configures forms of embodied 'sensing-and-acting' within. We argue that a 'diagnosis' can be conceptualised as emerging from an interaction in which space, the clinician-body, and the patient-body (or body-part) mutually configure one another. By conceptualising diagnosis in this way, this article draws attention to the corporal bases of diagnostic power and counters Cartesian-like accounts of clinical work in which the patient-body is objectified by a disembodied medical discourse.
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Affiliation(s)
- John Gardner
- Science and Technology Studies Unit (SATSU)Department of SociologyUniversity of YorkUK
| | - Clare Williams
- Department of Sociology and CommunicationsBrunel UniversityLondonUK
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Abstract
Selecting the appropriate treatment for dystonia begins with proper classification of disease based on age, distribution, and underlying etiology. The therapies available for dystonia include oral medications, botulinum toxin, and surgical procedures. Oral medications are generally reserved for generalized and segmental dystonia. Botulinum toxin revolutionized the treatment of focal dystonia when it was introduced for therapeutic purposes in the 1980s. Surgical procedures are available for medication-refractory dystonia, markedly affecting an individual's quality of life.
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Affiliation(s)
- Mary Ann Thenganatt
- Parkinson’s Disease Center & Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, 6550 Fannin, Suite 1801, Houston, TX 77030 USA
| | - Joseph Jankovic
- Parkinson’s Disease Center & Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, 6550 Fannin, Suite 1801, Houston, TX 77030 USA
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Kuyper DJ, Parra V, Aerts S, Okun MS, Kluger BM. Nonmotor manifestations of dystonia: a systematic review. Mov Disord 2011; 26:1206-17. [PMID: 21484874 PMCID: PMC3652664 DOI: 10.1002/mds.23709] [Citation(s) in RCA: 126] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2010] [Revised: 02/07/2011] [Accepted: 02/15/2011] [Indexed: 11/09/2022] Open
Abstract
Nonmotor symptoms are increasingly recognized as important determinants of quality of life and disability in a wide range of movement disorders. There is a limited body of research suggesting that many of these symptoms are also commonly associated with primary and other genetic forms of dystonia. However, the significance, etiology, pathophysiology, and treatment of these symptoms remain poorly described. The following is a review of the literature that focuses primarily on the association of these types of dystonia with psychiatric disorders, cognition, sleep, pain, and autonomic symptoms. We will also discuss potential mechanisms and approaches to treatment for nonmotor features of dystonia.
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Affiliation(s)
- Daniel J. Kuyper
- Department of Neurology, University of Colorado, Denver, Colorado
| | - Veronica Parra
- Departments of Neurology and Psychiatry, University of Colorado, Denver, Colorado
| | - Shanae Aerts
- Departments of Neurology and Psychiatry, University of Colorado, Denver, Colorado
| | - Michael S. Okun
- Departments of Neurology, Neurosurgery, Psychiatry and History, University of Florida, Gainesville, Florida
| | - Benzi M. Kluger
- Departments of Neurology and Psychiatry, University of Colorado, Denver, Colorado
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Affiliation(s)
- Karen Low
- c/o Bristol Royal Hospital for Children, Upper Maudlin Street, Bristol BS2 8BJ
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Kusmierska K, Jansen EEW, Jakobs C, Szymanska K, Malunowicz E, Meilei D, Thony B, Blau N, Tryfon J, Rokicki D, Pronicka E, Sykut-Cegielska J. Sepiapterin reductase deficiency in a 2-year-old girl with incomplete response to treatment during short-term follow-up. J Inherit Metab Dis 2009; 32 Suppl 1:S5-10. [PMID: 19130291 DOI: 10.1007/s10545-008-1009-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2008] [Revised: 10/11/2008] [Accepted: 10/15/2008] [Indexed: 11/25/2022]
Abstract
Sepiapterin reductase (SR) catalyses the last step in the tetrahydrobiopterin biosynthesis pathway; it converts 6-pyruvoyl-tetrahydropterin (6-PTP) to BH(4) in an NADPH-dependent reaction. SR deficiency is a very rare autosomal recessive disorder with normal phenylalanine (Phe) concentration in blood and diagnostic abnormalities are detected in CSF. We present a 16-month-old girl with SR deficiency. From the newborn period she presented with an adaptation regulatory disorder. At the age of 3 months, abnormal eye movements with dystonic signs and at 4.5 months psychomotor retardation were noticed. Since that time axial hypotonia with limb spasticity (or rather delayed reflex development), gastro-oesophageal reflux and fatigue at the end of the day has been observed. Brain MRI was normal; EEG was without epileptiform discharges. Analysis of biogenic amine metabolites in CSF at the age of 16 months showed very low HVA and 5-HIAA concentrations. Analysis of CSF pterins revealed strongly elevated dihydrobiopterin (BH(2)), slightly elevated neopterin and elevated sepiapterin levels. Plasma and CSF amino acids concentrations were normal. A phenylalanine loading test showed increased Phe after 1 h, 2 h and 4 h and very high Phe/Tyr ratios. SR deficiency was confirmed in fibroblasts and a novel homozygous g.1330C>G (p.N127K) SPR mutation was identified. On L-dopa and then additionally 5-hydroxytryptophan, the girl showed slow but remarkable progress in motor and intellectual ability. Now, at the age of 3 years, she is able to sit; expressive speech is delayed (to 1 1/2 years), passive speech is well developed. Her visual-motor skills, eye-hand coordination and social development correspond to the age of 2 1/2 years.
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Affiliation(s)
- K Kusmierska
- Department of Biochemistry and Experimental Medicine, The Children's Memorial Health Institute, Al. Dzieci Polskich 20, 04-830, Warsaw, Poland.
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16
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Abstract
Voluntary stopping of eating and drinking (VSED) as a legal means to hasten death has been discussed by some as an option for persons who wish to end their lives. A case is presented of a woman who elected to forgo eating and drinking to end intractable suffering. The potential for benefit and harm in physicians discussing VSED is discussed. Physicians working with terminally ill patients need to consider the discussion of VSED as a therapeutic tool in their support and care of patients with intractable suffering.
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Affiliation(s)
- Zail S Berry
- Department of Medicine, University of Vermont College of Medicine, Burlington, Vermont 05451-8671, USA.
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Affiliation(s)
- Michele Tinazzi
- Department of Neurological and Vision Sciences, University of Verona, Verona, Italy
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18
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Silveira-Moriyama L, Schwingenschuh P, O'Donnell A, Schneider SA, Mir P, Carrillo F, Terranova C, Petrie A, Grosset DG, Quinn NP, Bhatia KP, Lees AJ. Olfaction in patients with suspected parkinsonism and scans without evidence of dopaminergic deficit (SWEDDs). J Neurol Neurosurg Psychiatry 2009; 80:744-8. [PMID: 19276101 DOI: 10.1136/jnnp.2009.172825] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Positron emission tomography and single photon emission computed tomography scanning have 87-94% sensitivity and 80-100% specificity to differentiate patients with Parkinson's disease (PD) from control subjects and patients with essential (ET) or atypical tremor. More than 10% of patients diagnosed as early PD can have scans without evidence of dopaminergic deficiency (SWEDDs). This study investigated whether smell tests can help identify possible cases with SWEDDs. METHODS The 40 item University of Pennsylvania Smell Test (UPSIT) was used to evaluate the sense of smell in 21 SWEDDs patients. Twenty-six ET patients, 16 patients with a diagnosis of idiopathic adult onset dystonia (D), 191 non-demented PD patients and 136 control subjects were also tested. Multiple regression analyses were used to compare the mean UPSIT score in the SWEDDs group with the other four groups (ET, D, PD and controls) after adjusting for the effects of relevant covariates. RESULTS The mean UPSIT score for the SWEDDs group was greater than in the PD group (p<0.001) and not different from the mean UPSIT in the control (p = 0.7), ET (p = 0.4) or D (p = 0.9) groups. Smell tests indicated a high probability of PD in only 23.8% of SWEDDs as opposed to 85.3% of PD patients. CONCLUSIONS In a patient with suspected PD, a high PD probability on smell testing favours the diagnosis of PD, and a low PD probability strengthens the indication for dopamine transporter imaging.
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Affiliation(s)
- L Silveira-Moriyama
- Reta Lila Weston Institute of Neurological Studies, UCL Institute of Neurology, London WC1N 1PJ, UK
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Abstract
OBJECTIVES Dystonia is often disabling and disfiguring. The aim of the study was to identify factors influencing the impact of dystonia on self-reported quality of life and health. MATERIAL AND METHODS Members of the Swedish Dystonia Patient Association participated in a survey covering demographic variables, satisfaction with treatment, physiotherapy and physical activity. Quality of life and health were assessed by the Craniocervical Dystonia Questionnaire and the Cervical Dystonia Impact Profile, respectively. Of 378 questionnaires, 76% were analysed. Multiple linear regression analyses were performed to evaluate associations of the above variables with quality of life and health. RESULTS Level of physical activity and satisfaction with treatment showed the highest association with quality of life and health. No significant relationship was found between form of dystonia and quality of life. CONCLUSIONS The study indicates a need for health care professionals to encourage physical activity and to question dystonia patients about satisfaction with treatment. Further investigations with prospective controlled trials are necessary to evaluate the value of physiotherapy and physical activity in patients with dystonia.
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Affiliation(s)
- L Zetterberg
- Department of Neuroscience, Section of Physiotherapy, Uppsala University, University Hospital, Uppsala, Sweden.
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20
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Serdans B. DBS: uncharted territory--a nurse's perspective. J Neurosci Nurs 2009; 41:53-56. [PMID: 19368071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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21
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Abstract
BACKGROUND Primary cranial dystonia (PCD) is related to a functional disorder in basal ganglia usually accompanied by impaired executive function. AIM To investigate symptom relief and neurocognitive change in response to treatment with botulinum toxin (BTX) in a group of patients with PCD. METHODS We assessed nine patients with PCD and nine age- and educationally matched healthy individuals using tests of memory, sustained attention, span of auditory attention, and perceptual flexibility. RESULTS Despite well-preserved intellectual skills relative to controls, we identified a sustained attention deficit in patients with PCD. After BTX treatment, there was an increase in the scores of the concentration endurance test (sustained attention) and the values did not differ significantly from control group patients' scores. CONCLUSION The results support the view that executive dysfunction in PCD is secondary to the disrupting effects of the symptoms. Treatment with BTX alleviates the symptoms and, consequently, improves sustained attention.
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Affiliation(s)
- N Allam
- Movement Disorders Unit, Hospital de Base do Distrito Federal, Brasília, DF, Brazil
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22
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Abstract
Dystonia refers to a syndrome of sustained muscle contractions, frequently causing twisting and repetitive movements, or abnormal postures. Although the pathophysiology of the abnormal posture is still unknown and a wide variety of abnormal postures can be observed, recent psychophysical studies have revealed abnormalities in the way patients with focal and generalized dystonia judge the position of their bodies in space [Bove M, Brichetto G, Abbruzzese G, Marchese R, Schieppati M. Neck proprioception and spatial orientation in cervical dystonia. Brain 2004;127(Pt 12):2764-78; Molloy FM, Carr TD, Zeuner KE, Dambrosia JM, Hallett M. Abnormalities of spatial discrimination in focal and generalized dystonia. Brain 2003;126(Pt 10):2175-82; Anastasopoulos D, Nasios G, Psilas K, Mergner T, Maurer C, Lucking CH. What is straight ahead to a patient with torticollis? Brain 1998;121(Pt 1):91-101]. Most intriguingly, patients do not always recognize "straight ahead" in the way normal individuals do [Anastasopoulos D, Nasios G, Psilas K, Mergner T, Maurer C, Lucking CH. What is straight ahead to a patient with torticollis? Brain 1998;121(Pt 1):91-101]. We describe a patient with childhood-onset dystonia who consistently drew images of his unaffected family members with 'dystonic' postures without being aware that this posture is abnormal.
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Affiliation(s)
- Roongroj Bhidayasiri
- Chulalongkorn Comprehensive Movement Disorders Centre, Chulalongkorn University Hospital, Bangkok 10330, Thailand.
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23
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Abstract
Health Related Quality of Life (HRQL) was assessed by the SF-36 in a group of patients with dystonia in New Zealand and Australia. The caregivers of these people were also asked to participate. Low scores from the SF-36 indicate a disability or limitation in HRQL. Compared with the national norms of the respective countries, the participants with dystonia for both countries were significantly lower in the eight dimensions of the SF-36, suggesting that patients with dystonia have lower HRQL compared with their respective national norms without dystonia. In contrast to the patients with dystonia, caregivers did not show lower HRQL scores than their national norms, suggesting that while dystonia affects the HRQL of those with the disorder, their caregivers may be less affected. Descriptive and demographic information were also gathered and are discussed. An important factor that may affect the HRQL of patients with dystonia is the length of time required to be diagnosed in this sample and the number of medical practitioners the patients consulted prior to a confirmed diagnosis.
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Affiliation(s)
- Vanessa K Lim
- Department of Psychology, The University of Auckland, Auckland, New Zealand.
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Vidailhet M, Vercueil L, Houeto JL, Krystkowiak P, Lagrange C, Yelnik J, Bardinet E, Benabid AL, Navarro S, Dormont D, Grand S, Blond S, Ardouin C, Pillon B, Dujardin K, Hahn-Barma V, Agid Y, Destée A, Pollak P. Bilateral, pallidal, deep-brain stimulation in primary generalised dystonia: a prospective 3 year follow-up study. Lancet Neurol 2007; 6:223-9. [PMID: 17303528 DOI: 10.1016/s1474-4422(07)70035-2] [Citation(s) in RCA: 262] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND We have previously reported the efficacy and safety of bilateral pallidal stimulation for primary generalised dystonia in a prospective, controlled, multicentre study with 1 year of follow-up. Although long-term results have been reported by other groups, no controlled assessment of motor and non-motor results is available. In this prospective multicentre 3 year follow-up study, involving the same patients as those enrolled in the 1 year follow-up study, we assessed the effect of bilateral pallidal stimulation on motor impairment, disability, quality of life, cognitive performance, and mood. METHODS We studied 22 patients with primary generalised dystonia after 3 years of bilateral pallidal stimulation. We compared outcome at 3 years with their status preoperatively and after 1 year of treatment. Standardised video recordings were scored by an independent expert. Data were analysed on an intention-to-treat basis. FINDINGS Motor improvement observed at 1 year (51%) was maintained at 3 years (58%). The improvement in quality of life (SF-36 questionnaire) was similar to that observed at 1 year. Relative to baseline and to the 1 year assessment, cognition and mood were unchanged 3 years after surgery, but slight improvements were noted in concept formation, reasoning, and executive functions. Pallidal stimulation was stopped bilaterally in three patients because of lack of improvement, technical dysfunction, and infection, and unilaterally in two patients because of electrode breakage and stimulation-induced contracture. No permanent adverse effects were observed. INTERPRETATION Bilateral pallidal stimulation provides sustained motor benefit after 3 years. Mild long-term improvements in quality of life and attention were also observed.
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Affiliation(s)
- Marie Vidailhet
- INSERM U679, Neurology and Experimental Therapeutics, Groupe Hospitalier Pitié-Salpêtrière, Paris, France.
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26
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Miller KM, Okun MS, Fernandez HF, Jacobson CE, Rodriguez RL, Bowers D. Depression symptoms in movement disorders: Comparing Parkinson's disease, dystonia, and essential tremor. Mov Disord 2007; 22:666-72. [PMID: 17266084 DOI: 10.1002/mds.21376] [Citation(s) in RCA: 94] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Depression is common in Parkinson's disease (PD) and affects 30 to 50% of all patients. In contrast to the wealth of research on depression in PD, little is known about the occurrence of depression in other movement disorders. The primary objective of the current study was to determine whether the high prevalence of depression symptoms seen in PD is also found in other movement disorders, by directly comparing rates of specific depression symptoms and depression severity across PD, dystonia, and essential tremor (ET). Three hundred and fifty-four patients with PD, 83 patients with dystonia, and 53 patients with ET completed the Beck Depression Inventory (BDI). We found no significant between-groups differences for depression severity, frequency, or endorsement of specific depression symptoms. Forty-eight percent of PD patients, 37.3% of dystonia patients, and 34% of ET patients were found to be at least mildly depressed (BDI score of 10 or higher). The most commonly endorsed symptoms were fatigability, difficulty with work, anhedonia, and sleep disturbance. Clinicians should be aware that depression is a frequent problem in dystonia and ET, in addition to PD, and inquire about depression symptoms in these patients so that they can be appropriately treated.
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Affiliation(s)
- Kimberly M Miller
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, FL 32608, USA.
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27
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Abstract
The objective of this study was to assess quality of life (QoL) in a community-based sample of people with various forms of dystonia and to identify the factors that predict QoL in dystonia. QoL was assessed using two generic questionnaires: the Medical Outcomes Study Short-Form 36 (SF36) and the EuroQol questionnaire. A host of demographic, clinical, and psychosocial variables were measured to identify the best predictors of QoL in dystonia. A comparison of EuroQol and SF36 scores with the norms for the general UK population of similar age showed that people with dystonia had scores indicative of worse QoL on all domains, particularly those related to physical and social functioning. The impairment of QoL was seen in all age groups and was similar for men and women. Compared to the focal dystonia group, participants with generalized dystonia scored significantly worse on all QoL measures. Participants who were unemployed also scored significantly worse. There was also a trend for younger and separated/divorced participants to score worse on QoL measures. A stepwise regression analysis revealed that functional disability, body concept, and depression were important predictors of QoL in dystonia. Dystonia influences various aspects of QoL, particularly those related to physical and social functioning. The impairment of QoL was greater for participants with generalized dystonia, those who were unemployed, younger, and separated/divorced. Functional disability, body concept, and depression were the best predictors of QoL in dystonia. Efforts to improve health care for people with dystonia should not only focus on management of the movement disorder but also consider modifying functional disability and negative body concept and depression that contribute to poor QoL in this disorder.
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Affiliation(s)
- Donna Page
- Cognitive-Motor Neuroscience Group, Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, University College London, The National Hospital for Neurology & Neurosurgery, London, United Kingdom
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28
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Bugalho P, Correa B, Guimarães J, Xavier M. Obsessive-compulsive disorder and executive deficits in two patients with primary dystonia. Parkinsonism Relat Disord 2006; 12:388-91. [PMID: 16731024 DOI: 10.1016/j.parkreldis.2005.12.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2005] [Accepted: 12/23/2005] [Indexed: 11/15/2022]
Abstract
In spite of the high prevalence of behavioral and cognitive disturbances found in most basal ganglia disorders and attributed to fronto-striatal dysfunction, the existence of psychiatric and cognitive symptoms in patients with primary dystonia remains controversial. We present a 42-year-old female with primary writer's cramp and obsessive-compulsive disorder (OCD) and a 59-year-old male with Meigs syndrome, idiopathic torticollis and OCD. Both patients had mild executive dysfunction. The coexistence of psychiatric, cognitive and motor symptoms of different intensity may be explained by variable dysfunction on different frontal-striatal loops, as proposed by the open interconnected model of fronto-striatal circuits.
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Affiliation(s)
- Paulo Bugalho
- Department of Neurology, Hospital Egas Moniz, Rua da Junqueira 126, 1349-019 Lisboa, Portugal.
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29
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Dahlgren Sandberg A. Reading and spelling abilities in children with severe speech impairments and cerebral palsy at 6, 9, and 12 years of age in relation to cognitive development: a longitudinal study. Dev Med Child Neurol 2006; 48:629-34. [PMID: 16836773 DOI: 10.1017/s0012162206001344] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/17/2005] [Indexed: 11/05/2022]
Abstract
Development of literacy skills was studied in six children (one male, five females) with severe speech impairments and cerebral palsy (CP). These skills were related to intellectual development, phonological abilities, and short-term memory. Three of the children were diagnosed with dystonia, and three with diplegia. They had no, or severely restricted, independent mobility (Gross Motor Function Classification System Level IV for four children and Level V for two), and severe fine motor problems, including difficulty with pointing. As they had no intelligible speech, the Bliss system was the primary communication mode. Assessments were made at approximately 6, 9, and 12 years of age. The results revealed that the children had difficulties acquiring literacy skills, although intellectual level and phonological ability predicted otherwise. Positive development during the first 3 years was followed by an arrest. A conspicuous decrease in IQ points was also found. Thus, phonological ability does not seem to have the same predictive power for literacy development in children with severe speech impairments and CP as in typically developing children. Further studies are needed to clarify the role of phonological abilities, working memory, and strategies used in literacy acquisition in these children. Such studies might also clarify the importance of articulatory abilities in early literacy acquisition.
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Abstract
Dystonia have many subtypes, and is classified as focal, segmental and generalized. As for focal dystonia, spasmodic torticollis (cervical dystonia) and writer's cramp are most common. Cervical dystonia is mainly treated effectively with selective peripheral denervation, and task specific focal dystonia of the hand (writer's cramp) is effectively alleviated by stereotactic ventro-oral thalamotomy. Generalized dystonia is dramatically improved with deep brain stimulation of the globus pallidus interna. Because the majority of dystonia is medically refractory and surgical treatment results in marked improvement, the authors strongly believe that dystonia should be regarded as a definite neurosurgical indication. Based on personal experience of nearly 200 cases of dystonia surgery, the authors describe a multimodal approach to various types of dystonias. Also we discuss possible relation between dystonias and psychiatric conditions, and future new indication of dystonia surgery.
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Affiliation(s)
- T Taira
- Department of Neurosurgery, Neurological Institute, Tokyo Women's Medical University, Tokyo, Japan.
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Affiliation(s)
- Beka Serdans
- Critical Care Division of New York-Presbyterian Hospital, New York, NY, USA.
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33
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Abstract
Deep brain stimulation (DBS) is a viable treatment alternative for patients with Parkinson's disease (PD), essential tremor (ET), dystonia, and cerebellar outflow tremors. When poorly controlled, these disorders have detrimental effects on the patient's health related quality of life (HRQoL). Instruments that measure HRQoL are useful tools to assess burden of disease and the impact of therapeutic interventions on activities of daily living, employment, and other functions. We systematically and critically reviewed the literature on the effects of DBS on HRQoL in PD, ET, dystonia, and cerebellar outflow tremor related to multiple sclerosis.
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Affiliation(s)
- A Diamond
- Department of Neurology, Parkinson's Disease Center and Movement Disorders Clinic, Baylor College of Medicine, 6550 Fannin Street, Suite 1801, Houston, TX 77030, USA
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Jahanshahi M. Behavioral and psychiatric manifestations in dystonia. Adv Neurol 2005; 96:291-319. [PMID: 16383228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Affiliation(s)
- Marjan Jahanshahi
- Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, London, United Kingdom
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36
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Seet RCS, Lim ECH. Symptomatic segmental dystonia from a cavernous angioma in the centrum semiovale. Parkinsonism Relat Disord 2005; 11:65-7. [PMID: 15619465 DOI: 10.1016/j.parkreldis.2004.08.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2004] [Revised: 08/10/2004] [Accepted: 08/10/2004] [Indexed: 10/26/2022]
Abstract
We describe a 68 year-old Chinese man who presented with segmental dystonia involving the neck and right upper limb, which was exacerbated with action. EEG and MRI of the cervical spine were unremarkable, but MRI of the brain revealed a small cavernous angioma measuring one centimeter in diameter in the left centrum semiovale. The dystonia was ameliorated but not abolished with trihexyphenidyl. Arteriovenous malformations have been described to cause movement disorders, but dystonia has not previously been reported in association with cavernous angiomas. A search of the literature revealed one report of a patient with chorea arising from a cavernous angioma. This interesting case illustrates how an uncomplicated cavernous angioma can rarely cause segmental dystonia and highlights the importance of neuroimaging in patients with late-onset movement disorders.
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Affiliation(s)
- Raymond C S Seet
- Division of Neurology, National University Hospital, 5 Lower Kent Ridge Road, Singapore, Singapore 119074
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Gorno-Tempini ML, Murray RC, Rankin KP, Weiner MW, Miller BL. Clinical, cognitive and anatomical evolution from nonfluent progressive aphasia to corticobasal syndrome: a case report. Neurocase 2004; 10:426-36. [PMID: 15788282 PMCID: PMC2365737 DOI: 10.1080/13554790490894011] [Citation(s) in RCA: 91] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Recent clinical and pathological studies have suggested that frontotemporal lobar degeneration (FTLD) and corticobasal syndrome (CBS) show clinical and pathological overlap. We present four years of longitudinal clinical, cognitive and anatomical data in the case of a 56-year-old woman, AS, whose clinical picture evolved from FTLD to CBS. For the first three years, AS showed a progressive speech and language disorder compatible with a diagnosis of the nonfluent aphasia variant of FTLD. At year four, 10 years after her first symptom, AS developed the classical clinical signs of CBS, including alien limb phenomenon and dystonia. Voxel-based morphometry (VBM) applied to AS's four annual scans showed progression of atrophy from the inferior posterior frontal gyrus, to the left insula and finally to the medial frontal lobe. This case demonstrates the clinical overlap between FTLD and CBS and shows that the two can appear in the same patient at different stages of the disease in relation to the progression of anatomical damage.
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Abstract
We describe the clinical features of 103 patients presenting with fixed dystonia and report the prospective assessment and investigation of 41 of them. Most patients were female (84%) and had a young age of onset [mean 29.7 (SD 13.1) years]. A peripheral injury preceded onset in 63% and spread of dystonia to other body regions occurred in 56%. After an average follow-up of 3.3 years (overall disease duration 8.6 years), partial (19%) or complete (8%) remission had occurred in a minority of patients. The fixed postures affected predominantly the limbs (90%), and rarely the neck/shoulder region (6%) or jaw (4%). In the prospectively studied group, pain was present in most patients and was a major complaint in 41%. Twenty percent of patients fulfilled criteria for Complex Regional Pain Syndrome (CRPS). No consistent investigational abnormalities were found and no patient tested (n = 25) had a mutation in the DYT1 gene. Thirty-seven percent of patients fulfilled classification criteria for documented or clinically established psychogenic dystonia; 29% fulfilled DSM-IV (Diagnostic and statistical manual of mental disorders, 4th edition) criteria for somatization disorder, which was diagnosed only after examination of the primary care records in many cases; and 24% fulfilled both sets of criteria. Ten percent of the prospectively studied and 45% of the retrospectively studied patients did not have any evidence of psychogenic dystonia, and detailed investigation failed to reveal an alternative explanation for their clinical presentation. Detailed, semi-structured neuropsychiatric assessments in a subgroup of 26 patients with fixed dystonia and in a control group of 20 patients with classical dystonia revealed dissociative (42 versus 0%, P = 0.001) and affective disorders (85 versus 50%, P = 0.01) significantly more commonly in the fixed dystonia group. Medical and surgical treatment was largely unsuccessful. However, seven patients who underwent multidisciplinary treatment, including physiotherapy and psychotherapy, experienced partial or complete remission. We conclude that fixed dystonia usually, but not always, occurs after a peripheral injury and overlaps with CRPS. Investigations are typically normal, but many patients fulfil strict criteria for a somatoform disorder/psychogenic dystonia. In a proportion of patients, however, no conclusive features of somatoform disorder or psychogenic disorder can be found and, in these patients, whether this disorder is primarily neurological or psychiatric remains an open question. Whilst the prognosis is overall poor, remissions do occur, particularly in those patients who are willing and able to undergo multidisciplinary treatment including physiotherapy and psychotherapy, suggesting that this type of treatment should be recommended to these patients.
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Affiliation(s)
- Anette Schrag
- University Department of Clinical Neurosciences, Royal Free and University College Medical School, London NW3 2PF, UK.
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Müller J, Wissel J, Kemmler G, Voller B, Bodner T, Schneider A, Wenning GK, Poewe W. Craniocervical dystonia questionnaire (CDQ-24): development and validation of a disease-specific quality of life instrument. J Neurol Neurosurg Psychiatry 2004; 75:749-53. [PMID: 15090572 PMCID: PMC1763554 DOI: 10.1136/jnnp.2003.013441] [Citation(s) in RCA: 94] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To develop and test a questionnaire for measuring quality of life in patients with craniocervical dystonia. METHODS A 29-item pool was developed based on semi-structured interviews of patients with cervical dystonia (CD) and blepharospasm (BSP). This preliminary questionnaire was administered to 203 consecutive patients with CD and BSP from Austrian dystonia and botulinum toxin outpatient clinics. For scale generation, a combination of exploratory factor and cluster analysis was applied. This resulted in the 24-item version of the instrument (CDQ-24) based on five subscales: Stigma, Emotional wellbeing, Pain, Activities of daily living, and Social/family life. The validity and reliability of the CDQ-24 was assessed in 231 consecutive patients with CD and BSP different from those examined with the preliminary questionnaire. This second survey included the CDQ-24, a generic QoL instrument (SF-36) and clinical rating scales. Sensitivity to change was analysed in 51 previously untreated (de novo) patients four weeks and one year following the first botulinum toxin treatment. RESULTS Internal consistency reliability was satisfactory for all subscales, with values of Cronbach's alpha ranging from 0.77 to 0.89. The CDQ-24 subscales showed moderate to high correlations with those SF-36 subscales measuring similar aspects (Pearson's correlation r = 0.50-0.73; p<0.001, each). Sensitivity to change was confirmed by highly significant improvements of all CDQ-24 subscores in the de novo patients from baseline to four week follow up. One year follow up data revealed a stable improvement. CONCLUSION The CDQ-24 is the first fully validated and disease specific questionnaire to evaluate quality of life of patients with cervical dystonia and blepharospasm and we propose its use in clinical trials as well as in daily clinical practice.
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Affiliation(s)
- J Müller
- University Hospital of Neurology, Innsbruck, Austria. University Hospital of Psychiatry, Innsbruck, Austria
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Junker J, Oberwittler C, Jackson D, Berger K. Utilization and perceived effectiveness of complementary and alternative medicine in patients with dystonia. Mov Disord 2004; 19:158-61. [PMID: 14978670 DOI: 10.1002/mds.10684] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The use of complementary and alternative medicine (CAM) is increasing worldwide, especially by patients with chronic diseases. To date, no data are available about utilization and perceived effectiveness of CAM in patients with dystonia. A questionnaire survey on utilization and costs of CAM was completed by 180 members of the German Dystonia Society, a patient advocate group. In total, 131 dystonia patients (73%) were current or former users of CAM, 55 patients used CAM in addition to botulinum toxin A injections, and 86 patients had experience with three or more CAM methods. The options used most widely were acupuncture (56%), relaxation techniques (44%), homeopathy (27%), and massages (26%). Among users of specific CAM methods, breathing therapy, Feldenkrais, massages, and relaxation techniques were perceived as most effective. On average, patients spent 1,513 Euro on CAM without reimbursement. There was no correlation between costs and perceived effectiveness of different methods. In line with other studies on chronically ill patients, our results show that dystonia patients frequently utilize CAM methods, often in addition to conventional treatment. There is a growing need to evaluate scientifically the effect of CAM methods on symptom severity and quality of life in dystonia, to prevent utilization of costly and ineffective CAM treatments.
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Affiliation(s)
- Judith Junker
- Department of Neurology, University of Muenster, Muenster, Germany
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Abstract
Sensory processing is impaired in focal hand dystonia (FHD), with most previous studies having evaluated only the symptomatic limb. The purpose of this study was to establish whether the sensory system is affected in other types of dystonias and whether the contralateral hand is also involved in FHD. We used a spatial acuity measure (Johnson-Van Boven-Phillips domes) to evaluate sensory spatial discrimination in both hands of patients with different forms of dystonias including primary generalized DYT1 dystonia (associated with a unique deletion in the DYT1 gene) (n = 13), FHD (n = 15), benign essential blepharospasm (n = 9), cervical dystonia (n = 10) and in age-matched controls. Clinical evaluation included the Fahn dystonia scale for the focal dystonia groups and the Marsden-Burke-Fahn scale for the generalized dystonia group. Spatial discrimination was normal in patients with DYT1 dystonia, despite all of these patients having hand dystonia. However, spatial discrimination thresholds were significantly increased in both hands in the focal dystonia groups (thresholds were similar for each group) and did not correlate significantly with either severity or duration of dystonic symptoms. Thresholds were significantly increased in the dominant hand compared with the non-dominant hand only within the FHD group. Our observations demonstrate involvement of both the dominant and non-dominant somatosensory cortices, and suggest that abnormal sensory processing is a fundamental disturbance in patients with focal dystonia. These findings of altered sensory processing in idiopathic focal but not generalized DYT1 dystonia suggest both a primary pathophysiological role for the phenomenon in focal dystonia and divergent pathophysiological processes in the two conditions.
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Affiliation(s)
- F M Molloy
- Human Motor Control Section, Medical Neurology Branch, National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD 20892-1428, USA
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Pringsheim T, Lang AE. Psychogenic dystonia. Rev Neurol (Paris) 2003; 159:885-91. [PMID: 14615677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
Psychogenic dystonia has been a controversial diagnosis over the past century. While this entity does exist, it makes up the minority of cases of dystonia seen at specialized centres. The diagnosis of psychogenic dystonia must only be undertaken by a neurologist with considerable experience in the assessment and treatment of organic dystonia. Features in the history and physical examination will reveal both clinical inconsistencies and incongruities with organic dystonia that support a psychogenic cause for the patient's symptoms. Patients with psychogenic dystonia suffer from motor conversion disorder, and co-morbid depression, anxiety and disorders of personality are frequent. While there have been no neuroimaging studies to date in patients with psychogenic dystonia, imaging studies in patients with organic dystonia offer insights on how one might assess this problem using functional neuroimaging. Neurophysiologic studies in patients with organic forms of dystonia may also be employed to further distinguish psychogenic from organic dystonia when doubt exists. The prognosis of psychogenic dystonia is disappointing, with the majority of patients suffering significant long-term disability. Recommendations are given regarding disclosure of the diagnosis of psychogenic dystonia to the patient as well as appropriate treatment.
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Affiliation(s)
- T Pringsheim
- University of Toronto, Department of Medicine, Division of Neurology, Toronto, Canada
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Gündel H, Greiner A, Ceballos-Baumann AO, Von Rad M, Förstl H, Jahn T. [Increased level of tonic sympathetic arousal in high-vs. low-alexithymic cervical dystonia patients]. Psychother Psychosom Med Psychol 2002; 52:461-8. [PMID: 12420249 DOI: 10.1055/s-2002-35277] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The purpose of this study was to assess whether alexithymia is a risk factor for autonomic dysregulation in cervical dystonia (spasmodic torticollis, ST). Alexithymia was assessed by an authorized German version of the TAS-20. In a first step, we recruited 10 ST-patients with high alexithymia scores (> 62; M = 69.2, SD = 3.0) and compared them with 10 ST-patients with low alexithymia scores (< 35; M = 28.7, SD = 4.3) on physiological and subjective responses to a cognitive and an emotional laboratory stressor. High-alexithymic ST-patients generally showed increased levels of autonomic arousal (higher SCL, more NS.SCF and lower T; 0.016 </= p </= 0.065) under all experimental conditions. In a second step, we used a less extreme alexithymia-definition (high >/= 57 vs. low </= 36) in a sample of 2 x 20 probands and found no significant differences. Our results suggest a chronically increased level of sympathetic activation in high-alexithymic patients with spasmodic torticollis.
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Affiliation(s)
- Harald Gündel
- Institut und Poliklinik für Psychosomatische Medizin, Psychotherapie und Medizinische Psychologie, Klinikum rechts der Isar, TU München, Germany.
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Doheny DO, Brin MF, Morrison CE, Smith CJ, Walker RH, Abbasi S, Müller B, Garrels J, Liu L, De Carvalho Aguiar P, Schilling K, Kramer P, De Leon D, Raymond D, Saunders-Pullman R, Klein C, Bressman SB, Schmand B, Tijssen MAJ, Ozelius LJ, Silverman JM. Phenotypic features of myoclonus-dystonia in three kindreds. Neurology 2002; 59:1187-96. [PMID: 12391346 DOI: 10.1212/wnl.59.8.1187] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Myoclonus-dystonia (M-D) is a movement disorder with involuntary jerks and dystonic contractions. Autosomal dominant alcohol-responsive M-D is associated with mutations in the epsilon-sarcoglycan gene (SGCE) (six families) and with a missense change in the D2 dopamine receptor (DRD2)gene (one family). OBJECTIVE To investigate the clinical phenotype associated with M-D including motor symptoms, psychiatric disorders, and neuropsychological deficits. METHODS Fifty individuals in three M-D families were evaluated and a standardized neurologic examination and DNA analysis were performed. Psychiatric profiles were established with the Diagnostic Interviews for Genetic Studies (DIGS) and the Yale-Brown Obsessive-Compulsive Scale (YBOCS). Cognition was evaluated with standardized neuropsychological tests. RESULTS Distinct truncating mutations in the SGCE gene were identified in each family. Additionally, a missense alteration in the DRD2 gene was previously found in one family. Motor expression was variable, with onset of myoclonus or dystonia or both affecting the upper body and progression to myoclonus and dystonia in most cases. Psychiatric profiles revealed depression, obsessive-compulsive disorder, substance abuse, anxiety/panic/phobic disorders, and psychosis in two families, and depression only in the third family. Averaged scores from cognitive testing showed impaired verbal learning and memory in one family, impaired memory in the second family, and no cognitive deficits in the third family. CONCLUSIONS Cognitive deficits may be associated with M-D. Psychiatric abnormalities correlate with the motor symptoms in affected individuals. Assessment of additional M-D families with known mutations is needed to determine whether these are characteristic phenotypic manifestations of M-D.
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Affiliation(s)
- D O Doheny
- Department of Neurology, Mount Sinai School of Medicine, Annenberg 14-51A, Box 1052, New York, NY 10029, USA.
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Doheny D, Danisi F, Smith C, Morrison C, Velickovic M, De Leon D, Bressman SB, Leung J, Ozelius L, Klein C, Breakefield XO, Brin MF, Silverman JM. Clinical findings of a myoclonus-dystonia family with two distinct mutations. Neurology 2002; 59:1244-6. [PMID: 12391355 DOI: 10.1212/wnl.59.8.1244] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Myoclonus-dystonia has recently been associated with mutations in the epsilon-sarcoglycan gene (SCGE) on 7q21. Previously, the authors reported a patient with myoclonus-dystonia and an 18-bp deletion in the DYT1 gene on 9q34. The authors have now re-evaluated the patient harboring this deletion for mutations in the SGCE gene and identified a missense change. In the current study, the authors describe the clinical details of this family carrying mutations in two different dystonia genes. Further analysis of these mutations separately and together in cell culture and in animal models should clarify their functional consequences.
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Affiliation(s)
- D Doheny
- Department of Neurology, Mount Sinai School of Medicine, New York, NY, USA.
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Silfors A, Solders G. [Living with dystonia. A questionnaire study among members of the Swedish Dystonia Patient Association]. Lakartidningen 2002; 99:786-9. [PMID: 11894618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
The dystonias are movement disorders with sustained muscle contractions causing twisting movements or abnormal postures. A patient survey sent to 268 members of the Swedish Dystonia Patient Association was returned by 221 (82%). Most of the patients (81%) were women and the most common form was cervical dystonia (spasmodic torticollis). Median age at onset was 41.6 years. The time from onset of symptoms to correct diagnosis was on average 6 years. 21% had relatives with movement derangements. Injection with Botulinum toxin and physical therapy were ranked as the most effective treatments. Many patients expressed a need for more physical therapy as well as a desire to meet the same physician each time and to receive more intensive psychological support.
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Kaji R. [Sensory-motor disintegration in the basal ganglia disorders]. Rinsho Shinkeigaku 2001; 41:1076-8. [PMID: 12235800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
Basal ganglia lie between the cerebral cortex and the thalamus, and have dense fiber connections between them. These connections form 4-5 distinct loops to allow parallel processing of information. Among them, the most intensively studied is the motor loop, which comprises 2 distinct direct and indirect pathways. The direct pathway disinhibits the powerful inhibition of Gpi/SNr upon the thalamic VL nuclei with a net result of facilitatory influence upon the motor cortex. By contrast, the indirect pathway exerts an inhibitory effect. Overall this dual system provides a center-surround mechanism to focus its effect on selected cortical neurons. The functional role of the loop in motor control has not been precisely understood. Several lines of evidence have recently been presented to support the view that this mechanism is used to focus the output to a specific group of muscles required for performing a specific task. Recent observations in dystonia and Parkinsonism suggest that this operation is made possible through opening the sensory channel for the expected sensory feed-back afferents during movement. Thus one of the important functions of basal ganglia seems to be the gating of sensory input for motor control.
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Affiliation(s)
- R Kaji
- Department of Clinical Neuroscience Hospital of the University of Tokushima
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Serdans R. Beka Serdans tells her story: a shattered dream ... a bright future. Semin Nurse Manag 2001; 9:196-8; discussion 198-9. [PMID: 12030074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Affiliation(s)
- R Serdans
- Care4Dystonia, Inc, New York, NY, USA
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Pittock SJ, Joyce C, O'Keane V, Hugle B, Hardiman MO, Brett F, Green AJ, Barton DE, King MD, Webb DW. Rapid-onset dystonia-parkinsonism: a clinical and genetic analysis of a new kindred. Neurology 2000; 55:991-5. [PMID: 11061257 DOI: 10.1212/wnl.55.7.991] [Citation(s) in RCA: 96] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Rapid-onset dystonia-parkinsonism (RDP) is an autosomal dominant disorder linked to chromosome 19q13 that is characterized by sudden onset of primarily bulbar and upper limb dystonia with parkinsonism. METHODS The authors evaluated 12 individuals from three generations of an Irish family and obtained detailed medical records on a deceased member. The authors describe the clinical, psychiatric, and genetic features of the affected individuals. RESULTS Five of eight affected members developed sudden-onset (several hours to days) dystonia with postural instability. Four of the five also had bulbar symptoms. Two have stable focal or segmental limb dystonia. One has intermittent hemidystonia with dysarthria that comes on abruptly in times of stress or anxiety. Three had a history of profound difficulty socializing, and at presentation two developed depression. Three patients had a trial of dopamine agonists without benefit. Genetic analysis suggests linkage to chromosome 19 with lod score of 2.1 at zero recombination. CONCLUSION This is the third reported family with chromosome 19q13 rapid-onset dystonia-parkinsonism. Psychiatric morbidity appeared common in affected members of this family and may be part of the RDP phenotype.
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Affiliation(s)
- S J Pittock
- Division of Neurosciences, Beaumont Hospital, Crumlin, Dublin, Ireland
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Takahashi H. Acute dystonia induced by adding midodrine, a selective alpha 1 agonist, to risperidone in a patient with catatonic schizophrenia. J Neuropsychiatry Clin Neurosci 2000; 12:285-6. [PMID: 11001613 DOI: 10.1176/jnp.12.2.285] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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