PubMed · 14411282
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P KOTAIAH. 1959. Asterixis.. https://pubmed.ncbi.nlm.nih.gov/14411282/
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OBJECTIVE: To make evidence-based treatment recommendations for the medical and surgical treatment of patients with Parkinson disease (PD) with levodopa-induced motor fluctuations and dyskinesia. To that end, five questions were addressed. 1. Which medications reduce off time? 2. What is the relative efficacy of medications in reducing off time? 3. Which medications reduce dyskinesia? 4. Does deep brain stimulation (DBS) of the subthalamic nucleus (STN), globus pallidus interna (GPi), or ventral intermediate (VIM) nucleus of the thalamus reduce off time, dyskinesia, and antiparkinsonian medication usage and improve motor function? 5. Which factors predict improvement after DBS? METHODS: A 10-member committee including movement disorder specialists and general neurologists evaluated the available evidence based on a structured literature review including MEDLINE, EMBASE, and Ovid databases from 1965 through June 2004. RESULTS, CONCLUSIONS, AND RECOMMENDATIONS: 1. Entacapone and rasagiline should be offered to reduce off time (Level A). Pergolide, pramipexole, ropinirole, and tolcapone should be considered to reduce off time (Level B). Apomorphine, cabergoline, and selegiline may be considered to reduce off time (Level C). 2. The available evidence does not establish superiority of one medicine over another in reducing off time (Level B). Sustained release carbidopa/levodopa and bromocriptine may be disregarded to reduce off time (Level C). 3. Amantadine may be considered to reduce dyskinesia (Level C). 4. Deep brain stimulation of the STN may be considered to improve motor function and reduce off time, dyskinesia, and medication usage (Level C). There is insufficient evidence to support or refute the efficacy of DBS of the GPi or VIM nucleus of the thalamus in reducing off time, dyskinesia, or medication usage, or to improve motor function. 5. Preoperative response to levodopa predicts better outcome after DBS of the STN (Level B).
Various types of abnormal posture are observed in Parkinson's disease (PD). Lateral flexion is very common and frequent among them. The clinical characteristics of lateral flexion in PD vary and are classified into two types, the chronic and subchronic types. The chronic type of lateral flexion in PD appears subclinically and worsens, which is related to the laterality of parkinsonian symptoms and the progression of the disease. The subchronic type of lateral flexion in PD develops subacutely and worsens rapidly in several months. An atypical and rare type of tonic truncal dystonia, Pisa syndrome, may be induced following the intake of neuroleptics. The clinical features of the subchronic type of lateral flexion in PD are similar to those of Pisa syndrome. Differences between lateral flexion in PD and Pisa syndrome are described.
Alien hand syndrome (AHS) is a rare condition that occurs in patients with brain injury. It has also been described in stroke subjects, after callosotomy, and in corticobasal degeneration. The common feature of AHS is the involuntary autonomous activity of the affected extremity that is perceived as being controlled by an external force. AHS as a nosologic entity has been challenged. A complex variety of abnormal involuntary motor behaviors may follow cerebral lesions in different cerebral locations such as the corpus callosum, the parietal, or frontal regions. Although different subtypes of AHS have been distinguished, this classification clearly does not cover the wide clinical variety of abnormal (involuntary) motor behaviors of the upper extremity. In this report, we provide a review of literature on abnormal involuntary motor behaviors of the upper extremity after a stroke, which may help to improve early recognition of AHS and facilitate adjustment of rehabilitation therapy. Furthermore, we briefly discuss the complex variety of abnormal, involuntary motor behaviors that may follow after cerebral lesions, their anatomic substrates, the underlying mechanisms, and the prognosis.